I was in the ER last month when I was found passed out in the shower...

[TreasonousBastard]

then went back to the ER the next night when I felt the same symptoms. They found my pulse and blood glucose way too high, but otherwise OK, and I was released in the mornings. Got an envelope from the hospital a couple of days later, but it was just a survey about how well they did. Just got the bill in the mail, though.

It was not itemized, just the total of $18,000 and change.

18 grand! You woulda thought I got a brake job on my Mercedes. But, it appears Medicare bargained that down to around 8 grand and paid about $7,000 of that.

So, from $18,000, I owe them a little over a thousand. Although grateful that I don't owe them the whole thing, the absurdity of it all astounds me.

[lapfog_1]

1. They jack up the bill

just because of the game they know is going to be played by Medicare and/or insurance companies.

Sorry you have to cover $1000 of it yourself...

How many tests did you have done? And they really owe you an itemized bill... just call them up and ask for it.

[GeorgeGist]

2. It's quite a racket ...

they've got going; with the government's blessing.

[calguy]

39. It's a racket to cheat on taxes

They know Medicare will pay only $7000. So they bill $15,000, knowing they'll only collect half. When they do taxes they'll claim $8,000 bad debt loss against the 7,000 collected. They also claim operating expenses against that bill. In other words, they show a huge loss as they drive around in those expensive cars on the way to the country club. Many rich doctors I've known brag about paying almost zero taxes.
There outa be a law......

[redstatebluegirl]

3. Do you have a medigap policy along with medicare?

I'm asking because I will be going on medicare this summer and am trying to decide what to do.

[Heartstrings]

5. Look into Medicare Advantage policies offered in your area.

I pay $185. per month (besides Medicare being deducted from my SS check). This may seem like a very high premium but I concentrated on what this policy would cover re; pharmaceuticals, emergency room, outpatient and inpatient hospital and skilled nursing days. Pay close attention to those, especially inpatient and SNF. I rest easier knowing I’m covered for those at close to or at 100% with no deductible or cap.

[Viz]

23. Medicare Advantage-just say NO!

Is the privatization of Medicare put into place by GW Bush and now expanded through the executive actions
of Trump. It is private insurance paid for by the Medicare system and if you find yourself with a serious
medical condition- these insurance companies do what they do best- DENY! Check out with a google search
for articles by Thom Hartmann and others. I personally know someone who was allowed to die because they
were Medicare Advantage instead of traditional Medicare.

[redstatebluegirl]

24. I have heard the same thing about that.

I don't have enough years in at my university to get retirement medical so I have to find something that will cover me. I have some preexisting conditions that terrify insurance companies. I am pretty sure I will need a medigap policy or I'll be screwed.

[True Blue American]

28. I have had Medicare Advantage for years.

No cost. My trip to the ER for what they thought was a stroke, but after extensive tests including brain it was found my Carpal Tunnel caused the block. Steroids, fixed it..

My cost $85.

[Blue_true]

57. My older brother also has Medicare Advantage.

He has had several hospitalizations, no complaints from him.

It seemed that my brother HAD to sign up for an advantage plan. But he did his homework and got a good one. I think many people go with local Medicare advantage plans and when they get sick, get screwed. My brother went to the Medicare.gov site to start and selected his plan from information he gleaned from there.

[Heartstrings]

27. I have "traditional" Medicare

and this coverage. I’ve worked for Blue Cross and WPS, read the fine print, and my policy is great....sorry about your friend and not sure what policy they had but I stand behind mine 100%.

[True Blue American]

30. Yes

The plans for your area are in the back of the Medicare book. Run from $0 for HMO to $70 for PPP.

Most Doctors are on the HMO list.

[Hoyt]

33. Pesky fact -- Part C was enacted by Clinton in 1997. Until 2003, it was called Medicare Plus Choice

It's name changed in 2003.

30+% of Medicare beneficiaries voluntarily choose Part C because it fits their needs better than traditional Medicare plus a supplemental.

[stopbush]

34. My Medicare Advantage plan is great.

See my post #32 below.

