Anybody Understand Med Bill?

[WalterTrull]

OK, I receive Medicare and have a supplemental policy, so I don’t actually pay medical bills other than insurance premiums. Recently, I got an x-ray and the lab billed Medicare $2,339, Medicare only allowed $392.84, but the lab accepted it. Why? How? This seems really fishy, but regular practice. Anybody know what’s going on? I know, people like me who don’t actually pay for this foolishness shouldn’t make waves, but somehow, I figure we do, or will.

 

[Polymath257]

OK, I receive Medicare and have a supplemental policy, so I don’t actually pay medical bills other than insurance premiums. Recently, I got an x-ray and the lab billed Medicare $2,339, Medicare only allowed $392.84, but the lab accepted it. Why? How? This seems really fishy, but regular practice. Anybody know what’s going on? I know, people like me who don’t actually pay for this foolishness shouldn’t make waves, but somehow, I figure we do, or will.

It is part of the contract they have that they have to accept whatever Medicare allows. Yes, it is messed up. Essentially, the costs of treatment are both inflated and are passed off to those without coverage. And they are the ones least able to pay.

 

[sun rise]

Chargemaster pricing, the list price, is fictitious. The only people that get charged that are people without insurance. Hospitals get away with such things because there's no real competition in the vast majority of places. And charges in the USA are much much more than any other nation.

That's one reason medical tourism is such a big thing - to get decent prices that reflect true costs and allow for a reasonable return.

 

[curiousB]

Medicare has predetermined rates that they pay for procedures such as an x-ray. Hospitals, clinics, etc. always jack up theses prices in hopes that Medicare, and insurances in general, will negotiate.
It's all a big scam! I've worked in the pharmacy industry for the last 10 years and I've always said that if the average American citizen knew exactly what was going on with Healthcare in the country, there would be protests in the streets to say the least. Just like x-rays and other procedures, some of these drugs prices are beyond ridiculous. The most expensive drug in this country today is Harvoni, a "miracle" hep c drug. Cost is $38,000 per month; treatment is a 12 week course. So $38,000 x 3month = $114,000 for 90 pills!! Insane but I digress...

 

[WalterTrull]

OK again, beating a dead horse, never-the-less: I started looking up some other charges for x-rays, (I had 2 this year) because I seemed to remember multiple charges. Turns out 6 months ago I had another x-ray: $2,432 for x-ray, $2,954 for outpatient, $100 for professional charge, and $100 for diagnostic. That’s to date. The receipts keep coming in for that one!! $5,586.45 for one x-ray (Medicare paid $501.70). I can’t wait to see the rest of the charges for the latest one. Jeesh. I’m starting a spreadsheet, not that it will accomplish anything, just satisfy my curiosity.

 

[Terrywoodenpic]

I am surprised at the cost of Xrays these days. they do not even use film. it is just a scan and available on line to the medics.

I saw my Physiotherapist today and he showed me my xray taken a few weeks ago by a different hospital.
They can call up everything including medications you are on, and stuff from years ago anywhere in the UK that has put your records on line.

 

[It Aint Necessarily So]

OK, I receive Medicare and have a supplemental policy, so I don’t actually pay medical bills other than insurance premiums. Recently, I got an x-ray and the lab billed Medicare $2,339, Medicare only allowed $392.84, but the lab accepted it. Why? How? This seems really fishy, but regular practice. Anybody know what’s going on? I know, people like me who don’t actually pay for this foolishness shouldn’t make waves, but somehow, I figure we do, or will.

Physicians cannot charge different insurers different rates for the same service.

The insurer will pay whichever is lower, the charge allowed or the charge billed. This gives the physician incentive to charge at least a few percent more than whatever the highest allowable charge is from the insurer that pays best. So, if Medicaid pays $30 for a particular service, Medicare $45, and Blue Cross $75, the charge should be about $80 to all of them, with the unpaid balance written off. When the day comes that somebody pays the $80, it suggests that the allowable rate might be above $80 now, meaning that the charge needs to go up to $90 so that it is never paid in full by any payer.

Then in comes the uninsured patient, and it is illegal to not charge the full $90, even if the physician was willing to take less.