A Travel Guide for Hemodialysis Patients
By Barbara Shaw

Today there are thousands of dialysis centers in the United States and around the world, making travel for hemodialysis patients easier than ever before. As a person with kidney failure, you are dealing with many daily stresses. A trip with your spouse, family or friend allows you to leave behind many of your responsibilities. It places you in a new, relaxing environment where the only structured time is your dialysis. Spending a week at a resort or the winter in a warmer climate is nice, but even a weekend in a nearby city visiting relatives or camping will give you a break from your daily routine.

I want to travel. What is the first step?

Decide where you want to go and when. Think about alternate dates and locations in case your first choices are not available. 

Who can help me plan dialysis for my trip?

You will need to talk with your dialysis center's travel coordinator, usually the social worker or charge nurse, at least one month before you plan to travel. The coordinator may offer to find centers near where you are going and call to check for availability. If you do not have access to a travel coordinator, you can handle this part of the planning yourself. Someone at your clinic will need to send the unit you are visiting the necessary medical records and insurance information.

When should I start planning for a trip?

It is never too early to explore possibilities. Many dialysis centers, especially in popular tourist areas such as Hawaii, California, Arizona and Florida, need at least three months notice. If you plan to travel during holiday times such as Christmas or to popular seasonal destinations (the beach or mountains in the summer, "snowbird" areas during the winter), contact centers six months in advance. Although they may not have a dialysis schedule yet, units usually have a first come, first served policy. It is wise to put your name in at more than one center if possible. Remember, you can always cancel tentative dialysis plans. 

How do I find dialysis units?

The Patient Travel Service, sponsored by Fresenius Medical Care North America, is a free service that continually updates its information on all dialysis centers in the U.S. and abroad. Although the service does not publish a list, it can provide the most current information on all the centers near where you are going. Call (800) 634-6254 between 9 a.m. and 5 p.m. Eastern Time, Monday through Friday to speak with a representative. 

Is there information about dialysis travel on the Internet? 

Numerous resources are available on the Internet. Helpful Web sites include: 

• www.dialysisfinder.com. Enter an address, city, zip code or state for a map and listing of dialysis units in the area.

• www.globaldialysis.com. Includes international listings for places to stay, travel agents, tours, cruises and travel insurance as well as dialysis centers.

• www.medicare.gov/dialysis/home.asp. This site lists Medicare approved dialysis facilities in the United States. It has a feature allowing you to compare many facilities.

• www.nephron.com. Search this site for dialysis units.

• www.dialysistravel.com. Many of the centers in Europe accepting dialysis travelers can be found on this site. 

What about payment?

If Medicare is your primary healthcare coverage, it will pay for 80 percent of your treatment cost anywhere in the U.S. or U.S. territories. Medicare does not cover treatments on cruise ships - even U.S. cruises - or at facilities outside of the United States. Facilities often ask patients to pay the 20 percent Medicare co-payment for dialysis and medications. If you have secondary coverage, ask your insurance company about reimbursement of the co-payment. The payment policies of commercial health insurers vary. Many require that you get authorization before treatment, so check with them before making plans. Medicaid (state medical assistance) programs will pay for treatments if you are traveling within your state, but generally not if you travel out of state.

What should I say when I call a dialysis facility?

First, tell them your name and ask for the person in charge of making visitor dialysis arrangements. Once that person is on the line, tell them your name, home city and state, the name of your dialysis unit, and that you will be traveling and would like to dialyze at their facility. Be specific about when you will be in the area. If you are Hepatitis B antigen positive or have special treatment needs, it is important to tell them at this time. Always get the name and job title of the person with whom you speak.

What information will the facility ask me for?

The dialysis facility will ask you for your name, address and phone number. It is also a good idea to have the following information ready: 

• Your clinic's name, address, phone and fax numbers.

• Name of a contact person at your facility.

• Your date of birth.

• Date your dialysis began.

• Days and length of your treatment.

• Hepatitis B antigen status (positive or negative).

• Insurance coverage(s) and policy number(s).

What if they do not have openings when I want to go?

Flexibility is the key to scheduling treatments for a trip. Facilities may not be able to give you the days or times you prefer because they need to schedule permanent patients before visitors. Some centers set aside certain shifts for visitors. If they offer you a schedule or treatment length that is not like your usual one - for instance, Monday/Wednesday/Friday when you usually dialyze Tuesday/Thursday/Saturday - talk with your doctor and charge nurse. Check with your dietitian for any changes in your food and beverage guidelines. If they do not have any openings, try to find out the reasons why. The more information you have, the easier it will be for you to decide if you should pursue your travel plans. Ask if they can suggest another clinic in the area.

The clinic cannot give me a clear answer. What can I do?