[pazzyanne]

35. So is mine.

[Blue_true]

58. People need to go the the Medicare.gov site instead of paying attention to mailers.

I am starting to get the mailers because of my age. My older brother got plenty of them, but selected his Advantage plan after visiting Medicare.gov and comparing the high rated plans.

[pazzyanne]

64. Great advice.

[yellowdogintexas]

51. yes you will be subject to all kinds of precertifications

and case management which flatly does not happen in Part B

Medicare Part B is not designed for profit. It never was. There is a small overhead built in to cover increase in operating expenses, raises, and other cost of doing business.

Part B has the fastest turnaround time, lowest cost per claim, lowest error percentages in the industry. It also has very high provider satisfaction (other than the negotiated rates) because they know that they will get that check every 2 weeks, it will be correct and require very few appeals. Most of those are due to coding errors or a dust up with eligibility.

We should all have access to it, should we want it. Every employer should offer it as the public option. If this happens, it should have a few modifications to balance it out for younger people.

Interesting bit of trivia: Childbirth can be covered by Medicare. I actually paid a childbirth claim The family was covered under SSI which has a long waiting period, but we covered that delivery. I didn't ever find out why they had SSI but there are a lot of diagnoses which will eventually qualify the patient and after another waiting period, the family.

[True Blue American]

53. I have never been turned down for anything.

And I have had some pretty expensive infusions, tests, etc.

My Family Doctor is $5 per visit.. Well being tests all free.

[Blue_true]

56. She is better off to go to the Medicare.gov site and review

5-star and 4-star plans. My brother did and he has no complaints after selecting a 4-star plan.

[stopdiggin]

8. you probably wany to do that

please don't take my word (I'm bumbling through this just like you) but pretty much everybody I've talked to says "Yes" you do want the extra coverage. A fairly modest monthly translates into almost worry free complete coverage. I won't try to guide you to specific resources (I trust you can manage to find them on your own) but if you do feel like you need help try your local library (librarians are ninja warriors!), the AARP, the senior center, and whatever your state has for "Health and Aging."

[True Blue American]

31. Medicare only pays80%.

[yellowdogintexas]

52. 80% of the negotiated rate, so if your $2000 bill is cut to $500

you only owe 20% of $500.

[Grasswire2]

10. medigap is the best way to go because..........

....the benefits are standardized by law and you know exactly what you are getting.

Advantage plans are often deliberately misleading/confusing with their marketing ploys.

The best medigap of all was Plan F, but I believe that is being phased out. Do some research on other medigap plans.

[llmart]

42. You are correct that Plan F is being phased out.

However, the next best thing is Plan G. It has absolutely everything that Plan F has/had except for Plan G has a deductible of $183 per year. Plan F had zero deductible. As far as I'm concerned, I can afford the Plan G deductible and everything else is completely covered 100%.

[still_one]

45. +++ you are right, and you have choice you don't have with an advantage plan. Problem is

Supplemental F is more expensive, and some feel they don't need thhe flexibility of it, or the higher premium cost

[csziggy]

54. I got the Plan F when I signed up for Medicare in 2017

Just in time for the MRI to show that I had a bad aortic valve. Then further tests while arranging to have that valve replaced showed a cancerous kidney. The two operations did not cost me a penny. The ACA BC/BS plan I'd been on had been denying the MRI for almost six months. If I'd been on that for a few years more, the bad valve would not have been diagnosed and I would have died of kidney cancer.

My husband got Plan G a few months earlier. He does not have the various health issues I do but is slightly older so we wanted (and could afford) Cadillac plans for us both.

We found out that if you buy the plans that are close to being discontinued as individuals and not part of a group (such as AARP or and organization) you are grandfathered in. As long as you pay your premiums and stay with the same company, they still provide you the same plans.

[Grasswire2]

61. good job!

I had plan F but had to drop it about 12 years ago. Very regrettable. You can only get back in if the insurer does a complete review of your health record and premiums are likely to be higher.

