MTPR

Dialysis Experience 'A Slap In The Face' For Plains Man

Jul 26, 2019

On Monday, NPR’s Morning Edition aired a story about Plains resident Sov Valentine, who received a bill of more than half a million dollars for 14 weeks of dialysis at a Missoula clinic.

Thursday, Fresenius, the dialysis company that sent him the bill, said they would waive it.

Valentine, a 50-year-old personal trainer, said he felt relief at the news.

“It felt like a victory," he said. "It felt righteous.”

But there was also disappointment that he had to fight a life-threatening kidney failure, then face potential bankruptcy over a bill Valentine felt was unwarranted.

“It speaks to people who will basically sell their soul to extract money from people who are dying," Valentine said.

"It just felt really wrong from the very beginning, like when there’s a hurricane and they try to sell water for $10 a gallon and this kind of stuff. Scalping the stuff, essentially.”

Valentine began dialysis in January, after feeling progressively run down for months. He received treatment at a Fresenius clinic in Missoula, 70 miles from his home in rural Plains. Then, a few days later, Valentine got notice from his insurance provider Allegiance that he was out of network, and his family would need to pay for anything not covered by their insurance.

But Valentine needed dialysis three days a week to survive, and he says he was told Montana didn’t have an in-network facility. So he continued to visit the Missoula clinic. Valentine says no one would tell his family how much the sessions cost — then the bills came all at once.

“It was just boom, $140,000, $145,000, and then a month-and-a-half or so later, boom: $540,000," Valentine said. "And they wanted it in 10 days, and had already started sending us collection notices.”

Fresenius charged Valentine nearly $14,000 per session — about 59 times the $235 Medicare pays.

Valentine said one of the nurses who treated him at the Fresenius clinic contacted him on Facebook yesterday with stories of others struggling under the weight of gargantuan charges.

“She’s had patients who were eating cat food because they couldn't afford the bills and their own food," he said.

[Editor's Note: After publication, a Fresenius spokesman contacted us and objected to this quote, calling it, "sensational and unsubstantiated. I did speak with Kevin directly who admitted to never seeing the actual Facebook post or verifying this claim before publication/air. Additionally, he never reach (sic) out to me before publication/air yet still used a section of the statement I provided to KHN."

It's true that our reporter did not see the Facebook message Sov Valentine mentioned. Fresenius' statement to KHN is below in its entirety.]

"Which is funny, because they always assign you a dietitian and tell you to follow these guidelines. And she’s had people approach her about wanting to commit suicide because of these bills.”

Valentine said most dialysis patients look like zombies, pale without energy to navigate the process. His wife, Jessica, a physician, was his advocate on days spent recovering from sessions.

A Fresenius spokesperson said the company waived Valentine’s bill because they should’ve been treated as in-network from the beginning, as Allegiance’s parent company has a contract with the dialysis provider.

But Valentine says that’s backpedaling after his story received a rash of media attention this week.

“You know, It’s a slap in the face," he said. "Because we were doing research and talking with them. Jessica would be on the phone for four hours at a time on her days off.

"It’s greed. I’m fine with capitalism, I’m fine with them making a profit, even if they charge double what it cost them to do it. Who knows, maybe even triple. But to mark stuff up, in some of the cases Jessica found it was 4,600%.”

Now, Valentine is preparing for a kidney transplant. There’s not much he would do differently following his billing ordeal. He felt he dotted all his i's and crossed all his t's from the beginning.

So what advice would he give to others in his situation?

“The main thing is you have to have a team, a support team that knows what’s what," Valentine said. "Because they lie. They absolutely lie to you on the phone, in person."

"They smile and lie to your face.”

Statement of Brad Puffer, spokesperson of Fresenius Medical Care North America:

 

“We sympathize with anyone who is trying to navigate challenging insurance circumstances while managing a difficult diagnosis. This person was unfortunately a victim of a healthcare system where insurers are increasingly shifting the financial burden to patients. We have a contracted rate with Cigna, Allegiance’s parent company, which should be honored by Allegiance. Our patients should not face “balance bills” that are high because an insurance carrier fails to provide adequate in-network options. We are fortunate to have built excellent relationships with payors and have the largest contracted network in the country to ensure patients can access the care they need.

 

“We are working directly with this patient to immediately resolve the situation. We are committed to doing the right thing so that our patients are not placed in the middle of these disputes. In the future, we pledge to better identify situations where we believe the insurer has incorrectly classified one of our facilities as being out of network. This will allow us to address the matter directly with the insurer in the first instance, without them placing the patient in the middle.

 

We welcome ongoing efforts to improve transparency around billing and to help end these gaps in insurance coverage that unnecessarily burden our patients. We take great pride in the superior care we provide that helps our patients thrive while receiving life-sustaining dialysis treatment, which remains our top priority.”