Health Care Scams

Last June I was having some intestinal issues and after discussion with my doctor on the phone I proceeded to the emergency room of my local hospital.  I met with a physician for about fifteen minutes, gave blood and urine for testing, had an IV put into me for fluid and eventually had a CAT scan of my abdomen.  I was there in the waiting room for maybe 3 hours.  Doctor came out, told me there were no blockages, it was nothing serious and prescribed two weeks-worth of medication.

Toritto and Medicare then received a billing from the ER for $28,857!!

Now any medical facility or doctor who serves a Medicare patient has agreed in advance to accept the amount that Medicare pays in full settlement.  Medicare can decide the amount for services through the medical code system; it then pays 80% and my supplemental insurance with Blue Cross pays the remaining 20%.  The private insurance which pays 20% costs me more than my Medicare plan.

The invoice billing had about $4,500 in blood and urine tests.  The remaining $24,313 was for the CAT scan!  Laughable!

Well all of the services provided were approved, relieving me of any liability to the hospital.

Medicare paid and the ER accepted $443.50 in full settlement.

Why bill $28K+ and settle for less than $500?  Probably because private health insurance companies negotiate EVERYTHING.  Providers therefore ask for outrageous amounts for services knowing full well its a negotiation to get paid.

Medicare however publishes these settlements in advance and providers know what they are going to receive in payment.

With private insurance however the game is different.  Suppose your policy has a $5,000 deductible.  Your insurer would be in a position to pay a more attractive settlement to the provider than Medicare would have paid while sticking the patient with $5,000 of the settlement offer.

Nice.  Who the hell knows what an uninsured patient will owe.  Will he receive a $24,000 bill?  The issue becomes one of transparency.  One never knows what the bill is gonna be and there are very few ways to find out in advance.

Last month I received a bill from some radiology doctor I never met for $875. I can only presume that somewhere along the way he looked at the at the CAT scan or was somewhere in the vicinity having coffee while I was on the table.  The bill came from some medical billing company in Indianapolis 6 months after the event.  Doctors don’t even bother collecting their own bills anymore.

So I contacted Medicare (by far the best government entity I have ever dealt with) and it turns out the bill was never submitted.  The billing company clearly hoped the old man would simply pay it.

So I called them up and asked if the bill had been submitted.  “Oh no!  We’re sorry”.

Why didn’t the bill get submitted?  Because Medicare authorized $85.  The government paid 80% and my private insurance covered the remainder.  But not until I got a bill for $17 which my private insurance had already paid.  Seems to me like a nice way to make a few extra bucks from old people.  Bill ’em first and see it they pay.

If hospitals were paid at Medicare rates they would have received $19.7 billion less in revenue between 2016 – 18.  Every year, Medicare issues a fee schedule that determines how much the federal insurance program will reimburse hospitals for specific services.

Any hospital or physician who accepts Medicare agrees to accept Medicare rates in full settlement no matter what they bill.  If Medicare turns down a payment for service  I am not responsible.  Usually, a decline is based on a need for the hospital to provide more information.

How does Medicare get away with paying less? “Medicare doesn’t negotiate rates. It sets them.”   How?  Because it the largest insurer by far with tens of milions of insured patients.

And doctors might be okay getting less per procedure because Medicare patients tend to need a lot of care. As a result, the total bill can add up. Nearly 4,000 doctors were paid more than $1 million from Medicare, according to data released this month.

So why is Medicare considered “bloated?”

Because people use it more.  In 2020 I spent about a month in a hospital with surgery to remove my spleen.  Half that time was in an ICU>

I never got a bill.

The GOP is already ranting about cutting “social entitlement” programs.

For all of you fools getting your info in the Fox News bubble, they mean you.  I ain’t worried.  There won’t be any cuts to existing programs.  It’s you MAGAs rubes around 45 years old who will not get what I have.

You know who you are.  Like me, you paid more to the IRS than Donald Trump did for 4 years while living comfortably in his tower.




About toritto

I was born during year four of the reign of Emperor Tiberius Claudius on the outskirts of the empire in Brooklyn. I married my high school sweetheart, the girl I took to the prom and we were together for forty years until her passing in 2004. We had four kids together and buried two together. I had a successful career in Corporate America (never got rich but made a living) and traveled the world. I am currently retired in the Tampa Bay metro area and live alone. One of my daughters is close by and one within a morning’s drive. They call their pops everyday. I try to write poetry (not very well), and about family. Occasionally I will try a historical piece relating to politics. :-)
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4 Responses to Health Care Scams

  1. beetleypete says:

    Reading this makes me thankful for the NHS, despite its current problems.

    I went into hospital for cancer tests, last September. Scan of my kidneys. Ultrasound of abdomen and bladder. Examination of results by an expert. A meeting with the top uruology man. Then a Cystoscopy and a bladder fill done by the same top man. Then more urine test analysis. Last of all, a further meeting with the top man. Total time spent? 4 hours, 30 minutes.
    Cost to me? Zero.

    The current government wants to charge us extra for seeing a family doctor, or an attendance at the Emergency Room for an accident. We already pay for the NHS through National Insurance salary deductions when working, so nobody is going to accept increased charges.

    Best wishes, Pete.

    Liked by 1 person

  2. jtmarlinnyc says:

    Thank you for your valuable catalogs of today’s medical-service issues. One of the advantages that used to be cited for the U.S. medical care system is that doctors did not have so many patients to care for as in the British National Health Service. But now primary-care physicians are being given panels of 2,000 or more patients. No wonder doctors with a following are pulling out from under the health-insurance companies and forming concierge practices where they can reduce their panels to one-fifth the numbers they are expected by insurers to handle.

    Liked by 1 person

  3. John says:

    The Hippocratic Oath has been the Hippocryte Oath for many years now and I doubt thing will ever get any better.

    Liked by 1 person

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