[csziggy]

63. I was sort of surprised they approved me for it

I'd already had eleven major operations since 2001 and was being checked out for the heart problem. A friend was selling Banker's Life (Connecticut Penn) and got me in.

I plan to keep this insurance since I will never be able to get another policy if pre-existing conditions are back to being excluded.

Sorry you lost your Plan F - it really is nice to have!

[erronis]

20. If you're eligible, the USAA Medigap plan is very good. Also check with Council On Aging

for general Medicare advice. https://www.n4a.org/healthinsurance

[TreasonousBastard]

22. Good Luck! I don't have a supplemental because the VA takes care of most of my expenses...

including drugs. So, I know little about other plans, but there seems to be some good advice in this thread.

My mother had a plan through AARP in her last days, and went through several "heroic" treatment stays but everything seems to have been covered. It can be done.

It's amazing that some people can be covered at little cost, while others suffer and die from lack of coverage. Some hate the idea of Obamacare, some think Medicare is than answer... Just stop arguing about the means and fix the damn system.

[redstatebluegirl]

25. I just wish they would make it easier. I'm not stupid but this system makes me feel that way.

[TreasonousBastard]

26. Personally, I'm terrified that the VA drops me for some reason...

like my income goes up or they change the rules.

I have absolutely no idea how to find basic services in the "open market". I have used non-VA specialists at times and Medicare came through, but it ain't always easy without "primary care".

[Blue_true]

55. Like my older brother did, when you get the notice from Medicare,

log onto your computer and go to the Medicare.gov site. Medicare rates insurance providers that work with it. My brother signed up with a four star provider and has not paid a cent after two or three hospitalizations.

I see people here complaining about Medicare healthcare and drug coverage and I wonder how much homework they did before signing up to a plan.

The long and short of it, if I use my brother as an example, do your homework and evaluate the 5 star and 4 star plans on Medicare.gov, it likely saves you headaches down the road.

[SWBTATTReg]

4. Yes, amazing how the money/bills can pile on so quickly. My 1 day stay costs over $24K, when I ...

had a similar blackout event (heart issue) occur in Sept., last year. I was dreading receiving the bill since then, and so far, the total cost to me was approximately +-$700. Split between my Gold Advantage plan (work, from retirement and medicare). I don't blame anyone dreading the bill(s) from an overnight stay...I'm covered but you really don't know what the final bill is going to be, that you'll have to cover. Scary.

[spanone]

7. Brake Job, you could have bought a Mercedes for that

[dmr]

9. Ouch!

I carry a secondary policy with Bankers Life to my Medicare. I am thankful for both.

Last June I had my right hip replaced, and was hospitalized for 5 days. Everything was covered. I paid nothing out of pocket. What a relief that was! I expected bill's to fly in from everybody and his brother, but it didn't happen.

Compare that to 2014, I was in the hospital for 11 days, and I'm still paying what Medicare didn't cover.

I have metastatic breast cancer, and go in every 28 days to the infusion clinic, and I have numerous PET scans, and monthly blood labs. Very costly, but with the added coverage, I am no longer racking up the out of pocket expenses. The relief is unimaginable. Of course, I pay around $350 monthly for the Medicare, Bankers Life, prescription coverage, and recently I added vision and dental coverage.

I wish you and all the best.

[Frustratedlady]

11. How good is the dental coverage? Vision?

I haven't explored them because I didn't want them emailing me every 5 minutes, but I do need the dental, if reasonable and good coverage for dentures.

[yellowdogintexas]

41. Regular Dental Plans (standalone) are very similar

to one another. Depending on premium, your routine exams may be free, or have a small charge. You may have a deductible on other dental work like fillings, extractions, root canals etc.

As a general rule, Routine cleaning etc, 1 set of xrays annually are low or no cost.
fillings are covered at 80%
and surgery (wisdom teeth, other extractions, root canals and crowns) are normally 50%. There will be a waiting period for anything other than routine care. In other words, don't take out the dental when you know you are going to have a big procedure done right away

Sometimes there is a negotiated rate, however be very thorough if you consider a Dental HMO or network. There usually are not many dentists who participate.