• Ask to be put on a waiting list.

• Ask when you should call back.

• Mail or fax a follow-up note to confirm your request for treatment. Include a date when you will call back.

They do have an opening. What happens next?

If you are calling well in advance, the unit will probably "pencil in" your treatment or place you on a list. Dialysis facilities generally do not confirm treatments until they have reviewed your medical records and your arrival date is closer. Check back with the facility every now and then to see if they have received your records and if everything is as planned.

Is there anything I should ask?

Ask them to explain the following:

• Payment policy. Ask how and when they will expect payment and how much it will be. What part of the treatment cost is your responsibility? What amount if any is due in advance? Are there any other charges?

• Required medical records and insurance cards. They may want to speak to a contact person in your unit for these. Make sure you understand whether they will contact your unit directly or if you should ask your unit to contact them.

• Doctor's visit. Some facilities require you to see their doctor before your first treatment. Ask if this is the facility's policy.

I have scheduled my treatments and my unit will send the records. Now what?

You or your facility should follow up to make sure your medical records were received and to confirm the times and dates of your treatments. Most units will ask that you arrive early for your first treatment. If you will be seeing their doctor, find out the location and time.

Everything is set, but I am worried about dialyzing in an unfamiliar unit.

It is natural to feel anxious about any change in your dialysis routine. To ease your fears, ask the host facility about their equipment, treatment procedure, visitor policies or anything that may concern you. The more you know about your illness and treatment, the more control you will feel in an unfamiliar setting.

I have arrived. Is there anything left to do?

Finally, you are there! When you arrive in town and are settled, call the dialysis unit to confirm your treatment and the time you need to be there. Occasionally, units may have to shift schedules because of their patients' needs. Also, get or check driving directions to the facility.

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A Travel Guide for Peritoneal Dialysis Patients

By Teresa Bounama

There are many important reasons a peritoneal dialysis (PD) patient travels. Travel can be a short, fun trip just to get away from daily routines or a longer vacation to enjoy a more relaxing environment with family and friends. There are also work related business trips and short notice trips in emergencies. Travel can include both domestic and international destinations with dialysis supply delivery to a home, a hotel, a business, a seaport for a cruise, a campground or a variety of unique requests. Each type of travel requires its own proper planning to assure a successful trip. 

I am a CAPD/CCPD patient who wants to travel. What is the first step?

Decide where you want to go and when. Also, think about back up dates and alternative vacation places or PD supply delivery options in case your first choice is not available. Check the Internet, which has many useful Web sites discussing destinations and where patients write about their travel experiences and provide recommendations. If you are in good health and your doctor agrees, you are ready to begin making arrangements. Discuss your ideas with your doctor, nurse and/or social worker and get their suggestions. Contact your supplier's Customer Service Health Care Representative and discuss your plans. Be sure that the address you are expecting to ship your supplies to is able to accept the delivery - do not assume anything.

What is my insurance coverage when I travel?

You should bring up questions regarding medical records and insurance coverage before your trip. Ask your clinic to explain the payment policy should you have an emergency and/or need emergency treatment away from home. Patients who use Medicare as their primary healthcare insurance should be aware that health services are not covered outside the United States. Patients need to check with Medicare regarding travel policy. Coverage may also limit cruise ship travel in international waters even though the ship embarks from the U.S. Contact your Medicare Representative for clarification.

If you have secondary coverage, ask your insurance company about reimbursement of the co-payment. The payment policies of commercial health insurers vary. Many require that you get authorization before treatment, so check with them before making plans. Medicaid (state medical assistance) programs will pay for treatments if you are traveling within your state, but generally not if you travel out of state.

How much time is needed to start planning a trip?

The general rule is to start planning at least four to six weeks ahead for domestic travel in the United States and 12 weeks for international destinations. There may be additional delivery costs for off schedule deliveries with less than two weeks notice. Contact your supplier to find out if delivery is available.

Domestic Travel - Generally two to four weeks notice will leave enough time to actually ship supplies to any destination within the lower 48 states and four to six weeks to Hawaii and Alaska. Cyclers may also be available for shipment. Ask your supplier.

International Travel - A wide variety of destinations based on current accessibility are available. Remember eight to 12 weeks will be needed for supplies to ship internationally and clear through customs entry. Local delivery of supplies may also be an option. Ask your supplier.

The basic documents required include:

• Clear copy of your passport or driver's license and birth certificate.

• Current prescriptions. 

• Doctor's Letter of Medical Necessity: Ask your patient representative if an original or copy is needed for your particular destination. A sample of this letter is available from your clinic or supplier. 

What can I do to ensure safe delivery of my supplies?

