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Old Yesterday, 04:00 PM
 
4,926 posts, read 2,389,923 times
Reputation: 5810

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Quote:
Originally Posted by BBCjunkie View Post
"Fine" is relative.

When I had to self-pay for all my cancer treatment not too many years ago, I was usually able to get providers to agree to charge me the Medicare rate if I paid in full at the time of treatment. The bill would first be generated at the market rate/self-pay amount, and then the provider would issue a second, modified statement showing the amount of the discount so that my bottom line equalled what they would have gotten from Medicare if I'd had that coverage.

I still have my paperwork from that period of time and just looked up a few examples. These are from 2010-2012:

Vascular surgeon's fee for inserting chemo-port: self pay $2600, Medicare rate $1500
Breast cancer surgeon's fee: self pay $18K, Medicare rate $11K
Radiology office fee for MUGA heart scan: self pay $1200, Medicare rate $500
Oncologist's fee for 'chair time' only (not including any drugs administered): self pay $325/hour, Medicare rate $150/hour
Chemo-port flush: self pay $85, Medicare rate $50
Radiology offcce fee for whole-body PET/CT scan: self pay $3400, Medicare rate $1471
Radiology office fee for MRI scan of liver:self pay $1700, Medicare rate $808
Radiology office fee for lower back MRI: self pay $900, Medicare rate $500

Now, I've no idea what they would have gotten from Medicaid versus Medicare but what they offered was the Medicare rate and as the saying goes, beggars can't be choosers.

None of the testing labs (Quest, LabCorp, etc) would offer any discount whatsoever. Their self pay rate is what they charge if you don't have insurance. Period. No discussion or negotation allowed. They were the only type of provider who was never willing to give any sort of discount.

There was one instance when I did get the Medicaid rate and it's a story worth telling:

After my surgery I was getting bills left, right and center from anyone who was involved in the hospital stay. One was a bill from a "physicians assistant in the operating room" for -- get this: $8000! I didn't pay my actual SURGEON much more than that!! I thought it must be a mistake, maybe they used one too many zeroes?!? The billing was handled by some offshore billing firm so you can imagine the phone calls that ensued for MONTHS on end in my attempt to negotiate the amount. I finally got the name of someone on this (USA) side of the ocean who was connected with the billing (by this time the PA's company - this was a person I had no idea was even in the OR and never met before, during or after - was threatening me with a collection agency if I didn't pay up immediately.) She listened to my tale of woe and said in view of the runaround I had been put through by the offshore billing company, she would send me an adjusted bill at the Medicaid rate for that service which would be - ready for this? $745.

Needless to say, I paid it asap. But from $8000 to $745 was mindboggling. And yes their "retail"/self pay fee for someone standing around handing the surgeon instruments or whatever, was actually $8K. It wasn't a mistake or typo! Makes one wonder what insurance companies were paying for that.....or other self pay patients...
This is exactly what most people don't understand, Those with insurance pay premium to help those with Medicare or Medicaid. I'm all for helping those less fortunate - but I've seen so much abuse of the compensation and Medicaid system in my years in Medicine so it's frustrating to see these large copays, deductibles and out of pockets now.
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Old Yesterday, 04:24 PM
 
29,998 posts, read 35,090,257 times
Reputation: 11907
Quote:
Originally Posted by GeoffD View Post
The Social Security program is pretty much cash flow neutral right now. There is absolutely no reason to hike payroll taxes today since the money will merely get "borrowed" and spent as general funds. It's totally reasonable that corporate America and the affluent people who own the stock are fighting any tax hike and advocating mass cuts in the program. They pay 50% of it. Every extra dollar they pay in payroll taxes is a dollar less profit.


Personally, I think the Social Security tax rate should be changed to make it variable. Keep the program cash flow neutral. In 2020, it might need to go from 6.2% to 6.3%. Stop the whole charade of "Trust Fund". That money was spent years ago.
Did you see the WH is/isn't toying with the idea of a payroll tax reduction. Perhaps short term to help the economy if at all. There are reports they are considering and denials they are per CNBC.

https://www.cnbc.com/2019/08/19/trum...l-tax-cut.html
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Old Yesterday, 06:09 PM
 
11,080 posts, read 9,466,881 times
Reputation: 6784
Your last line could be taken a couple of ways. The boomers with no assets may (or will have to) keep working. I do believe a significant percentage of boomers at or above retirement age have little or negative net worth. At some point they'll age out of being able to work.

Quote:
Originally Posted by RationalExpectations View Post
I'm not so sure the original premise is particularly reliable. I'm sure there are many who are ill-prepared, financially, and of course they will have many financial difficulties. At the same time, I don't believe there is a large swath of boomers attempting to retire with little or no assets.
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Old Yesterday, 06:18 PM
 
11,080 posts, read 9,466,881 times
Reputation: 6784
So they're talking about either raising taxes or cutting benefits. That's what's going to have to happen.

