Having spent almost three decades working in healthcare I understand that the amount billed vs the total received from third party payers are two different animals. And billing has to make up for the uninsured patients.

I had a routine visit with a physician in March and received the bill last week. The doctor's bill was 212.00, Medicare B & G covered 68.90, leaving me 143.10. I don't have a huge problem with this charge- the Dr. was very thorough and the visit wasn't rushed.

Then there was the hospital's facility bill for $505.14, $469.92 paid by Medicare. I contacted billing to explain the charges. The representative stated that this was for taking my vitals and for incidentals, such as the paper on the exam table.
Keeping in mind that I did the bulk of the intake info online prior to the visit, the $500 was for an MA to escort me to the exam room, take vitals, ask a few questions, and to pay for a piece of paper.

These charges coupled with $75 out of pocket from an earlier visit to a specialist mean that my deductible has been met for the year, but the facility charge seems ridiculous.

Medicare will be knocking down the questionable facility fee soon. ONLY doctors working for hospital owned clincs can charge this. Those in independent practice cannot. You see where Medicare wants things to go. All doctors working for hospitals. Those in private practice are left out in the cold.H
Here is more lengthy explanation:

https://www.medicaleconomics.c...-farce-everyone-pays

quote:

Originally posted by ZSMICHAEL:
Medicare will be knocking down the questionable facility fee soon. ONLY doctors working for hospital owned clincs can charge this. Those in independent practice cannot. You see where Medicare wants things to go. All doctors working for hospitals. Those in private practice are left out in the cold.

OP said nothing about Medicare, simply insurance and their are so many variables with regular medical insurance, even with Obama care that more details are needed. I'm not an expert on the end of things. If it was about medicare I'm surprised. I've not yet been billed incorrectly on any co-pay with my Advantage plan. And I had one hospital stay (22 days) and surgery that was more than 1.5 million. I think the total out of pocket on that deal was something in the order of $750 which was mostly pre op tests.

quote:

OP said nothing about Medicare, simply insurance and their are so many variables with regular medical insurance, even with Obama care that more details are needed

^^^^^^^^^^^^^^^^
Reread the post. Has nothing to do with OBAMA care. The guy has regular Medicare.

I'm covered by Medicare A, B, and Supplement Plan G (Medigap). The out of pocket bill wasn't my issue, it was more the excessive facility charge by the hospital to Medicare.

^^^^^^^^^^
I understand that the out of pocket was not your concern. The link should explain the Facility charge. It is a subtle way to get doctors to work for hospitals and leave private practice.

Sorry, I had overlooked the link to clarify the Medicare component. The article describes a pretty sad state of affairs.

quote:

Originally posted by NOCkid:
Having spent almost three decades working in healthcare I understand that the amount billed vs the total received from third party payers are two different animals. And billing has to make up for the uninsured patients.

I had a routine visit with a physician in March and received the bill last week. The doctor's bill was 212.00, Medicare B & G covered 68.90, leaving me 143.10. I don't have a huge problem with this charge- the Dr. was very thorough and the visit wasn't rushed.

I don't know how long you've been on Medicare but you are NOT responsible for the difference between what any medical bills and what Medicare pays.

Here's what you're responsible for paying for anything that Medicare covers under Part B:
1) Every year, you have to pay Medicare's deductible which for this year 2022 is $233 first.

2a) After you paid the deductible and assuming you don't have any Medicare Supplemental plans, your coinsurance for any Medicare approved treatment is 20% of the Medicare Approved amount if the doctor "accepts assignment but definitely not the difference between what the doctor billed and what Medicare pays.

2b) If the doctor doesn't accept assignments, then they are paid by Medicare 95% of the Medicare Approved Amount and the doctor can bill you UP TO 15% of what Medicare paid them which is 95% of the Medicare Approved amount. The math here is more complicated so it's better to go to a doctor that accepts Medicare assignment.

I hope you have an account with Medicare.gov where you can download the doctor billings that Medicare has processed. When the doctor's bill is processed, Medicare says what was billed, what they paid, and what you may be responsible for.

If you have a Medicare Supplement insurance, you may have to pay deductibles until you reach the amount where the supplemental insurance takes over paying the deductibles. What the supplement does is puts a cap on how much deductibles you'll pay in each year. So you're balancing the sure certain expense of paying the additional premium each month versus the unknown probability of you incurring a high amount of care and associated deductibles.

To your specific example: Assuming you already paid the deductible for this year of $233 and Medicare paid $143.10, then you're only liable for $35.78. The Medicare Approved amount is $178.88 because what they paid ($143.10) is 80% of !78.88 and you're liable for the remainder which is $35.78.

Medical billing in this country is completely broken and out of control.

I had a colonoscopy a few months back and watched in amazement as bill after bill after bill rolled into my Aetna claims page over the space of a month after the colonoscopy. It’s like everybody has their hand out for a piece of the pie.

And dummy me thought it was going to be like one or two bills at most I’m not shitting you it was like six separate bills for one procedure. WTF?

quote:

Originally posted by PASig:
Medical billing in this country is completely broken and out of control.

I had a colonoscopy a few months back and watched in amazement as bill after bill after bill rolled into my Aetna claims page over the space of a month after the colonoscopy. It’s like everybody has their hand out for a piece of the pie.

And dummy me thought it was going to be like one or two bills at most I’m not shitting you it was like six separate bills for one procedure. WTF?

And some of those bills get thrown in just in case it does slip through. I had a procedure done last year scheduled by a specialist. I thought I had my ducks in a row as far as insurance goes. The procedure was done at an outpatient facility.

I check in. The person says here's my deductible part so I pay it. Afterwards, I do my monthly download of any eobs. I find out I already satisfied my deductible for the year with zero coinsurance. On top of that, the facility sent a separate bill from the one sent by my doctor. The doctor's bill was paid; the facility's bill was declined.

I followed up to get the deductible paid back to me since I didn't owe any. The facility said they will return the deductible after the insurance settles. They just have to resubmit. This was back in October. The Insurance never paid them which tells me their bill was bogus. And they sent me my refund only in February.

If they would have come after me for the full bill, my position would have been my arrangement was with the doctor, not with them. That they didn't come after me also says they were just trying to snag some dollars.

I had some cardiac testing done in March of 2021. Bills came in April and I paid them. Fast forward to first week of April of 2022. A bill arrived! Over a year later! And my HRA has a year time limit for submission for reimbursement. End result was I was screwed. Of course I called everyone involved and got no answer at all as to why it took a year to get a bill to me!

^^^^^^^^^^^^^
You have Medicare?? There is a timely filing limit for claims. It is one year.

They billed Medicare right away. The bill came out of my yearly deductible of $233. My HRA generally covers the deductible, but they have a year deadline for claims. I missed it by about a week.

Completely agree with Zsmichael. Small guys are screwed.
I received a bill for my son over a year after he was seen- bcbs. I called the facility and told them it was outside timely filing…
They said no.. since I work in billing, I brought up a few points, naturally they told me not to worry about it, but it REALLY pissed me off, because as a small med facility I would be turned down without a second thought, yet the major hospital was going to make good on a year old claim they waited well past timely filing to put in.
Do not worry for a second about how they’ll get theirs. Just make sure YOU are being billed appropriately. It is appalling what they get away with.

I'm glad Mrs. Flash spent 10 years doing medical billing for the County.

It's saved is more than a few times, the last time at the Dentist's office.

When I saw the thread title, I thought it was the name of a physician: Visit Billing, M.D.

You can thank government meddling for 95% of the nonsense involved in medical billing and charging.