Medicare (again)

[Buckrub]

Sorry to beat a dead horse, but this is just amazing.

Just got the monthly "Medicare (CMS) Report" for my wife. She went to her doctor. Fairly routine, but he did some tests that he hasn't done before.

Total amount billed by doctor? $1,030.80

Total amount allowed by medicare? $1,008.30

Discount REQUIRED by medicare? $982.80

Total ACTUAL amount billed (the amount the doctor HAS to agree to accept as FULL payment)?? $25.50

What kind of medical insurance we have is debated hotly. But how can we get any doctor care at all if this continues? Won't they just all go out of business? I was there with my wife that day. He did a lot of things.....and lab tests, and......well, a LOT. Twenty Five bucks for ALL that?

THIS (medicare) is touted as a successful government program? Are you kidding me?

Every month, it's the same thing. This one was Over The Top.........but they're all similar.

[Hombre]

I guess I don' t understand if the amount billed is 1030 and the amount allowed is 1008 it seems a 22.00 discount would be required?

[Buckrub]

No. If I'm off a few cents, sorry.

But Medicare disallowed $22.50. Not covered. Something that isn't covered. Of the remaining 1008 bucks, they paid a total of twenty five bucks. That's the point.

Forget the difference in 1030 and 1008. Meaningless. Immaterial. Coincidental.

The issue is, of the entire VALID amount of 1008 dollars, Medicare is willing to pay $25 for all those procedures, total. And the doctor, if he chooses to accept Medicare patients, has to accept as payment in full.

Just amazing.

[Hombre]

In my opinion it is broken both ways. I had a procedure that the hospital charged $30K and settled at $800, why even have the original amount. Why do hospitals put a crazy amount and settle for soo much less. This needs fixed.

[Thumper]

I once knew a gal who was .. heck, I forgot her title, but all she did was medical billing. It was like bargaining. She said they always billed high, knowing the total would get negotiated down. If nobody challenged the charges (rare), they'd come out ahead.

About 10-12 years ago, Lynn's company moved their headquarters to Wis-frigging-consin and wanted her to relocate. She left the company and decided on a career change, but her company insurance ran out as she took a bit of time off to decide what to do, then made a decision and started job hunting. She quickly found a job and started work, but there was a 90-day lag before her new company insurance kicked in.

One day at work, she started stumbling around the office like she was drunk ... dizzy spells, couldn't speak clearly, etc. Of course, it was something like 11 days before her benefits kicked in and she had no medical coverage! I took her to the Emergency Room and they admitted her. She was in the hospital for three days. There was NO SURGERY ... only tests ... and more tests ... and a few more tests. They finally determined it was high blood pressure and experimented with different b/p meds until they got her stabilized, then released her with an Rx for b/p meds.

Note: She'd never been seriously ill and never been in a hospital since the day she was born, but you know about Murphy's Law! We gambled and lost. Of course she's never been seriously ill since that time either. :(

Shortly after, the bills started rolling in ... from EVERYWHERE! Doctors, labs, clinics ... you name it ... we received bills from them. Total? $67 frigging THOUSAND dollars! Again, there wasn't even any surgery involved ... just "tests" ... all to find out it was simply high b/p!

Of course I didn't have that much cash layin' around ... so I hit the phones and most everyone I talked to was willing to "negotiate". It was usually an offer of, "If you pay it immediately (as in right now), we'll lower the bill to $xxxx!" I'd whip out my credit card, give them the number and they'd mark my bill "paid in full". Then I'd move on to the next bill. Final tally? Just a hair (and I mean, just a few bucks, 10-20 maybe) over $18,000!!

That said, your $1030 to $25 doesn't sound right. I think there's sumpin' missing there.

[Buckrub]

I get all that.

But this isn't negotiations. Those aren't reductions of 4,000% though!

This is a fixed amount for specific listed services that are 4,000% below retail. Why be a doctor?

How has all this fixed any part of the health insurance system?

[Thumper]

I've got a good buddy who's a doctor. We were hunting buds and he even started going to Ohio with me during deer season. He started out as a pharmacist years ago and decided to go back to school to become a doctor. He had his own practice for a bazillion years and was actually my "family" doctor when I had my company and before I started using the VA. One day I was over at his house and we were putzing around his garage when he said he was thinking about closing his practice and going back to being a pharmacist. It wasn't so much the Medicare thing ... this was due to the high cost of malpractice insurance. He'd never in his entire career had a claim filed against him ... but the cost of insurance was putting him in the poorhouse. He lived VERY modestly I might add ... more of a "country doctor" that the high-falutin' type. Heck, if you didn't have any money/insurance, he'd accept a bunch of chickens and a hog or two for his payment.

He went a couple more years and decided to take an early retirement instead of going back into pharmacy. He was a darn good doctor too ... just couldn't afford to stay in business.

[Buckrub]

I read somewhere that 3% of all US doctors now take no insurance from anyone. Cash only. You file if you want, but you pay before going into waiting room. 3% and growing.

Very free doctors in my hometown will take Medicare Advantage plans, and have signs clearly saying so. Most also post signs they won't take any NEW medicare or medicaid patients, including the new subsidized folks.

