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Related: Culture Forums, Support ForumsThis is why no one understands medical billing
I recently had a diagnostic mammograma little fancier that a regular mammogram. I have a Medicare advantage plan. The mammogram resulted in:
A bill from the hospital for $33.25.
A check from the hospital for $15.00.
A Visa gift card from the insurance company for $50.
I have no idea why any of this happened. The mammogram was fine.
Rorey
(8,445 posts)I saw that offer of a Visa gift card. I guess I should get around to making an appointment. I just hate mammograms so much that it's hard to motivate myself, even though I know I should.
doc03
(35,148 posts)are always something like hospital billed $5000 - $3000 contract agreement - $1500 discounts. Insurance paid $450
you responsibility $40. Who pays the $5000 they billed in the first place, anyone?
lark
(23,003 posts)They overbill the price because 1 insurance co. will pay more and they can't bill differing rates for the same procedure. They just w/o the difference, they never expected to collect it from most of the companies anyway. It's really stupid but dumb laws drive dumb practices and the legislators writing the laws know nothing at all.
yellowdogintexas
(22,114 posts)We are so screwed until we are all on the same plan (whatever the hell it is) and things are consistent across the board.
It. Is. Insane.
Except for original Medicare It is very straightforward. Once you get past actually getting set up it's good
I have original Part B and a MedSup.
yellowdogintexas
(22,114 posts)the billed amount and the allowable. This helps offset unpaid bills by the uninsured or those with inadequate coverage. These writeoffs result in significant tax exemptions for the facilities and physicians.
Remember the $100 aspirins? Same thing.
All participants in a given plan have contracts with every insurance company that they are willing to work with. The contracts establish the allowable charge for any particular service the patient may receive.
Medicare is a total failure in these situations, because you have to divest yourself of any assets five years prior to the actual need for government funding of long term care.
Response to yellowdogintexas (Reply #8)
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ret5hd
(20,433 posts)and I got a separate bill for:
1) Vehicle Relocation Fee
(move vehicle from lot to rack)
$50 Pay to Steves Relocation, Inc
2) Fluid Removal Fee
(drain used oil)
$123 Pay to Mikes Fluid Removal Service, Inc
3) Fluid Installation Fee
(fill with new oil)
$1,537.50 Pay to Mikes Flyid Installation Service, Inc
etc etc etc
How long would we accept this???
But we have NO choice.
lark
(23,003 posts)We did get a copay reduction this year, but there was an included increase on some pharmacy costs. Luckily it won't affect me because I only take a blood pressure pill regularly. I have a Medicare Advantage plan. Oh, I forgot, I did get an increase in my dental coverage, they sent me a $300 card to pay for dental and vision out of pocket expenses. That was a 30% increase over last years' coverage and was much needed! Money back or gift cards - nah, not here anyway.
Pobeka
(4,999 posts)What is still hidden is the actual cost for the mamograph -- equipment depreciation, lab space, personel etc.
Glad your mamogram turned out good!
yellowdogintexas
(22,114 posts)no deductible and no copay for a routine screening mammogram
If your mammogram is for deeper examination it has to be processed according to contract and you get all those ancillary bills.
I will never in my life figure out why we keep getting refunds from our providers!!!
I pretty much think it is bad bookeeping
lark
(23,003 posts)I was over the Quality Control group and we had two billing systems during the 20 years I worked there. When I first started, the billing error rate was amazingly about 55% - outrageous! I implemented a bunch of steps, working with the Practice Administrators, and we got it down to around 22%. It would have been lower but every new release of the billing software always had new problems which we had to work through and that happened about every other year.
I'm seeing it now as a patient, my payments not applied to the right date of service or to the right person, creating credits and debits and I get a statement only showing the debits as due when the balance is actually zero. The rehab center I was going to is fantastic, their therapists are the bomb and they have a great facility - but the billing wasn't great and I had to call them 4 times regarding already paid visits they were billing me for. Every time it was their error. Sheesh!