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Don't get too excited about the original billing with a procedure, inpatient hospital, etc. This is my wife's latest Brain MRI with and without contrast.
In actuality we paid $78 as the provider discounted it a little.
This was original medicare with NO supplement. For your information
Medicare-approved amount $7,835.10
Medicare paid $360.66
You may be billed $92.01
Don't get too excited about the original billing with a procedure, inpatient hospital, etc. This is my wife's latest Brain MRI with and without contrast.
In actuality we paid $78 as the provider discounted it a little.
This was original medicare with NO supplement. For your information
Medicare-approved amount $7,835.10
Medicare paid $360.66
You may be billed $92.01
Medicare approved the service, but not $7,835.10 as a fair reimbursement. Thus, the actual 'Medicare-approved amount/fee' for this service is $450.83, of which Medicare paid 80% - $360.66 (80%x$450.83). Your 20% share was $90.17. Not sure where the remaining $1.84 came from.
The nurse making $40 an hour, ancillary staff(techs, aides, secretaries) $10 an hour, supplies are expensive, computers and software for charting, food, medication, unlimited soda. All the behind the scenes staff like IT computer support, case management, mid level and upper management, supervisors, administrators with pay perks, directors of feel good sunshine committees, nurses that review charts, dietary staff, housekeeping, it’s all very expensive. Some of its necessary, and some it is fluff to meet requirements for magnet status which costs millions for they can have a prestigious plaque on the wall. Hospitals are adding amenities to make it like a hotel or resort, to improve satisfaction which is part of a government survey for reimbursement(HCAPS). Where I worked they installed fancy fireplaces in waiting rooms, among other things. Your bill is paying for everything not just what was performed on you.
Last edited by Matthew_MI; 07-24-2019 at 09:22 PM..
The nurse making $40 an hour, ancillary staff(techs, aides, secretaries) $10 an hour, supplies are expensive, computers and software for charting, food, medication, unlimited soda. All the behind the scenes staff like IT computer support, case management, mid level and upper management, supervisors, administrators with pay perks, directors of feel good sunshine committees, nurses that review charts, dietary staff, housekeeping, it’s all very expensive. Some of its necessary, and some it is fluff to meet requirements for magnet status which costs millions for they can have a prestigious plaque on the wall. Hospitals are adding amenities to make it like a hotel or resort, to improve satisfaction which is part of a government survey for reimbursement(HCAPS). Where I worked they installed fancy fireplaces in waiting rooms, among other things. Your bill is paying for everything not just what was performed on you.
If only that were the case. Truth is hospitals “cost shift” and those with resources are forced to pay for indigent patients. This type of shenanigans is illegal under federal antitrust law, but the corrupt insurance/hospital industry lobbied and received a tacit exemption when EMTALA was enacted in the '80s.
The practice is now woven into the fabric of healthcare in this country. Hospitals routinely use software that places a patient's FICO credit score front and center during admissions. People with money in the bank have a giant bullseye painted on their gowns.
I just had an experience concerning Medicare and being admitted for Observation. I have Medicare A & B and BCBS federal Employee Ins. After this I will never ever let myself be talked in to this type of stay in a hospital. Unless I have a signed statement that my visit will be coded as an admission.
I went to the ER yesterday for a high pulse rate and high blood pressure. Feeling tired and out of it. The treatment was well done and a number of tests were done. I was put on a saline IV and my pulse and blood pressure started to return to normal. So possible dehydration.Though no one confirmed that. One doctor said he didn't know what was wrong.
After 4 hours in the ER they want me to spend an overnight in their hospital 14 miles away. I said I was much better and no real need for an overnight in their hospital. They said you need to be monitored overnight and another Labs and test done. So I agree and immediately said I'm aware Medicare will not completely pay my bill if I'm there for observation. I asked the doctor if she was aware this goes on. She tells me yes she is, that I will be coded as an admittance and not observation. I then ask what about the charges for the ambulance ride. I said that ride must be around $800 to $1000. She said the Insurance pays that. So I reluctantly agree to an overnight stay. The ambulance comes I'm at the hospital at 8pm.
Everything is going well I'm montored, more labs and Echo is done, another IV. At least 5 doctors have visited me. I seem to be back to normal then all hell broke loose. I'm in shock by it. A man from the hospital office comes in and gives a long speech on this being an observation admitance. That I'm aware Medicare will not pay the usual amount because of Observation and I will be billed for the remainder. That he has a list of the charges other than the ambulance ride. The charges are close to $17,000. I damn near fell out of the bed. He has me sign a form that he spoke to me about all this. Then a nurse comes in and says she needs more labs done. I said screw the labs and this hospital I'm the F out of here. I was told this was to be an admittance by the admitting doctor at your ER. Not only that what kind of a hospital comes in to the room with a list of charges and wants paper work signed concerning this. Plus why wasn't this mentioned to me before the Amubulance ride that what I'm hearing now, was the hospitals intentions all along. I told them If I knew this was their intention I would of said absolutely No to this trip to he hospital.