[Thumper]

A very close friend of ours here in town has been a nurse for a local doctor for many years. She decided to retire last year, but he convinced her to stay with him for a couple more years and they'd retire together. Same deal, he can't afford to stay in business. He's decided to retire at 62 years old (the minimum for Social Security) and either close or sell his practice. He had no previous plans on retiring anytime soon, but she agreed to stay on and they'll both retire when he shuts down the practice in another year and a half. (she's in her 70's btw)

[Buckrub]

My gastrointerologist retired Dec 31.

Sitting in a doctor office now.

It ticks me off that the national discussion for last few years is stated to be about "health care". Actually health care proceeds on mostly unchanged, except for the plethora of new drugs and procedures. The problem us Health Care Insurance.

[Niner]

There ought to be a law......

[BarryBobPosthole]

All the doctors I know personally have fucking big ass boats and houses you could get lost in and McIntosh sound systems. Of course, they are poor as church mice. Y'all oughta see a doctor that doesn't have a bone tied up in his hair.

BKb

[Buckrub]

Hope you stay happy in this for many years.

[BarryBobPosthole]

I know. Its just like always: my experience don't count for shit and yours is the only valid one.

BKB

[Buckrub]

Now Barry........give me a freaking break.

Can you tell me how long YOU have been on Medicare? Explain this massive experience to me, please.

And you didn't make a post about your experience, or in come-back to mine. You just said all the doctors you know are rich.

?????????????????????

And my experience ain't the only valid one EVER, but it's the only experience that happens to be MINE, for gosh sakes! It IS the only one I happen to know about. Geez pete.

[Buckrub]

You know what?

Stick it. This gets real old, and fast. No one I know thinks I'm a freaking idiot, except you guys.

Fine. I'll try and stay out of y'all's Mensa Club.

[Hombre]

Two retired guy oughta be sitting in a hammock laughing at us poor schmucks who still have to work......not raising their blood pressure on a website .... Its the golden years fellas!

[BarryBobPosthole]

Hey, pull your head out. I was responding to Thumper about his post that doctors are going intothe poorhouse, the poor things, not anything you said about Medicare.

All i'm saying is that all the doctors I know, and that's probably 8 or so people, are rich motherfuckers, at least by my standards. You seem to think that's not the average case. Here's a link to what they really make. And I think they deserve every penny of it by the way. But the information isn't secret.
http://www.medscape.com/features/slideshow/compensation/2014/public/overview#1

BKB

[Chicken Dinner]

Back in the day (10 years now) when I was in public accounting I used to have a bunch of hospitals as clients and followed the healthcare industry pretty closely. Even back then if you're payer mix was skewed too high to Medicare or Medicaid, you were going to go broke. Basically, you lose money on government insurance and hope to make it up on everybody else. Why a doctor would accept Medicare patients is beyond me. (There's actually a law that says that Medicare can't be charged more than the lowest negotiated rate of all your insurance clients.) Insurance companies actually do the same thing and have negotiated rates with doctors who are in network. It's just not as bad as Bucky's example. I know my wife receives a monthly treatment for her MS that the infusion place charges $7k, the insurance company's negotiated rate is $2k. We pay $20.

One of the areas that I think is really interesting is prescription medicine. I take a generic cholesterol medicine and I looked at the explanation of benefits and the Insurance company's negotiated rate is actually equal to my co-pay. (Something like $13 and change.) The insurance company is actually paying nothing. To top it off, I could go to Target or Walmart and buy it for $5 without any insurance involvement at all.

That's a messed up system.

[Thumper]

Me??? Hey, when I had my business, I had a bazillion doctors as customers. They lived high on the hog and were what I would call "rich". But, many doctors refuse (or they did then) Medicare patients. My bet is, they had very few of them. The two doctors I mentioned above both have small practices and have a high percentage of Medicare patients. I honestly don't know where the doctor lives where our friend is the nurse, but he drives a very modest car. The doctor who is a good personal friend drives a 5-6 year old Ford pick-up and I'd have to say MY house is nicer than his, although he has more property. He is "comfortable", but far from wealthy. When I go to his office I always joke with him that his patients make me look like a young kid!

[BarryBobPosthole]