But here's the kicker. That article still adheres the fallacy that there is a Social Security Trust Fund that can be drawn from to pay benefits. Everything they talk about is how to extend the amount of time before that is exhausted. I'll let you in on a little (well, actually HUUUUGGGGGGEEEEEE) secret. The SS Trust Fund, as an external store of assets which the government as a whole can draw from to pay SS benefits, doesn't exist. The only assets in it are US Treasury securities. Have you looked at the federal budget deficit lately (hint, it's huge and growing.) If the Treasury has to come up with this money to float SS benefits, where is it going to come from?

Quote:
Originally Posted by nicet4 View Post
From The Motley Fool

The No-Nonsense Way to Save Social Security
No frills here. Just a simple solution right under the noses of lawmakers that would fix Social Security for 75 years.




That is a total 2.66% which, when split between the employee and employer, comes to just 1.33% which works out to less than $14 extra in payroll taxes per week.

What I find amazing is the number of people crying over the demise of private pensions but the thought of a couple extra bucks to social security is unthinkable.
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Old Today, 05:47 AM
 
Location: Fort Lauderdale, FL
689 posts, read 183,696 times
Reputation: 1105
Arrow Supplemental Security Income (SSI)

Nobody has mentioned Supplemental Security Income (SSI).

https://www.ssa.gov/ssi/text-over-ussi.htm

SSI is a Federal income supplement program for elderly people who have not earned enough work credits to qualify for regular Social Security. To qualify for monthly SSI payments you must be: 65 or older, blind or disabled; a U.S. citizen or lawful resident; and have very limited income and financial resources.

The Social Security Administration also runs this program, but it is funded by general tax revenue of the U.S. Treasury.
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Old Today, 06:31 AM
 
1,789 posts, read 650,887 times
Reputation: 1906
Quote:
Originally Posted by BBCjunkie View Post
"Fine" is relative.

When I had to self-pay for all my cancer treatment not too many years ago, I was usually able to get providers to agree to charge me the Medicare rate if I paid in full at the time of treatment. The bill would first be generated at the market rate/self-pay amount, and then the provider would issue a second, modified statement showing the amount of the discount so that my bottom line equalled what they would have gotten from Medicare if I'd had that coverage.

I still have my paperwork from that period of time and just looked up a few examples. These are from 2010-2012:

Vascular surgeon's fee for inserting chemo-port: self pay $2600, Medicare rate $1500
Breast cancer surgeon's fee: self pay $18K, Medicare rate $11K
Radiology office fee for MUGA heart scan: self pay $1200, Medicare rate $500
Oncologist's fee for 'chair time' only (not including any drugs administered): self pay $325/hour, Medicare rate $150/hour
Chemo-port flush: self pay $85, Medicare rate $50
Radiology offcce fee for whole-body PET/CT scan: self pay $3400, Medicare rate $1471
Radiology office fee for MRI scan of liver:self pay $1700, Medicare rate $808
Radiology office fee for lower back MRI: self pay $900, Medicare rate $500

Now, I've no idea what they would have gotten from Medicaid versus Medicare but what they offered was the Medicare rate and as the saying goes, beggars can't be choosers.

None of the testing labs (Quest, LabCorp, etc) would offer any discount whatsoever. Their self pay rate is what they charge if you don't have insurance. Period. No discussion or negotation allowed. They were the only type of provider who was never willing to give any sort of discount.

There was one instance when I did get the Medicaid rate and it's a story worth telling:

After my surgery I was getting bills left, right and center from anyone who was involved in the hospital stay. One was a bill from a "physicians assistant in the operating room" for -- get this: $8000! I didn't pay my actual SURGEON much more than that!! I thought it must be a mistake, maybe they used one too many zeroes?!? The billing was handled by some offshore billing firm so you can imagine the phone calls that ensued for MONTHS on end in my attempt to negotiate the amount. I finally got the name of someone on this (USA) side of the ocean who was connected with the billing (by this time the PA's company - this was a person I had no idea was even in the OR and never met before, during or after - was threatening me with a collection agency if I didn't pay up immediately.) She listened to my tale of woe and said in view of the runaround I had been put through by the offshore billing company, she would send me an adjusted bill at the Medicaid rate for that service which would be - ready for this? $745.

Needless to say, I paid it asap. But from $8000 to $745 was mindboggling. And yes their "retail"/self pay fee for someone standing around handing the surgeon instruments or whatever, was actually $8K. It wasn't a mistake or typo! Makes one wonder what insurance companies were paying for that.....or other self pay patients...



Very distressing story. Why did you have to self-pay for all your cancer treatment? Did you not have insurance? Or did you for some reason have to get the entire treatment outside of your insurance network?


Incidentally, PAs do not stand around handing the surgeon instruments (those are OR techs, who are paid very little), but actually do routine parts of surgery, ie, they do cut and stitch (in addition to helping the surgeon with the exposure), and therefore have to be fully proficient in anatomy and surgical technique. For a number of things that surgeons do, you need more than two hands at the same time, and surgeons cannot grow additional hands. PAs also do routine parts of preop workup and postop follow up, and generally in non-teaching hospitals function in various ways in which surgical residents (ie, surgeons in training) function in teaching hospitals. The only things they don't do is make critical treatment decisions, for which only a physician can be legally responsible (eg, in case of breast cancer they cannot decide where exactly to cut and how much to cut, but they surely can do the cutting under the surgeon's direction). That PA probably closed your skin incision, placed the drains and bandages, which took at least 30 min, while the surgeon was out of the OR, starting the next surgery on someone else with a different PA. In some types of surgeries that are highly routinized (eg, joint replacements in orthopedics), PAs tend to actually do more than half of the surgery - the surgeon places the prosthesis, makes sure that it is well seated, and leaves the OR for the next case, while the PAs (often more than one) put everything else back together.

