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Thread: Medicare day!

  1. #11
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    Did you never pay Medicare taxes IL? It is a contributory program.

  2. #12
    Senior Member iris lilies's Avatar
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    Quote Originally Posted by Yppej View Post
    Did you never pay Medicare taxes IL? It is a contributory program.
    Oh you mean, I paid in and now Iím getting mine? Well OK.

  3. #13
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    Reimbursement rates by Medicare may be a matter of some interest. Hospitals and physicians who accept Medicare assignment "cannot charge you more than the Medicare Approved Amount".

    The long-term economic viability of providers who accept Medicare assignment can be questioned if the level of reimbursement is lower than "cost".

    I am acquainted with a 70-ish woman who had a total knee replacement in March of 2019. The L*** Medical Center charged $12,252 for this procedure, which involved staying one night in the hospital, plus preparation for surgery, anesthesia, an artificial knee joint, the surgery, plus a day of recovery in a private room. Medicare approved $175.50 ... Seriously?

    I do not know how Medicare determined the approved amount. But the Sheraton Hotel in Duluth on a MONDAY night charges $183 (with no surgery going on!).

  4. #14
    Senior Member jp1's Avatar
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    Quote Originally Posted by dado potato View Post
    Reimbursement rates by Medicare may be a matter of some interest. Hospitals and physicians who accept Medicare assignment "cannot charge you more than the Medicare Approved Amount".

    The long-term economic viability of providers who accept Medicare assignment can be questioned if the level of reimbursement is lower than "cost".

    I am acquainted with a 70-ish woman who had a total knee replacement in March of 2019. The L*** Medical Center charged $12,252 for this procedure, which involved staying one night in the hospital, plus preparation for surgery, anesthesia, an artificial knee joint, the surgery, plus a day of recovery in a private room. Medicare approved $175.50 ... Seriously?

    I do not know how Medicare determined the approved amount. But the Sheraton Hotel in Duluth on a MONDAY night charges $183 (with no surgery going on!).
    That obviously seems absurdly low. The $12k price sounded reasonable. A friend of mine had both knees replaced last year at a cost of around $40k apiece at the Hospital for Special Surgery in NYC. I don't know what the billed amount was, although I assume it was more, but reduced to $40k under my friend's insurance carrier's negotiated rates. Both times she had a nice room with a view of the East River.

  5. #15
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    Quote Originally Posted by dado potato View Post
    Reimbursement rates by Medicare may be a matter of some interest. Hospitals and physicians who accept Medicare assignment "cannot charge you more than the Medicare Approved Amount".

    The long-term economic viability of providers who accept Medicare assignment can be questioned if the level of reimbursement is lower than "cost".

    I am acquainted with a 70-ish woman who had a total knee replacement in March of 2019. The L*** Medical Center charged $12,252 for this procedure, which involved staying one night in the hospital, plus preparation for surgery, anesthesia, an artificial knee joint, the surgery, plus a day of recovery in a private room. Medicare approved $175.50 ... Seriously?

    I do not know how Medicare determined the approved amount. But the Sheraton Hotel in Duluth on a MONDAY night charges $183 (with no surgery going on!).
    I question the EOB on this. Medicare has a flat rate reimbursement by DRG code for the procedure. Back when I was on that side (2001) the reimbursement was nearly $8k. Something is very wrong either with facility coding or her interpretation of the EOB.

  6. #16
    Senior Member catherine's Avatar
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    Quote Originally Posted by Gardnr View Post
    I question the EOB on this. Medicare has a flat rate reimbursement by DRG code for the procedure. Back when I was on that side (2001) the reimbursement was nearly $8k. Something is very wrong either with facility coding or her interpretation of the EOB.
    I agree. The $175.50 was probably what SHE had to pay (and even that sounds low unless she has a supplemental plan also). Medicare would have reimbursed the hospital whatever their standard charges were.
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  7. #17
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    Back in 2007 my MIL spent a month in intensive care after surgery and her supplement was so good that she didn’t pay anything. She was only 67 and was really sick after the surgery.

  8. #18
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    Quote Originally Posted by Teacher Terry View Post
    Back in 2007 my MIL spent a month in intensive care after surgery and her supplement was so good that she didn’t pay anything. She was only 67 and was really sick after the surgery.
    Mom had what was called Blue Cross Medigap. She had a monthly premium and never an OOP expense (out of pocket). It gave her peace of mind as she lived on a fixed income even though the premium was $168 (in 2007).

    I think these days they are called advantage plans. The advantage being you know exactly what your healthcare cost will be each month.

    Of course, Part D and meds are an additional expense.

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