My own opinion is that doctors earn every penny they make, at least the ones that aren't quacks do! My own personal doc, who I've known and gone to since 84 when he first got out of medical school, still lives in the same subdivision he did when I first met him. Its what I'd call a modest but very nice house. Every time I see him he bitches about Obama, and antivaxxers and gun control and just about the same stuff you guys (and me) bitch about. What I mean to say is he's a pretty regular, if somewhat odd, guy. The odd part is he has no filter. And I mean none. Back when my knee got hurt I flew home from Texas in a wheel chair and had to practically crawl to my truck to drive to his office so he could drain my knee and give me some pain relief. He introduced me to a HOT young intern and said she'd be assisting. Then when she walked out of the room he said 'she's got some big old titties don't she?" i knew better than to fall for it. She was his daughter. Who was getting ready to go to Baylor her specialty after just graduating OU med school. She was going to Baylor to study forensics. So when I say he's a regular guy, he's got a little more mad money in his pocket than most of us do.
To get to my point, it was hard for him to turn away Medicare patients in a town this small and look everyone in the eye. So he completely opted out of an open family practice and joined a concierge medical provider called MDVIP. He did it to protect his income. I can't blame him. The fee schedule that providers use is pretty standard and very much out of line with real costs. There is a whole cottage industry of consultants who will negotiate doctor bills for you and get you a much reduced settlement. A lot of people don't negotiate. I know I don't. I just pay what I'm told to pay.
So the Medicare issue isn't a problem with Medicare alone, its a problem with thesame fee schedule that everyone else, including Medicare, uses. Medicare though, is in a much better negotiating position and gets much bigger discounts than we do. Don't fool yourself into believing that anyone is losing any money though. Its why the rates in the fee schedule are what they are.
The government doesn't need to try to regulate the fee schedule. But you have to wonder with hospitals in particular making billions of (mostly tax free) dollars because of it if it'll ever get fixed by the industry. I haven't heard anyone too excited about fixing it.

BKB

[Buckrub]

Back in the day (10 years now) when I was in public accounting I used to have a bunch of hospitals as clients and followed the healthcare industry pretty closely. Even back then if you're payer mix was skewed too high to Medicare or Medicaid, you were going to go broke. Basically, you lose money on government insurance and hope to make it up on everybody else. Why a doctor would accept Medicare patients is beyond me. (There's actually a law that says that Medicare can't be charged more than the lowest negotiated rate of all your insurance clients.) Insurance companies actually do the same thing and have negotiated rates with doctors who are in network. It's just not as bad as Bucky's example. I know my wife receives a monthly treatment for her MS that the infusion place charges $7k, the insurance company's negotiated rate is $2k. We pay $20.

One of the areas that I think is really interesting is prescription medicine. I take a generic cholesterol medicine and I looked at the explanation of benefits and the Insurance company's negotiated rate is actually equal to my co-pay. (Something like $13 and change.) The insurance company is actually paying nothing. To top it off, I could go to Target or Walmart and buy it for $5 without any insurance involvement at all.

That's a messed up system.

I got mad. Still am some. So bite me or something.

One sentence in this, Hank........stands out. It's just not as bad as Bucky's example. That was my point. I KNOW about insurance companies negotiating stuff..."If you want to see OUR clients as patients, you have to agree to accept X". Same as with Medicare. SO are they the same?

NO.

That's my point. Insurance companies see a $1000 procedure, and they say "Tell you what. We'll pay you $593 for that, take it or leave it". And they take it. But they do NOT say "I ain't paying you a nickel more than $25.00 for that". That's not absurd. That's not good money management. That's not looking out for anyone's interests. That's not attempting to intelligently discover what the PROPER amount to charge is.

That's coerced robbery. That's all that is. They claim they don't want to steal from the little guy, so they steal from the big ones. And THAT is the b/s elitist goshawful attitude that all governments have, and as they grow they become emboldened. And they increase it more and more. They get fat. Little guy gets nowhere near what they said he'd get, and the big guy suffers most, cause he has most.

I hate it.

And I don't care what house a doctor lives in. What a steaming pile of smokescreen to bring that up. So what? Is it FAIR that he lives in a big house? Most of my doctors live in nice houses........here in town............none live in a big mansion. Heck, my dentist has the biggest house of any of 'em. And he runs Free Clinics all over the state. What does any of that matter? Seriously, why give that as an answer to what I posted? For what? Just a smokescreen.

The issue is that these guys risked a lot, gave up a lot of wage earning years, and do amazing things (or try to), and their being compensated is only fair, as I see it. To have them arrive at a fair price for a skill they have, and to be able to charge that to most folks, and then have the US Federal Government devise a system that pays them LESS than a penny on the dollar.......actually one fourth of a penny on the dollar......is sick, egotistical, ignorant, demeaning, insane, and helps not one American. To do so with a big blathering tone of "We devised a GREAT National Health Insurance system. Y'all ALL ought to try it" is...........I don't know. Evil is about the best word I know.

So the problem is SIMILAR to other entities, yes. It sounds similar. But is it the SAME? About like baseballs and apples are about the same, yeah. NOT.

[BarryBobPosthole]

You're so full of shit your eyes are brown. Medicare simply plays by the same rules everyone else in the insurance industry does. The difference is they have a much larger 'group' of users to use in their negotiations. Its not devised to screw your beloved doctors. Its devised so they can tell hospitals and other providers to take it or leave it when it comes to rates. You saying Medicare is unfair to doctors is laughable. What other business can you name where when before you get work done you have no idea of what it will cost? That's negotiated by insurance providers with the providers and the amount they pay depends on what deals they can make using their own large 'group' of subscribers.
The actual charge standard is the 'chargemaster'. Do some reading up on it. Its interesting. And infuriating. If you or I buy directly from providers we pay the full Chargemaster price. If an insurance dompany buys from them, they pay a different negotiated rate. Why should Medicare not be able to do the same without you claiming some poor doctor can't even afford new Lamborgini' for their kids. Give me a large break.

BKB

[Buckrub]

Disagree.

[Captain]

I disagree with your disagree.... I think ;-)