Last edited by elnrgby; Today at 06:39 AM..
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Old Today, 06:48 AM
 
Location: USA
136 posts, read 16,808 times
Reputation: 145
Stagnant wages.. hubby hasn't had a true raise aside from COL increases in many many years. He loves the company and didn't want to leave, has worked there since high school and rose up. I know, his choice to stay. They also have a 401K program but to me those are failures, unless you are doing really well and can afford to put into them more than minimally. Companies not offering pensions is the problem. Paying bills, maintaining good credit, family responsibilities, dealing with what life throws at you financially its entirely possible people don't have enough to retire. Its not all about irresponsibility. You can be very conscientious trying to make it and come up short for your later years. My husband's plan would of been to keep on working. Fortunately that won't be necessary because of my own situation. We won't live high on the hog in retirement but we'll be OK. I know a number of people that were hard working all their lives and won't be able to retire because their companies didn't offer pensions and they lacked the funds (not from wasting money) to save much of anything themselves.
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Old Today, 09:22 AM
 
Location: North East
88 posts, read 21,148 times
Reputation: 230
Quote:
Originally Posted by coffeemoments View Post
Stagnant wages.. hubby hasn't had a true raise aside from COL increases in many many years. He loves the company and didn't want to leave, has worked there since high school and rose up. I know, his choice to stay. They also have a 401K program but to me those are failures, unless you are doing really well and can afford to put into them more than minimally. Companies not offering pensions is the problem. Paying bills, maintaining good credit, family responsibilities, dealing with what life throws at you financially its entirely possible people don't have enough to retire. Its not all about irresponsibility. You can be very conscientious trying to make it and come up short for your later years. My husband's plan would of been to keep on working. Fortunately that won't be necessary because of my own situation. We won't live high on the hog in retirement but we'll be OK. I know a number of people that were hard working all their lives and won't be able to retire because their companies didn't offer pensions and they lacked the funds (not from wasting money) to save much of anything themselves.

UUhhmmm.....

"They also have a 401K program but to me those are failures, unless you are doing really well and can afford to put into them more than minimally. Companies not offering pensions is the problem."

Wait, you took a career path that had no pension, but offered a 401 plan, yet you didn't invest in it??? The problem wasn't the lack of pension but the choice not to fund your own retirement.
Here go to this site and see what you could have had if you payed yourself first.

https://smartasset.com/retirement/40...tor#Jva69V6i7F
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Old Today, 09:38 AM
 
Location: USA
136 posts, read 16,808 times
Reputation: 145
Quote:
Originally Posted by homestead123 View Post
UUhhmmm.....

"They also have a 401K program but to me those are failures, unless you are doing really well and can afford to put into them more than minimally. Companies not offering pensions is the problem."

Wait, you took a career path that had no pension, but offered a 401 plan, yet you didn't invest in it??? The problem wasn't the lack of pension but the choice not to fund your own retirement.
Here go to this site and see what you could have had if you payed yourself first.

https://smartasset.com/retirement/40...tor#Jva69V6i7F

First off, it wasn't me it was my husband that had the 401K. And I don't think you read my post very well. I listed the reasons why it was difficult to contribute to it. Sure he could of put money into it but then bills and responsibilities would suffer. Sometimes there isn't enough to manage both *today* and putting aside for tomorrow. That may not be your reality but that is reality for a lot of people. He took almost no vacations in all the years he worked there. Vacation days were for emergencies only primarily. Years of no vacations or vacations days at all. Tons of overtime (unpaid). His company didn't offer a pension. When he retires they won't have to pay much at all.
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Old Today, 09:51 AM
 
29,998 posts, read 35,090,257 times
Reputation: 11907
Quote:
Originally Posted by coffeemoments View Post
First off, it wasn't me it was my husband that had the 401K. And I don't think you read my post very well. I listed the reasons why it was difficult to contribute to it. Sure he could of put money into it but then bills and responsibilities would suffer. Sometimes there isn't enough to manage both *today* and putting aside for tomorrow. That may not be your reality but that is reality for a lot of people. He took almost no vacations in all the years he worked there. Vacation days were for emergencies only primarily. Years of no vacations or vacations days at all. Tons of overtime (unpaid). His company didn't offer a pension. When he retires they won't have to pay much at all.
Unfortunately that is the norm for many. Not enough is just that not enough. Many of the reports that get translated into articles by someone other than those who write the report are trying to make that point. Obviously they know when they say that in order to have x amount saved in retirement and to do so you need to save Y amount monthly is beyond the ability of millions.
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