So I left the hospital and I'm home now. Wondering how could I have let this happen. Then I say you probably did all you could. I understand that Medicare A doesn't pay for observation, but the way it was done by the hospital just seemed cruel to me. Obviously this is very common practice in our Health care system. I have never in my 71 years checked myself out of a hospital. I've never been this angry the way a hospital stay was handled. Especially one that between the ER and the hospital stay amounted to 18 hours and $17,000 plus what the cost of the Ambulance will be. I'll never be able to pay my portion of this outrageous rip off. I have no idea how much that will be, and all the stress this is causing.
Interesting. 3 years ago I had an overnight observation admission to a hospital that was fully covered by medicare and my federal retiree insurance policy. Dinner and breakfast were pretty good, too.
I just had an experience concerning Medicare and being admitted for Observation. I have Medicare A & B and BCBS federal Employee Ins. After this I will never ever let myself be talked in to this type of stay in a hospital. Unless I have a signed statement that my visit will be coded as an admission.
I went to the ER yesterday for a high pulse rate and high blood pressure. Feeling tired and out of it. The treatment was well done and a number of tests were done. I was put on a saline IV and my pulse and blood pressure started to return to normal. So possible dehydration.Though no one confirmed that. One doctor said he didn't know what was wrong.
After 4 hours in the ER they want me to spend an overnight in their hospital 14 miles away. I said I was much better and no real need for an overnight in their hospital. They said you need to be monitored overnight and another Labs and test done. So I agree and immediately said I'm aware Medicare will not completely pay my bill if I'm there for observation. I asked the doctor if she was aware this goes on. She tells me yes she is, that I will be coded as an admittance and not observation. I then ask what about the charges for the ambulance ride. I said that ride must be around $800 to $1000. She said the Insurance pays that. So I reluctantly agree to an overnight stay. The ambulance comes I'm at the hospital at 8pm.
Everything is going well I'm montored, more labs and Echo is done, another IV. At least 5 doctors have visited me. I seem to be back to normal then all hell broke loose. I'm in shock by it. A man from the hospital office comes in and gives a long speech on this being an observation admitance. That I'm aware Medicare will not pay the usual amount because of Observation and I will be billed for the remainder. That he has a list of the charges other than the ambulance ride. The charges are close to $17,000. I damn near fell out of the bed. He has me sign a form that he spoke to me about all this. Then a nurse comes in and says she needs more labs done. I said screw the labs and this hospital I'm the F out of here. I was told this was to be an admittance by the admitting doctor at your ER. Not only that what kind of a hospital comes in to the room with a list of charges and wants paper work signed concerning this. Plus why wasn't this mentioned to me before the Amubulance ride that what I'm hearing now, was the hospitals intentions all along. I told them If I knew this was their intention I would of said absolutely No to this trip to he hospital.
So I left the hospital and I'm home now. Wondering how could I have let this happen. Then I say you probably did all you could. I understand that Medicare A doesn't pay for observation, but the way it was done by the hospital just seemed cruel to me. Obviously this is very common practice in our Health care system. I have never in my 71 years checked myself out of a hospital. I've never been this angry the way a hospital stay was handled. Especially one that between the ER and the hospital stay amounted to 18 hours and $17,000 plus what the cost of the Ambulance will be. I'll never be able to pay my portion of this outrageous rip off. I have no idea how much that will be, and all the stress this is causing.
Interesting. 3 years ago I had an overnight observation admission to a hospital that was fully covered by medicare and my federal retiree insurance policy. Dinner and breakfast were pretty good, too.
I'm wondering if the observation policy has always been in effect with Medicare Part A not paying the bill. Or did it start in the 3 years since your Hospital Stay.
I'm wondering if the observation policy has always been in effect with Medicare Part A not paying the bill. Or did it start in the 3 years since your Hospital Stay.
No, Part B has always paid for observation. You should be fine - and whomever got you all riled up should be fired. Beyond stupid they don't know Part B covers observation/outpatient. Not so sure about ambulance transport - my sister had ambulance services a number of times between nursing home/hospital, Medicare always paid.
No, Part B has always paid for observation. You should be fine - and whomever got you all riled up should be fired. Beyond stupid they don't know Part B covers observation/outpatient. Not so sure about ambulance transport - my sister had ambulance services a number of times between nursing home/hospital, Medicare always paid.
IME as well. My dad was admitted several times for "observation". Medicare Part B covered it. His Medigap picked up charges Medicare didn't. Don't recall the exact percentage details.
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