Medicare Charges

[marko]

This may have been covered once before but I have a question on a Medicare charge.

My statement says:
Amount facility charged: $6641
Medicare approved amount: $6641
Amount Medicare paid: $482
Maximum you may be billed: $323

So, what happened to the $6642 minus $482? I get that I have to pay the $323, but I can't figure out the rest of it. I know I'm bad at math, but.....

 

[wmc1000]

Simply means that the facility writes off the difference.

 

[marko]

Simply means that the facility writes off the difference.

So for my slip and fall, I got 2 CT scans, 3 Xrays, an EKG and 5 hours in the ER etc for a total of $802?

 

[Happyras]

Yeah, but if you bought a Plan G, it would be $0

 

[Happyras]

While we are on the subject, I find it really messed up that Medicare does not cover annual physical exams and blood panel work. BUT...if they code it correctly it can be covered. I would like to know what others do for annual check ups to get it covered, or blood panels in addition to Lipid tests, which pre-Medicare, were routine?

 

[MichaelB]

This may have been covered once before but I have a question on a Medicare charge.

My statement says:
Amount facility charged: $6641
Medicare approved amount: $6641
Amount Medicare paid: $482
Maximum you may be billed: $323

So, what happened to the $6642 minus $482? I get that I have to pay the $323, but I can't figure out the rest of it. I know I'm bad at math, but.....

The provider has a price agreement with Medicare for this procedure, yet they went ahead and billed a higher price. So, the question is not what happened with the difference, it’s why the provider billed an incorrect price.

 

[teej1985]

Was this your first Medicare claim of the year? Does it include the part b deductible? otherwise it make no sense why you are getting billed more than 20%

 

[marko]

Was this your first Medicare claim of the year? Does it include the part b deductible? otherwise it make no sense why you are getting billed more than 20%

It might have been. I don't pay that much attention but found the discrepancy/numbers interesting.

 

[audreyh1]

While we are on the subject, I find it really messed up that Medicare does not cover annual physical exams and blood panel work. BUT...if they code it correctly it can be covered. I would like to know what others do for annual check ups to get it covered, or blood panels in addition to Lipid tests, which pre-Medicare, were routine?

I suspect our PCP simply codes that she is monitoring certain ongoing conditions, and due to that annual bloodwork is required. I think they know very well how to play the coding game.

 

[teej1985]

It might have been. I don't pay that much attention but found the discrepancy/numbers interesting.

It must have been. There's no other reason you would be charged that much after Medicare paid.

 

[Dash man]

This may have been covered once before but I have a question on a Medicare charge.



My statement says:

Amount facility charged: $6641

Medicare approved amount: $6641

Amount Medicare paid: $482

Maximum you may be billed: $323



So, what happened to the $6642 minus $482? I get that I have to pay the $323, but I can't figure out the rest of it. I know I'm bad at math, but.....

Which Medicare supplement/Advantage plan are you on?

 

[Telly]

This may have been covered once before but I have a question on a Medicare charge.

My statement says:
Amount facility charged: $6641
Medicare approved amount: $6641
Amount Medicare paid: $482
Maximum you may be billed: $323

So, what happened to the $6642 minus $482? I get that I have to pay the $323, but I can't figure out the rest of it. I know I'm bad at math, but.....

Unlike any Medicare notification I have ever received! It doesn't make sense to me

What I get, as a simple example:
Facility charges their rack rate, say $2,000.
Medicare approved amount, say it's $1,000.
If my deductible has previously been met, Amount Medicare paid: $800
Maximum you may be billed: $200.

Then it's sent on to my Medigap insurer.

I always see the Medicare Approved amount to be significantly less than the provider's rack rate. And Medicare then works from their approved amount. If I have NOT reached my deductible, the Medicare Approved amount would still be $1,000 in my example above, but the Medicare paid amount would be less to take into account any unmet deductible.

 

[youbet]

Unlike any Medicare notification I have ever received! It doesn't make sense to me

What I get, as a simple example:
Facility charges their rack rate, say $2,000.
Medicare approved amount, say it's $1,000.
If my deductible has previously been met, Amount Medicare paid: $800
Maximum you may be billed: $200.

Then it's sent on to my Medigap insurer.

I always see the Medicare Approved amount to be significantly less than the provider's rack rate. And Medicare then works from their approved amount. If I have NOT reached my deductible, the Medicare Approved amount would still be $1,000 in my example above, but the Medicare paid amount would be less to take into account any unmet deductible.

Agree Telly. I was about to type the same thing then noticed you already did the job. The numbers OP gave just make no sense. I agree that your example is how it works.

 

[marko]

Which Medicare supplement/Advantage plan are you on?

Unlike any Medicare notification I have ever received! It doesn't make sense to me

What I get, as a simple example:
Facility charges their rack rate, say $2,000.
Medicare approved amount, say it's $1,000.
If my deductible has previously been met, Amount Medicare paid: $800
Maximum you may be billed: $200.

Then it's sent on to my Medigap insurer.

I always see the Medicare Approved amount to be significantly less than the provider's rack rate. And Medicare then works from their approved amount. If I have NOT reached my deductible, the Medicare Approved amount would still be $1,000 in my example above, but the Medicare paid amount would be less to take into account any unmet deductible.

Thanks to all for the replies. But my actual question is not about how much I'm paying but about the discrepancy in how the notice has been calculated.