This type of dental coverage can be purchased by anyone; it is not exclusive for Medicare.

I have no experience with the dental plans that are part of Advantage plans, but all of the employer based group dental plans I have had are just like the one I described above, just have a much lower premium to the employee because the employer is picking up part of it. I seriously doubt that any dental plan is much different across the board; they seem to be fairly standardized.

[Frustratedlady]

50. Thanks for the information.

I'll look into them, but I doubt they will be much help with dentures. They are so expensive anymore, so I'm sure the coverage will be small.

Back in the mid-1950s, I worked for an oral surgeon and can't believe the difference in pricing today. If you can believe, it cost $8 to pull a tooth.

I suppose it's all relative.

[PennyK]

13. Me too!

And I don't pay a penny out of pocket.
How lucky was I to be diagnosed with breast cancer AFTER turning 65?
All treatments -- and I had chemo, radiation, mastectomy, and several complications -- were paid for.

[lunatica]

12. I have Medicare supplemental

Through United Healthcare which I found in AARP Medicare Supplemental plans.

I chose AARP Medical Supplemental Plan N. I pay around $120 a month for it. My co-payments are $20 per office visit and $50 per emergency room visit. Hospitalization is covered no matter how often you have to be in the hospital in a year.

AARP won’t steer you wrong. And call the Medicare people because they are very thorough in explaining all the complicated stuff that practically immobilizes us.

[Freddie]

14. My brother has the same plan

Last year his Non-Hodgkin’s Lymphoma came back (after 22 years). He had an autologous bone marrow transplant, spent 3 weeks in Hershey Medical Center. Paid nothing for the whole thing except for some prescription co-pays. He’s doing great now. I plan on getting the same plan when I’m 65.

[lunatica]

21. Thanks for your corroboration!

I’m a really healthy person who rarely gets sick so my experience with hospitals is minimal, but it’s good to know I have this coverage after your post!

[Skittles]

37. question

when you say $20 and $50, that is after what Medicare has paid for?

[lunatica]

47. I pay $20 for Doctor's office visits

And $50 for emergency room visits. I don’t know if it’s before or after Medicare pays for everything else, but I do know I’ve had to pay up front when I go to the doctor. I assume it’s the same in the emergency room. I would use this plan for hospitalization.

I also have Medicare for prescription drug coverage from Human. I don’t pay any premiums and the doctor’s office visits are $0 copay, specialist copay is $45 and Hospital emergency is $90. No hospitalization on this plan, and It covers prescription drugs completely.

If you go through AARP you can talk to someone without having to choose a plan. I found this was the best way to understand all the confusing choices. The person you talk to can sign you up for any of the plans, so they don’t push you into any one, nor do you have to choose right then. My overall plan is the Gold Plus

[yellowdogintexas]

43. I just took out a supplemental and

ended up with Mutual of Omaha because of a medication I take. It isn't the drug it is the diagnosis which narrowed the plans from which I could choose. I got a fairly good deal and if I need it I will be glad I have it. I had to go through underwriting because I didn't get it when I initially signed up.

At 71 I feel extra protection is a good idea.

[llmart]

46. I have my Medicare supplement Plan G from AARP's United Healthcare.

My monthly premium is $114. No co pays or ER visit costs because it's a higher plan than your Plan N.

Just for comparisons sake.

[IronLionZion]

15. Medical billing is designed to help patients die of shock

but seriously, it has to do with the fact that insurance/Medicare bargains it down. They want more money so they start with as high a price as they can before compromising. An itemized bill would also be outrageously high. For example, new mothers are charged for holding their own babies. Over the counter drugs like Tylenol will be hundreds of dollars.

One large contributor is packing in the costs of treating uninsured patients in the ER. Another is defensive medicine where they do unnecessary tests in case you sue them for negligence.

ER is expensive. Depending on where you are, it's often subsidized by taxes in some rural areas just to keep one open.

[yellowdogintexas]

49. these days, medically necessary and usual & customary treatment

will limit unnecessary testing to a certain extent.

