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Thread: Another medicare thread

  1. #11
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    I’ve read that without the supplemental plan, Medicare has to stick to the contract limits for charges. So the rest of the bill goes to no one, as it’s not legal to hill the patient beyond the contracted Medicare rates. With the supplemental plan, it gives them one more place to bill. Supplemental plans benefit hospitals, but not patients.

    That’s the theory at least ...

  2. #12
    Senior Member catherine's Avatar
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    Quote Originally Posted by Tammy View Post
    I’ve read that without the supplemental plan, Medicare has to stick to the contract limits for charges. So the rest of the bill goes to no one, as it’s not legal to hill the patient beyond the contracted Medicare rates. With the supplemental plan, it gives them one more place to bill. Supplemental plans benefit hospitals, but not patients.

    That’s the theory at least ...
    Really.. I wasn't aware of that. The value of the supplemental plan is they cover the cost-sharing. Here's a rather sobering example:

    I have to say I was astounded, and not in a good way, yesterday when I was looking for a specific Medicare claim from a routine procedure my DH has every 6 months. It involves an endoscopy and a biopsy. It's an outpatient procedure and he's usually there for maybe 4 hours. I don't know why I wasn't aware of the cost before--I think it's because under our commercial plan the bills dribbled in from different places and I never really added it all up. But the Medicare claim consolidated everything and the cost of that biopsy is $59k!!!! I am absolutely horrified. I could see if this were some lifesaving treatment, but it's an elective biopsy!! And do you know what we paid for it?

    Zero.
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  3. #13
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    Of course - don’t act on what I said. I’m just repeating my father’s experience ...

  4. #14
    Senior Member iris lilies's Avatar
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    Quote Originally Posted by Tammy View Post
    I’ve read that without the supplemental plan, Medicare has to stick to the contract limits for charges. So the rest of the bill goes to no one, as it’s not legal to hill the patient beyond the contracted Medicare rates. With the supplemental plan, it gives them one more place to bill. Supplemental plans benefit hospitals, but not patients.

    That’s the theory at least ...
    Yet Medicare and Medicaid payments don’t cover hospital costs. So I guess they’re just supposed to eat that as well?

  5. #15
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    Yes. About 2/3 of our business at the hospital I worked at since 2010 was Medicare and Medicaid. It pays a much lower percentage of the bill than private insurance. That was one of our unique challenges as a public hospital.

    Interestingly, the biggest bills went to those with no insurance, who were self pay,

    People are not charged the same amount for identical services.

  6. #16
    Senior Member catherine's Avatar
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    Quote Originally Posted by Tammy View Post
    Yes. About 2/3 of our business at the hospital I worked at since 2010 was Medicare and Medicaid. It pays a much lower percentage of the bill than private insurance. That was one of our unique challenges as a public hospital.

    Interestingly, the biggest bills went to those with no insurance, who were self pay,

    People are not charged the same amount for identical services.
    All part of the wacky system. Did you ever read Steven Brill's analysis of hospital charges? It's really eye-opening.

    https://time.com/198/bitter-pill-why...re-killing-us/
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  7. #17
    Senior Member iris lilies's Avatar
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    Quote Originally Posted by Tammy View Post
    Yes. About 2/3 of our business at the hospital I worked at since 2010 was Medicare and Medicaid. It pays a much lower percentage of the bill than private insurance. That was one of our unique challenges as a public hospital.

    Interestingly, the biggest bills went to those with no insurance, who were self pay,

    People are not charged the same amount for identical services.
    But the hospital will settle at a much lower amount from those with no insurance. My friend regularly negotiates her large hospital bills down I can’t remember if she said she knocks off 1/3 or 2/3 but she gets them settled.She is a unique outlier who has Money and refuses to get insurance. Now she’s Medicare age though she did sign up for that because there is a penalty if you don’t.


    I don’t understand how your hospital continues to operate if it’s not meeting costs but whatever. I know rural hospitals here close up their doors. My rural hospital, about half a mile from where I live, is in the weekly newspaper regularly about finances. It’s the hospital for the entire county and it’s of importance and concern for residents of the county.
    Last edited by iris lilies; 11-13-20 at 11:43am.

  8. #18
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    Public hospitals get state money (property tax), federal money (grants and extra dollars for those on Medicare/Medicaid), hospital foundation support. Plus we don’t need to make a profit - just break even.

    And if we don’t meet quality measures we get less federal reimbursement. That’s always hanging over our head ...

  9. #19
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    And also - all those bigger dollars from the private plans make up some difference from the Medicaid Medicare losses.

    Charges are not the same as reimbursements are not the same as actual costs.

  10. #20
    Senior Member iris lilies's Avatar
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    Quote Originally Posted by Tammy View Post
    And also - all those bigger dollars from the private plans make up some difference from the Medicaid Medicare losses.

    Charges are not the same as reimbursements are not the same as actual costs.
    Yes all those bigger dollars from the private plans make up some difference for those of us who are on the public dole. It seems to me to be kind of a “ do your fair share” to have a supplemental plan unless you are destitute.

    But the bottom line for me is: I won’t go without a supplemental plan because I don’t believe that they won’t come after me for any costs. I don’t really know how that plays out so I’m not gonna test it.

    The small stuff like the cost of the supplemental plan is not what keeps me up at night. It’s a big cost that worries me. To that end I was just talking to our insurance guy yesterday to bump up our umbrella policy another million.

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