Battling Denied Claims: The Uphill Struggle Facing Dialysis Centers

Dialysis centers across the United States often face significant challenges when it comes to denied insurance claims, which can have profound implications for both patient care and their financial stability.

Here’s how ERISA Recovery can help:

  • Work behind existing resources and vendors
  • No upfront costs
  • Handle claims that are 2 to 3 years old (and can go back 6 to 10 years)
  • Win appeals as soon as 3 weeks and collect $1M within the first 3 months

One of the primary missions of dialysis centers is to ensure that patients receive the care they need, regardless of their financial situation. To accomplish this, these centers often employ dedicated social workers and financial counselors who work tirelessly to assist patients in navigating the complex world of health insurance. These professionals help patients understand their insurance coverage, advocate for appeals when claims are denied, and explore alternative financial assistance programs.

The Critical Role of Dialysis Centers

Dialysis centers provide crucial renal replacement therapy for patients with end-stage renal disease (ESRD) or chronic kidney disease (CKD). These treatments, which include hemodialysis and peritoneal dialysis, are essential for filtering waste and excess fluids from the body when the kidneys can no longer perform this function effectively. Given the regularity of treatments (typically three times a week), the financial burden on patients and healthcare providers can be substantial.

Dialysis centers strive to educate patients about their insurance policies and coverage as much as they can upfront, to reduce the likelihood of a claim getting denied.  Additionally, dialysis centers often collaborate closely with insurance providers to streamline the claims process. Establishing strong communication channels with insurers allows centers to address issues promptly, potentially preventing unnecessary denials. These partnerships are crucial for ensuring that patients receive uninterrupted care.

kidney, dialysis, kidney failure, nephrology, dialysis center

Challenges with Denied Claims

Despite the efforts above, denied insurance claims remain a persistent challenge for dialysis centers. When claims are denied, it can create a ripple effect, impacting both patients and the centers themselves.

Contributing factors to these denied claims can include areas such as complex insurance policies, in-network vs. out-of-network, pre-authorization requirements, coding errors, frequent treatment schedules, etc.  For patients, these denials may result in out-of-pocket expenses, delays in treatment, and added stress during an already challenging time.

From the perspective of dialysis centers and hospitals, denied insurance claims can strain their financial resources. These facilities rely on insurance reimbursements to cover the costs of staffing, equipment, and maintaining a sterile and safe environment. When claims are denied, centers may face cash flow issues, making it difficult to provide high-quality care consistently.

The ERISA Effect

To mitigate these financial challenges, dialysis centers often work closely with healthcare finance partners. At ERISA Recovery, we specialize in helping hospitals and dialysis centers recover revenue from denied and aged claims… revenue that would previously have been lost or written off.  ERISA Recovery’s advanced technology and team of experts work behind your existing vendors and staff to quickly and efficiently identify denied claims that we can win.

Our process is simple. First, we analyze your reports with no upfront cost or additional resources. Next, we start identifying opportunities for claims we can win (claims that were previously denied or missed).  Finally, we appeal those claims using our proprietary ERISA appeals process to collect where others can’t.  Our process is 100% contingency-based, so we don’t win until you win!