Make sure the address provided is correct and the contact person at the destination is aware and will accept the delivery. The address must be a deliverable address, not a P.O. Box. It is the patient's responsibility to provide the supplier with the contact person's name, phone number and address. Most vacation deliveries are done a few days to a couple of weeks prior to arrival depending on when drivers are available in that area. If the delivery requires a specific delivery date, check with your supplier to make sure they will be in that area on the required date. Advise if the delivery can be made a few days ahead of time and where the supplies can be held for you or if it must be delivered on a specific date after your arrival. For hotel deliveries, provide your supplier with a reservation or confirmation number and the group or individual's name on the reservation. This information should be written on the packages so the hotel will not refuse the delivery. Contact the hotel at least one day prior to your arrival to advise them of your time of arrival and confirm that your supplies have been delivered. The staff on duty when your supplies arrived may not be there when you check in. Be sure there is a notation of where the supplies were stored. This is very important since supplies may be locked in a closet and the staff person with the key may have left for the day. It does happen. Be aware that some hotels will charge your hotel bill if they must accept and hold your supplies prior to arrival. Ask if there is such a charge and how it is calculated.

What supplies should I carry?

Carry a universal connector. Travel with at least a three day reserve of supplies in case of unexpected travel delays - weather, flight delays, unexpected scheduling problems or shipment delays.

What if I there is a problem with my dialysis?

Discuss a contingency plan with your nurse before your departure. Locate a backup clinic or hospital at your destination. Call that unit to get their address and a 24-hour telephone number. Ask if they need a copy of your prescription, medical history or insurance card and about their payment policy. There are several Web sites that can help you locate clinics or you can call The Patient Travel Service at (800) 634-6254 to find the nearest clinic with a peritoneal dialysis program. 

What about traveling with a cycler machine?

Domestic and International Travel - Suitcases may be available through your clinic for travel.

International Travel - Check with your supplier if CCPD cyclers are available at your international destination. 

Airline Travel - When arranging your airline ticket, this is a good time to advise the airline that you will be carrying two suitcases with a cycler and stand. You can check the stand with your regular baggage. However, it is not recommended to use the baggage carousel for the console. The handling will damage the operations of the cycler. Explain your need to the airline ahead of time and request to store the console in the first class closet compartment. If this is not available due to security, ask if they offer a gate check-in. Upon arrival at the check-in desk, explain to the arrival agent that you have prearranged with your reservation to have the console hand-carried to the loading area for your flight. At your destination, the cycler should not be unloaded onto the baggage carousel. If you experience problems in this area, please let your patient representative know. Generally, with two weeks notice your supplier can ship a cycler to your vacation address preventing the extra airline charges for excess baggage. 

Are there any other helpful hints?

• IV poles are cumbersome when traveling. Ask your clinic about ordering an over-the-door hook. These can also be purchased in the housewares department of many chain stores. It is more convenient to pack in your luggage.

• If you are traveling to a foreign country, phrase cards written in multiple languages are invaluable.

• To avoid problems when passing through customs or security checks, keep medications in their original labeled containers. Bring a copy of your prescription (Rx) and Doctor's Letter of Medical Necessity. Consult the embassy of a country first if you have any doubt about the legality of your medications.

• Prior to departure, consult the local government for proper disposal of product. Various governments' preferences are for disposal in a landfill and not drained into their sewer system. Be considerate and never leave waste behind at a hotel or lodging. The supply company will pick up the cycler at the end of the trip. However, disposal of unused product is the patient's responsibility.

I have arrived at my destination. With what else should I be aware?

Enjoy yourself. Upon returning from your trip, please let your supplier's Customer Service Health Care Representative know how your trip went. Any comments or suggestions will be used to help other dialysis patients when planning their trips. The most important part of the travel process is taking the time to plan your trip while leaving room for flexibility. Start with a few small well-prepared trips until you feel comfortable making a longer one. As the saying goes, "Sometimes it is the journey not the destination that may be the most rewarding."

Barbara Shaw is the Senior Patient Travel Coordinator for Fresenius Medical Care North America. Ms. Shaw has assisted thousands of patients and social workers to arrange visitor dialysis for over 14 years. 

Teresa Bounama is a Customer Service Global Travel/Logistics Specialist for Fresenius Medical Care North America. Ms. Bounama has worked for Fresenius Medical Care North America for over eight years in Customer Service and has 20 years past experience in international and domestic transportation logistics working for the Chicago North Western Transportation Company and Sea-Land/Containers/Intermodal.

The material contained in this article is copyrighted by Fresenius Medical Care North America and may not be copied or rewritten without permission. 

This article originally appeared in the July 2003 issue of aakpRENALIFE, Vol. 19, No. 1.

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