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Strange Medicare payments

edwardh1 | Posted in Business on February 17, 2009 09:34am

Wife has an out patient hand operation- Medicare seems to pay the hospitals close (85% or so) of what they charge, like $5500..
The doctor charges $4300 for this 1 hour hand operation- the Medicare pays him $675.

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  1. User avater
    jonblakemore | Feb 17, 2009 09:48pm | #1

    I let my wife deal with our health insurance.

    She's an RN and knows how to plead more effectively than I do.

     

    Jon Blakemore

    RappahannockINC.com Fredericksburg, VA

  2. frammer52 | Feb 17, 2009 10:10pm | #2

    Does sound strange.  makes me want to look at some of my surgery over the last 3 yrs.  Actually, not, it scares me!

  3. User avater
    nater | Feb 17, 2009 11:23pm | #3

    Medicare says it will pay this amount for a certain thing. The hospital usually loses money on these. Insurance company does the same thing, but without quite as much clout as the government. Who is left but the guy who doesn't have insurance, so they raise the rates so the guy who doesn't have anyone behind him has to pay. So the big amount is what the hospital bills, knowing that they won't ever get that from most people.

    1. ponytl | Feb 18, 2009 03:59am | #6

      we did not have insurance to cover the birth of our last child... the added cost was 2400yr... and we didn't plan on have'n another child...

      we did have insurance that would cover him the minute after he was born...  but nothing to cover prebirth and the birth...

      told the doctors this on the front end and the hospital... they cut us a deal... charged us exactly what an insurance co would pay them (about 60% of the normal charge) as long as i paid them in full BEFORE the birth... which i did... cost me about 14k total... that was all the tests (her doctor limited them  to only must haves) and the birth ect...

      everyone was more than fair and helpful... showed to be more than willing to work with us...

      BTW  I went on a selling spree hard core on ebay... took me  just over 30 days to see enough #### on ebay to pay for everything... I almost named him "ebay"  but wife wasn't too big on that

      P

      1. Virginbuild | Feb 18, 2009 05:14pm | #7

        60% of usual and still 14K WOW! been awhile since I have fatherd children. First two (twins) cost about 600 dollars for birthing,50 yrs ago.

        May your children be a blessing to you each and every day.

        Virginbuild

      2. TooManyToys | Feb 18, 2009 05:15pm | #8

        A few months ago I had a sleep study done.  Charge was $9900 and they accepted the $980 from BCBS.  The CPAP machine I got was from an out of netweork provider.  The bill is $3745 and BCBS paid me $721, with BCBS stating I owed the provider the remaining money.  The provider is accepting the $721 ands writing off the remaining amount.

        I have no clue how this system works other then postulating that they get to use the "write off" against their taxes.  What is really confusing about this is BCBS does not have any in-network providers of this equipment.  So you are at the mercy of the provider for their determination of how much to pay.

        My mother (96 YO next Saturday) spend about 5 months last year in hospitals and rehab.  The cost numbers are staggering, as are the actual charges that some of the providers are willing to take on write down.

        Edited 2/18/2009 9:16 am ET by TooManyToys

        Edited 2/18/2009 9:20 am ET by TooManyToys

        1. [email protected] | Feb 18, 2009 07:46pm | #13

          "I have no clue how this system works other then postulating that they get to use the "write off" against their taxes."

          They can't write it off on their taxes.  It just decreases the amount of profit that they declare. 

          John

      3. edwardh1 | Feb 18, 2009 05:25pm | #9

        with slumdog millionaire so popular (its not about the game show) ebay actually might have been a timely name

      4. Mac | Feb 18, 2009 05:39pm | #10

        I was born in 1931. Still have hospital bill - cost $55.00 for 14 days, including circumcision at $15.00.  This was depression in Iowa.

      5. CJM | Feb 18, 2009 09:37pm | #16

        $14k today.In 1975 I had no insurance and the total charge for pre natal checkups, delivery, hospital stay, was $1000. A lot of money then but still affordable, not so today.

  4. migraine | Feb 18, 2009 12:11am | #4

    Yeah , that seems about right.  I had hand surgery twice for carpal tunnel and both times, the PPO/HMO(EPO) paid about that. Plus, the subsequent follow visits were included

    Just had a front end and rear end alighnment done at the same time(One after the other and the top was done first!!!)and I believe the doctor was paid $1100 through pacific care HMO



    Edited 2/17/2009 4:12 pm by migraine

    1. Shoemaker1 | Feb 18, 2009 02:53am | #5

      My wife had her carpel tunnel done today. No cost, in and out in 1 hour. no insurance no hassle other than the snow storm to get there.
      Got to love Canada!!

  5. BryanSayer | Feb 18, 2009 06:30pm | #11

    Part of what I call the MSRP is about bargaining NEXT year for what the rates will be. Plus the bigger the MSRP, the bigger the discount looks. Ever notice that your EOB shows you how much you "saved" by using XYZ insurance?

    1. villagehandyman | Feb 18, 2009 07:12pm | #12

      the difference between what the hospital charges and what the insurance or medicare pays is considered a loss and is deductible from their taxes

      1. [email protected] | Feb 18, 2009 07:50pm | #14

        Sorry, but that isn't true.   They are not able to write of the discount from their taxes.  No matter how much they charge, the amount they received is what is income. 

        John

        1. edwardh1 | Feb 18, 2009 09:36pm | #15

          I agree with kiddoc.

        2. DaveRicheson | Feb 19, 2009 12:09am | #17

          Doesn't BCBS negoiate amounts paid for procedures with participating providers, both hospital and PSCs?

          1. [email protected] | Feb 19, 2009 01:16am | #19

            Yes.

            John

      2. peteshlagor | Feb 19, 2009 12:17am | #18

        Better check with your tax man. 

        If'n you don't collect all you bill, and settle for the payment, where's the income from which to write this off from?

        It only gets wrote off AFTER the company recognizes it as income.  When they bill to Medicare or such, many providers do recognize the income at that time - but only the income they expect to receive.  Not this bogus inflated amount.

         

        1. edwardh1 | Feb 19, 2009 06:34pm | #20

          you can only deduct the write off IF YOU COUNT the first (higher) billed amount as income.

          1. DaveRicheson | Feb 19, 2009 07:15pm | #21

            Income is that which is recieved.

            A loss means you provided services or goods which cost you some of that income , and for which you did not recieve renumeration, in most cases.

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