When the bills feel like fraud

[Cida]

Originally Posted by reed303

My favorite (not) story needs another category. Maybe the ghost or virtual doc visit.

When my wife passed away in the hospital (kidney failure), I got a bill later from a doc I never heard of. The date of service was given as the day after she passed. And no specific procedure, just patient visitation or some such.

I mailed the bill back with copy of the death cert with the date and time circled. Never heard another word..

Interesting, but I wish you had sent on a copy to the boards that regulate hospitals and doctor licensing.

[cb at sea]

Hubby is on dialysis...we do hero-dialysis at home. Medicare is charged $7400.00 PER TREATMENT that I, his wife, performs for every single treatment. (4 X's weekly) Medicare pays about $200 of the charge, supplemental pays a bit and those payments are ACCEPTED..... If they can ACCEPT $250, why don't they just CHARGE that?

[stepka]

I wonder every day why we are not rioting over this. And I also wonder why a big percentage of our population is so brain dead that they think this is all just fine.

[ComeCloser]

Medicare negotiates a fee schedule with every single provider. It's based on many factors, including location.

A physician or facility in Manhattan, New York is expensive. The real estate, taxes, and all overhead is more expensive, and they will usually get a higher negotiated rate than a physician or facility in a generally cheaper area. This is just one example.

Then there is the concept of subsidizing. This comes up when you ask the question, "well, if they accept $100 from Medicaid, why won't they accept $100 from me?" As an uninsured self-pay patient, it is assumed you are either undocumented, or well enough off that you don't feel a need to insure yourself. The high fee you pay out of your pocket helps subsidize the patient who is insured at a lower contracted rate, or completely indigent.

Why do doctor's agree to lower contracted rated plans? It helps get them patient's to treat. In many cases its a roll of the dice - as with capitation payments. A doctor gets $ 8.29 a month to be your PCP. Some people may be on his roster and see him once a year - if that. Others will need to see him as much as twice a week. Capitation is very profitable if the patient never goes to the doctor, and can be actually draining on a practice filled with patients that need constant maintenance.

Back to Medicare. I have a patient, and Medicare pays 80% of my reduced contracted rate. I cant see Medicare patients if I wont negotiate a deal with CMS. For most doctors, unless they are truly gifted geniuses of their field, refusing to negotiate is cutting my own throat, so I do.

My patient cries that they don't have a supplemental insurance, to pay the 20% of this already reduced fee that Medicare says is the patient's responsibility. I feel bad so I don't charge the patient. Word gets around that the nice doctor isn't charging the obligatory 20%, CMS gets wind of it, and guess what happens?

My profile's contracted rate gets lowered again. It is assumed if I'm not charging the 20% then I don't mind getting paid even less.

And all I have typed is just the tip of the iceberg of what constitutes a full answer to your question.