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I've seen this before where Medicare makes a "mistake" and approves something then 1-2 years later figures it out. Then it gets worse because they take their $600 back from me (by deducting it from other patient payments!) and now I am left to chase the patient to get my money back. The patient has no incentive to pay me at that point because they've got their tooth.
So, you can be ripped off twice. Drop Medicare. You can't afford it. That would solve the problem of people bamboozling Medicare at your expense.
But, more detail, here:
Did this patient claim this implant was part of some broader procedure that might fit one of the conditions listed above? Sounds like quite a stretch - and a bogus claim and decision on the part of that patient and Medicare. Just proves you can't believe anything you read about the 'rules' - and there is always an exception.
I've been functioning for five years with a 'flipper' in place of my #5 tooth after an extraction. Have all my other teeth, except two upper wisdom (#1 and #16) which were removed 30 years ago. Haven't bothered with an implant b/c I'm not at all inconvenienced at the moment.
That's a ripoff for you toofache. That patient should be ashamed.
Interesting. My wife had an infection that required surgery a couple of years ago. The procedure to cure the infection involved part of both her mouth and jaw. Medicare did pay for the removal of an implant as part of that treatment.
However, they were quite specific in that they would not pay for a new implant, only for the infection.
So, you can be ripped off twice. Drop Medicare. You can't afford it. That would solve the problem of people bamboozling Medicare at your expense.
Looks like I won't be the only one dropping it. Medicare just announced a 21% pay cut for next year which will likely pass the vote. I think people don't realize this is actually a 42% pay cut for doctors. My office runs at about 50% overhead. So when Medicare pays me $100, half of it goes towards the staff salaries, office rent, supplies, etc. So if they only pay me $79, it still costs me $50 to provide the same service. I think we need to have ALL healthcare workers have skin in the game. If Medicare institutes a 21% pay cut, then all the nurses, ancillary staff, receptionists and everyone else needs to take a 21% pay cut also. Why am I the only one being penalized?
Looks like I won't be the only one dropping it. Medicare just announced a 21% pay cut for next year which will likely pass the vote. I think people don't realize this is actually a 42% pay cut for doctors. My office runs at about 50% overhead. So when Medicare pays me $100, half of it goes towards the staff salaries, office rent, supplies, etc. So if they only pay me $79, it still costs me $50 to provide the same service. I think we need to have ALL healthcare workers have skin in the game. If Medicare institutes a 21% pay cut, then all the nurses, ancillary staff, receptionists and everyone else needs to take a 21% pay cut also. Why am I the only one being penalized?
Since you seem to be familiar with this document, perhaps you might refer to the page or pages that says this. Most will not be up to reading ll85 pages.
Is this what you are alluding to. Seems to have been going on for nine years now.. New deadline is Apr. 1, 2015 and will most likely be delayed again.
There is HUGE misunderstanding here about what constitutes "preventative" services which is why this board is nothing but a complaint orgy. Most patients have little or no comprehension of the intricacies and protocols of medical coding which leads to complaints. "Preventative" does not include a new problem, it only includes screenings, immunization, nutrition, smoking cessation, etc but NOT new problems. If a new problem is found, this takes you out of the "preventative" territory and into the "diagnostic" area which is NOT free.
That moves the patient into the E/M category of codes (Evaluation & Management). Many patients approach a doctor's visit as a chance to address everything they can squeeze in including new complaints. If doctors spends the time and effort to address new problems during "preventative" visits and only bills for the preventative portion, then the doctor is saddled with the entire burden of all these new problems without appropriate compsensation. If something new is found but you don't want to address it because it's not free, then stop your doctor right there and tell him to go no further. These are YOUR insurance rules, not the doctor's rules. If we want someone else to pay for our care, we have to follow their rules. Obviously the one who makes the rules stacks them in their favor so they always win. This is the system we have chosen.
It's a little hard to stop them when you're under anesthesia as in a colonoscopy.
What I would have appreciated would have been a little heads' up - from SOMEONE. I had no idea that these polyps, which are nearly always non cancerous and non symptomatic, were commonly found and commonly sent off to be biopsied - with a $1000 price tag.
It's very common - but the layperson would have no way of knowing that and like me, is often surprised with the bill. I mean, I know NOW but that won't do much good since I don't have to have another colonoscopy for ten more years.
It's a little hard to stop them when you're under anesthesia as in a colonoscopy.
What I would have appreciated would have been a little heads' up - from SOMEONE. I had no idea that these polyps, which are nearly always non cancerous and non symptomatic, were commonly found and commonly sent off to be biopsied - with a $1000 price tag.
It's very common - but the layperson would have no way of knowing that and like me, is often surprised with the bill. I mean, I know NOW but that won't do much good since I don't have to have another colonoscopy for ten more years.
The alternative is to not remove the polyps, wake you up, and come back for another colonoscopy to remove them which the insurance will probably not pay for since they just paid for a colonoscopy. I always tell patients that when they are asleep, if I see something suspicious then it's in their best interest for me to go ahead and biopsy it. I have no idea what this means from an insurance/financial standpoint because I have no way of knowing the rules for all 43 insurance plans I am in-network with.
Since you seem to be familiar with this document, perhaps you might refer to the page or pages that says this. Most will not be up to reading ll85 pages.
Is this what you are alluding to. Seems to have been going on for nine years now.. New deadline is Apr. 1, 2015 and will most likely be delayed again.
The fees/RVUs in the document are on average 21.2% lower than existing fees. The talking heads in politics say that this year it will finally pass (maybe not) but the mere fact that this is on the table is concerning. The fact is there is not enough "government" money to pay for everyone's healthcare. The government has no money as it produces no goods or services....they simply take money from some and give it to others.
The alternative is to not remove the polyps, wake you up, and come back for another colonoscopy to remove them which the insurance will probably not pay for since they just paid for a colonoscopy. I always tell patients that when they are asleep, if I see something suspicious then it's in their best interest for me to go ahead and biopsy it. I have no idea what this means from an insurance/financial standpoint because I have no way of knowing the rules for all 43 insurance plans I am in-network with.
Maybe this might help you:
"If we send anything off for a biopsy or do any additional testing, I just want to remind you that this may incur some additional charges. You should check your insurance policy beforehand."
You don't have to know any details about their plan. You may not believe it, or care, or understand (fill in the blank) from your perspective, but the comments on this thread ought to be enough of a heads' up for you to realize that this IS a concern to your patients. And since they are your patients, that ought to concern you as well. It's part of their treatment plan.
"If we send anything off for a biopsy or do any additional testing, I just want to remind you that this may incur some additional charges. You should check your insurance policy beforehand."
You don't have to know any details about their plan. You may not believe it, or care, or understand (fill in the blank) from your perspective, but the comments on this thread ought to be enough of a heads' up for you to realize that this IS a concern to your patients. And since they are your patients, that ought to concern you as well. It's part of their treatment plan.
I guess I should also get upset at the grocery store clerk because he didn't tell me that it costs more to put more stuff in my shopping cart.
I guess I should also get upset at the grocery store clerk because he didn't tell me that it costs more to put more stuff in my shopping cart.
So you do colonoscopies and you are a dentist. Please tell me where you practice. With your callous attitude towards your patients I'd like to make sure I would avoid you at all costs.
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