How did the "Medicare approved amount" of $6641 turn into "Amount Medicare paid" $482? How did they approve an amount and then pay only a fraction of that and everybody's happy?

What's the point in 'shopping for medical' and 'knowing the cost beforehand' if the numbers are all fake?

 

[braumeister]

When I've received that sort of thing there are always some explanatory "Notes" underneath the lines showing bills/payments. Those notes are not always self-explanatory, but they should give you a clue. Are there such notes?

 

[marko]

When I've received that sort of thing there are always some explanatory "Notes" underneath the lines showing bills/payments. Those notes are not always self-explanatory, but they should give you a clue. Are there such notes?

The notes say:
"E" The amount Medicare paid the provider for this claim is $482.44
"F" This information is being sent to BCBS...send any questions regarding your benefits to them.

Maybe BCBS is going to pick up the rest? Just don't understand how MC can "approve" an amount and then pay a fraction of it.

 

[braumeister]

I've never received a Medicare notice with missing notes like that. What happened to A through D?
Certainly something wrong there, I would think.

 

[Dash man]

Thanks to all for the replies. But my actual question is not about how much I'm paying but about the discrepancy in how the notice has been calculated.

How did the "Medicare approved amount" of $6641 turn into "Amount Medicare paid" $482? How did they approve an amount and then pay only a fraction of that and everybody's happy?

What's the point in 'shopping for medical' and 'knowing the cost beforehand' if the numbers are all fake?

The $6641 is meaningless to you because Medicare decides what amount is paid for a service. The doctor or hospital can charge what they want, but they agree to accept Medicare rates.

$482 + $323 = $805
Part B deductible = $203
$805 - $203= $602
$602 x 80%=$481.60 Medicare pays
$602 x 20% = $120.44
$203 deductible + 120.44 = $323.44 you owe.

If you have Medigap coverage the $323.44 will be sent to the insurance company.

 

[CRLLS]

I've almost always seen the Medicare "approved" amount being less than the "billed" amount The amount Medicare actually pays is 80% of the approved amount. Once that is determined, Medicare sends that info to the Medigap insurance company. There, they determine what they will pay the provider based on the Medigap plan you chose, and pay the provider directly. I never pay a provider based on the Medicare statement "Amount you MAY have to pay" or the Medigap company's statement. Emphasis is on the word "MAY". Neither of these are an actual "bill". I wait until the provider sends me a bill. Usually, that is sent to me after both Medicare and the Medigap insurer has paid them. I have always checked and double checked all 3 statements for agreement before actually paying the provider. Sometimes matching them all up is challenging as the provider is sometimes noted as the physician's group name, sometimes the physician's name themselves and can vary from Medicare to Medigap and actual bill for the same service.

One other thing is that the online Medicare statements seem to be somewhat hit and miss about providing full information. Some pages show abbreviated info others show full detail. DW prints out her Medigap EOB's (?) so I can match them up later. I just noticed that her latest printout does not even have her name on it. It does show a place for amounts applied to deductible if applicable.

 

[travelover]

The $6641 is meaningless to you because Medicare decides what amount is paid for a service. The doctor or hospital can charge what they want, but they agree to accept Medicare rates.

$482 + $323 = $805
Part B deductible = $203
$805 - $203= $602
$602 x 80%=$481.60 Medicare pays
$602 x 20% = $120.44
$203 deductible + 120.44 = $323.44 you owe.

If you have Medigap coverage the $323.44 will be sent to the insurance company.

Excellent explanation. Wouldn't it be nice if the statement was this clear?

 

[marko]

The $6641 is meaningless to you because Medicare decides what amount is paid for a service. The doctor or hospital can charge what they want, but they agree to accept Medicare rates.

$482 + $323 = $805
Part B deductible = $203
$805 - $203= $602
$602 x 80%=$481.60 Medicare pays
$602 x 20% = $120.44
$203 deductible + 120.44 = $323.44 you owe.

If you have Medigap coverage the $323.44 will be sent to the insurance company.

Ah! Thanks.

 

[Calico]

The $6641 is meaningless to you because Medicare decides what amount is paid for a service. The doctor or hospital can charge what they want, but they agree to accept Medicare rates.

$482 + $323 = $805
Part B deductible = $203
$805 - $203= $602
$602 x 80%=$481.60 Medicare pays
$602 x 20% = $120.44
$203 deductible + 120.44 = $323.44 you owe.

If you have Medigap coverage the $323.44 will be sent to the insurance company.

Wow - I'm seriously impressed! I tried to solve that "puzzle" but couldn't do it!

Also - is there any chance you are available for virtual consulting if I ever get a confusing statement/bill now that I'm on Medicare? (Although I doubt I could afford your rates!)

 

[Dash man]

Wow - I'm seriously impressed! I tried to solve that "puzzle" but couldn't do it!



Also - is there any chance you are available for virtual consulting if I ever get a confusing statement/bill now that I'm on Medicare? (Although I doubt I could afford your rates!)

Funny you mention that. I recently saw a post by stedmakr about how they volunteer as Medicare Counselors. I found how to apply in my county and am considering it. I need to get past a medical issue first.

 

[Calico]

Funny you mention that. I recently saw a post by stedmakr about how they volunteer as Medicare Counselors. I found how to apply in my county and am considering it. I need to get past a medical issue first.

I hope you have a quick recovery from the medical issue.

If you do volunteer you would be great at the job!