Buckrub
07-18-2014, 10:19 AM
When someone tells you that Medicare is a "good example" of a really good socialized, nationalized, health care system, think on this:
Just got our monthly Medicare statements. My wife has two interesting items worth noting.
1) She got a pneumonia shot (I need to also!!! Probably will at my next physical). The doctor charged $130.00 for the shot. This is actually less than Walgreen's or others I've heard charge for it. He submitted it to Medicare. They DO cover this shot. But............
They broke it down so they wouldn't have to pay for it all. They (not the doctor) broke it down as $40.00 for ADMINISTRATION of the vaccine, and $90.00 for the vaccine. For the $90.00 vaccine, they approved payment of $77.85, but they paid only $76.29 (no explanation for the difference of $1.46 that they won't pay). For the $40.00 ADMINISTRATION (sticking the needle in the arm) of the vaccine, they will NOT cover that, paid zero. I guess they want you to administer it yourself, I don't know. So, for a $130.00 shot, Medicare paid the doctor a total of $76.29.
She has Part B Supplemental insurance, of course. When the claim for the $40.00 was submitted to them, they won't pay either. The reason? "Supplemental plan does not cover any item or procedure not covered by Medicare". Supplemental my butt.
2) On another claim at another doctor, she had a battery of tests. All are covered by Medicare. The amount the doctor billed and the amount Medicare actually paid, is as follows:
$35.00 $2.39
$14.00 $0.96
$14.54 $0.98
the list goes on for 25 such items, all relatively the same.
For a procedure that another doctor charged $65.00, Medicare paid $4.44.
So when you hear a doctor say "I don't take any new Medicare patients", this is why. Every insurance works to reduce the retail amount that the doctor charges, but most get by with only about 85% or so..........Medicare pays practically nothing, and if the Doctor accepts a medicare patient, he MUST agree to accept their payment.
Now, apply this concept to Obamacare, and you can see why a huge number of insurance companies either went out of business, or cancelled policies for many self employed and others...........
Y'all can argue that the previous system sucked (and it did/does have a few flaws, all correctable), but it was a shining pot of gold compared to this atrocity.
My two cents.
Just got our monthly Medicare statements. My wife has two interesting items worth noting.
1) She got a pneumonia shot (I need to also!!! Probably will at my next physical). The doctor charged $130.00 for the shot. This is actually less than Walgreen's or others I've heard charge for it. He submitted it to Medicare. They DO cover this shot. But............
They broke it down so they wouldn't have to pay for it all. They (not the doctor) broke it down as $40.00 for ADMINISTRATION of the vaccine, and $90.00 for the vaccine. For the $90.00 vaccine, they approved payment of $77.85, but they paid only $76.29 (no explanation for the difference of $1.46 that they won't pay). For the $40.00 ADMINISTRATION (sticking the needle in the arm) of the vaccine, they will NOT cover that, paid zero. I guess they want you to administer it yourself, I don't know. So, for a $130.00 shot, Medicare paid the doctor a total of $76.29.
She has Part B Supplemental insurance, of course. When the claim for the $40.00 was submitted to them, they won't pay either. The reason? "Supplemental plan does not cover any item or procedure not covered by Medicare". Supplemental my butt.
2) On another claim at another doctor, she had a battery of tests. All are covered by Medicare. The amount the doctor billed and the amount Medicare actually paid, is as follows:
$35.00 $2.39
$14.00 $0.96
$14.54 $0.98
the list goes on for 25 such items, all relatively the same.
For a procedure that another doctor charged $65.00, Medicare paid $4.44.
So when you hear a doctor say "I don't take any new Medicare patients", this is why. Every insurance works to reduce the retail amount that the doctor charges, but most get by with only about 85% or so..........Medicare pays practically nothing, and if the Doctor accepts a medicare patient, he MUST agree to accept their payment.
Now, apply this concept to Obamacare, and you can see why a huge number of insurance companies either went out of business, or cancelled policies for many self employed and others...........
Y'all can argue that the previous system sucked (and it did/does have a few flaws, all correctable), but it was a shining pot of gold compared to this atrocity.
My two cents.