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.

.

 

Advertisement