GEHA manages dialysis care through our Preferred Outpatient Dialysis Network. Click for a list of in-network dialysis facilities (PDF).
- If you are currently receiving dialysis at one of these in-network facilities, your providers and services will continue without interruption or additional out-of-pocket expenses.
- If you receive dialysis at a facility not on the list above, you might be responsible for the cost difference between the out-of-network allowable and the dialysis facility rate. For out-of-network facilities, GEHA reimburses two times the Medicare dialysis base rate at the highest wage index rate. We include the same supplies, drugs and labs that Medicare includes and the rate is adjusted as the Medicare rate changes. If you have Medicare Part B, the out-of-network dialysis provider should bill Medicare as your secondary insurance.
We urge you to speak with your nephrologist and discuss your dialysis needs. Your nephrologist may provide services at more than one dialysis facility or may be able to refer you to a nephrologist associated with a Fresenius or DCI facility. We understand each dialysis case is unique and we can help you understand how this change affects you. After you speak to your nephrologist, please call the GEHA Care Management Department and ask for an ESRD specialist at (800) 821-6136, ext. 3100
Dialysis and Medicare
When you have Medicare as your primary and GEHA as your secondary coverage, you may receive services at any dialysis facility that participates with Medicare.
Medicare Part B
We frequently get questions about whether members receiving dialysis should enroll in Medicare. Most dialysis patients, regardless of age, are eligible for Medicare if they have a diagnosis of end stage renal disease (ESRD). Dialysis is an outpatient service and Medicare Part B can help with dialysis expenses.
We encourage enrollment in Medicare Part B. This coverage can cost between $100 and $120 each month, but could save you thousands of dollars each month in out-of-pocket costs. If you have Part B, the dialysis facility will bill Medicare for the amounts that GEHA doesn't cover. Your dialysis center can help you apply for Medicare. If you have applied for Medicare and have been found to be ineligible, call GEHA's Care Management department and we can discuss other options that may be available to you.