AZ Blue Best Life Plus (HMO): Services to Treat Kidney Disease
Dialysis is used in end-stage renal (kidney) disease to replace kidney function and cleanse the body of toxins.
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When a provider determines that dialysis is required, they will write a corresponding order and help you make arrangements to commence with dialysis. There are several steps involved in commencing with dialysis that the provider will help guide you through, including helping with prior authorization.
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Commencing with dialysis involves the insertion of dialysis access into the body. Sometimes this is surgically fashioned using the body's own vessels (known as an A-V Fistula or Graft; commonly in the arm). Other times this is an internal/external device that is surgically implanted (known as a Tunneled Catheter; commonly in the chest or abdomen).
In the case of home dialysis, additional provider orders for durable medical equipment (DME) and Part B medications may be required, as well as home dialysis nurse visits.
For those already receiving dialysis, barring any complications with dialysis access, only annual renewal orders are required from the provider.
Contact the AZ Blue Best Life Plus Team at 1-800-446-8331 (TTY 711) with questions and for additional guidance and care coordination.
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Kidneys are essential for life. When the kidneys can no longer take care of the body's needs due to extensive damage or disease, dialysis is a needed replacement therapy. Dialysis can take place in an outpatient hospital facility, a dialysis center, or at home (in qualified cases). It is also provided during inpatient admission at a hospital.
Kidney disease education
Kidney disease education services teach kidney care and help members make informed decisions about their care. Up to 6 sessions per lifetime of kidney disease education services are covered for those who have Stage IV chronic kidney disease that will require dialysis or transplant, and a provider makes a referral for this service.
Kidney dialysis services and supplies
Generally, 3 dialysis treatments per week are covered for those who have end-stage renal disease (ESRD). This includes most renal dialysis drugs and biological products, all laboratory tests, home dialysis training, support services, equipment, and supplies.
The dialysis facility is responsible for coordinating dialysis services (in the facility or at home).
Covered services
Outpatient dialysis treatments (including dialysis treatments when temporarily out of the service area or when the provider for this service is temporarily unavailable or inaccessible).
Inpatient dialysis treatments (when admitted as an inpatient to a hospital for special care).
Self-dialysis training (includes home dialysis treatment training for your loved one and you).
Home dialysis equipment and supplies.
Certain home support services, such as, when necessary, visits by trained dialysis workers to check on home dialysis, to help in emergencies, and to check dialysis equipment and water supply.
Certain drugs for dialysis are covered under the Medicare Part B drug benefit.
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