Dialysis patients worry over HMSA policy change

Salome Tupou, who is suffering from kidney failure, tearfully described her fear of losing access to dialysis treatments when Hawaii Medical Service Association bans charities from helping to pay patients’ medical premiums.

On Feb. 1, HMSA said it will stop accepting payments from nonprofits that receive donations from dialysis clinics that treat patients whose medical premiums are paid for by the same charities.

In this case, the American Kidney Fund will no longer be able to pay for Tupou’s coverage because she qualifies for government-sponsored health plans such as Medicaid, which reimburses dialysis clinics at a significantly lower rate than commercial health plans like HMSA.

HMSA said it ends up paying as much as $20 million a year in excessive and unnecessary costs passed onto roughly 18,000 members facing a 19.8 percent rate hike this year. The average cost for kidney dialysis is $300 to $400 per treatment.

“I’m not able to work anymore. I don’t know how I’m going to pay for my medicine and dialysis. I feel like it’s not fair for HMSA to do this to us because it’s hard for us to find better coverage to take care of us,” said Tupou, a 47-year-old Kapahulu resident who has been on dialysis for more than two years. She was one of several patients who spoke about the policy at a news conference Wednesday. “Without the Kidney (Fund) to help us pay for everything like that, I don’t know where I’m going to turn to pay for my coverage.”

HMSA spokeswoman Elisa Yadao said the insurer is “completely committed to ensuring that all our members get the kind of coverage they need and access to the treatment they need” through an alternate health plan.

“We regret any anxiety these dialysis patients may be feeling right now,” she said. “The last thing these poor people need is to worry about what’s going to happen to them.”

HMSA said 100 of the 115 people who will be affected by the policy change next month already have secondary or alternate insurance coverage.

“So they’re going to be fine. They will have access to care and very little transition issues,” Yadao said, adding that the insurer will help the remaining 15 people transition into new plans.

Steve Pirri, president of U.S. Renal Care Inc., said HMSA is discriminating against patients and placing the burden of costs onto the state.

“All they’re doing is cost shifting and that’s not right,” he said. In addition, many providers do not accept lower-paying Medicaid, creating an access- to-care issue for dialysis pati­ents. U.S. Renal Care has 85 HMSA patients who will be affected by the change, he said.

“It’s not an out-of-pocket issue, it’s an access issue. If you’re a provider, Medicaid patients typically are the lowest rung and have the hardest access to that care,” he said. “Are they going to be able to see the same physicians? Highly unlikely based on the difference (in reimbursements).”

“I’m going to lose my doctors,” said dialysis patient Jeffrey Wong, 64, who relies heavily upon charitable assistance from the American Kidney Fund, which pays his $1,500-a-month policy. “My medicines would be between $500 to $800 a month. My copays for doctors may be to $200 to $400 a month easily. Those are not things I can afford to pay.”

In 2016, the American Kidney Fund was the center of an investigation by The New York Times, which reported that the nonprofit pushed dialysis centers to donate to the charity. The report said the charity resisted helping patients at clinics that did not donate money.

An American Kidney Fund spokeswoman previously told the Honolulu Star-Advertiser that it provided financial assistance for about 800 of Hawaii’s 3,600 dialysis patients in 2016, regardless of whether their dialysis provider contributed to the organization.

“Charitable assistance provides a critical health safety net for Hawaii’s citizens living with chronic diseases that are complicated and expensive to treat,” the nonprofit said in a statement. “This assistance gives patients access to the care they need and helps them avoid being financially devastated by kidney failure.”