Proposed NC bill could make Blue Cross accept third-party payments for dialysis

RALEIGH, N.C. (WNCN) – North Carolina lawmakers could take up a bill that would help low-income people who need dialysis treatment be able to pay for health coverage.

For truck driver Craig Moore, a doctor’s 2007 diagnosis of kidney failure meant he could no longer work.

He needed dialysis treatment three days a week for four hours a day.

“It’s kind of hard to get a full-time job when I’m married to the machine,” Moore said.

The American Kidney Fund stepped in and paid for his health coverage through Blue Cross Blue Shield.

The Fund does the same for about 1,200 other dialysis patients statewide who are insured through Blue Cross.

This past summer, Blue Cross stopped accepting third-party payments for dialysis patients.

That means for patients like Moore, the American Kidney Fund can only send them a check directly.

He and many other clients don’t have bank accounts, so they need to have the checks cashed, which creates a new problem.

“This change is having an enormous impact and the impact is on the patients,” said Tamara Ruggiero with the American Kidney Fund. “They may choose to use that check for their food or their rent or whatever the case may be.”

That means their insurance might not get paid.

A Blue Cross spokesman said the reason for the change are new federal guidelines that express concern with accepting certain third-party payments. The payments ultimately could skew the insurance risk pool.

“We are obligated as a regulated organization and agency to follow those guidelines,” said Lew Borman with Blue Cross.

Without a way to get their payments accepted, the American Kidney Fund turned to state lawmakers.

Rep. Marilyn Avila (R-Wake) sponsored a bill that would require insurance companies accept third-party payments from the American Kidney Fund.

Read more on HB 809

That bill is pending at the General Assembly.

But in recent days, Blue Cross said it will grandfather in dialysis patients who receive Medicare Advantage and Medicare supplemental insurance

“By the exception we’re making, we’ll be able to grandfather in those who may be the most severely affected,” Borman said.

But supporters of the legislation say that doesn’t go far enough.

“It still doesn’t solve the problem for all of their insured,” Avila said.

Moore wants to see a different solution.

“I think it should go back to the way it was. If the kidney foundation pays it, let them pay it,” Moore said.

The American Kidney Fund said all other insurance companies in North Carolina are still accepting their payments.

Blue Cross said the exception that it’s now offering would cover 91 percent of their clients that the American Kidney fund helps and the remaining ones would qualify for affordable care act plans.

Ruggiero disputed that, saying Blue Cross would not accept AKF’s payments for those plans and added that most dialysis patients need to choose Medicare as their primary insurance.

The bill has already passed the House and, when lawmakers reconvene, it will be pending in the Senate.

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