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Old 08-29-2015, 10:34 PM
Location: Chesapeake Bay
6,047 posts, read 4,220,146 times
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Originally Posted by utsci View Post
Sorry, I should have stated it differently. Medicare has a set fee that they pay doctors depending on the codes that are billed. Medicare pays the doctor 80% of that stated allowable fee and the patient is responsible for the remaining 20%, That's where your supplement comes in. The supplement pays the other 20% (sometimes) of the bill or close to it. So between Medicare, the supplement, and sometimes the patient the doctor collect the whole 100% of the Medicare allowable fee.

And see it from the doctor's business office perspective...you are seen and they bill Medicare. Medicare pays 80%. The business office then bills your supplement. They pay their portion. Then if there is anything left unpaid the business office bills the patient.

A lot of work for a very small return. It doesn't excuse treating patients differently depending on their insurance. But just try to think of all the work that goes into the business of medicine after the clinical work is done.
Actually, Medicare pays more than you might think.

Sometimes the bills/statements are unfollowable but others are straight forward. I had a CAT scan last Dec, the entire bill was a mass of numbers, none of which made any sense, but the bottom line was a balance due of zero. I looked at it 2-3 times, put in the drawer, forgot about it.

The second bill was from my doctor (when we reviewed the results of the scan) in Jan, had only one line with several columns. Those columns included amount billed, allowable, paid, suppl pay, etc. The end result was that the doctor received (in total) about 70% of what he originally billed.

I don't know how that final payment would work out if I were in a private health insurance plan rather than being on Medicare. Likely less than the original billed amount though.

BTW, in some Medicare plans the patient does not pay unpaid balances left over (balance billing).
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Old 08-31-2015, 09:41 PM
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No; because its Medicare who determines payment allowed and what patient can be charge for their part. Basically the pricing is cheap compared to what private allows which means private subsidies Medicare.
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