A public hospital will be supported by taxes. Often they are called the "county Hospital" No one can be turned away, they always accept Medicaid, and they have a huge number of services that are written off due to inability pay, insurance negotiated rates etc.

Our public hospital is John Peter Smith, which had one of the first residencies in Family Practice. It is also a Level 1 Trauma Center, which is the best available. Injured First Responders are always taken there, and severe trauma cases. The next closest one to the west is in Lubbock I believe. Our Hospital taxes are on our property tax bill, and I am glad they are because it means every property owner in the county is helping keep that place running. Parkland, where JFK was taken, is a public hospital and also a Level 1 trauma center.

You are quite correct regarding uninsured patients in the ER. Free standing walk in clinics will want $$ up front which the patient does not have, so people end up in the ER for relatively minor things which end up not being paid. Ironically the free standing clinics are so much less expensive because they are not part of a trauma center.

The whole racket just makes me nuts. Forty years of processing medical claims has made me very militant about it too

[tiredtoo]

16. My wife and i are (were) both on Medicare with an advantage plan

My wife died in March 2016 after fighting cancer for about 10 months which included two 10 day hospital stays, radiation therapy, chemo therapy and related scans.
Personally i have been fighting copd and now interstitial fibrosis for at least 7 years.
Out of pocket expenses.. a few hundred for drugs, Zero (0) for medical care. I do have a separate policy for prescriptions but it does not cover 100 percent of drug costs.

[rainin]

17. Is there any other business where they can tell you they don't know what's wrong,

and there's nothing they can do, and still charge you enough to bankrupt you? I think they should charge you $100 and if they find out what is wrong, you get to apply the $100 toward your bill if you elect to have treatment. That would have saved me $7000 I spent to be told they didn't know why I was having symptoms.

I hope you are feeling better soon!

[Traildogbob]

18. Criminals all

My daughter just had to get a DNA test to analyze her possibly of cancer in her family line. She is 30, we lost her mom to cancer when she was 10. The bill for the DNA test was $6,800 dollars. Because she can afford health care through the ACA while bar tending to get her college degree in nursing, she had to pay $9.00. That is "Nine" dollars. And trumps DOJ now in court to destroy the entire bill. MAGA? Trump has a plan, greater, cheaper blah blah blah. 2.5 years ago he claimed that plan we be published next week. Next week 2.5 years ago. GOP health care coming to you.

[Warpy]

19. Healthcare and housing can't be offshored

and are more reliable indicators of the true domestic inflation rate. Since both are unaffordable these days, it's a reliable indicator of just how far wages have been depressed by inflation phobic plutocrats.

Even a simple "soft" rule out of cardiac issues can be pricey and it's something they have to do with any person over 35 who loses consciousness. At least you did it in the privacy of your shower, I did it in a full post office and broke a leg on the way down.

[OneCrazyDiamond]

29. House boats?

[stopbush]

32. I'm on Medicare with Kaiser SoCal, including an Advantage plan.

I have $135 withheld from my monthly SS check for Medicare. The Advantage plans costs me $0 (the same Advantage plan with Kaiser would cost me $89 a month if I lived in Fresno. Go figure). I pay $20 a month for a dental/vision/hearing plan. Vision plan includes a free eye exam every two years and $325 benefit toward buying glasses or contacts.

I ended up staying overnight in the hospital on Xmas Eve. I had an SVT incident at home and fainted. Went to urgent care, ended up in two different ERs plus the hospital overnight for observation.

Total bill over $11,000, including two ambulance rides.

My cost: $190.

Which is to say I am more than happy with my Medicare Advantage Plan.

[Recursion]

36. Years ago we lived in Austria

My wife fainted at one point and had to be carried down 3 flights of stairs by the EMTs.

We were on the Austrian healthcare system, but like all Austrians we had to meet a deductible before it kicked in, 900 Euros, or about $1000.

I'm just saying this experience itself is kind of how most of the world works.

[Soph0571]

38. I read shit like this and it reinforces by love for the NHS nt

[Skittles]

40. I got called back after a routine mammogram

you know, for that "suspicious spot". Four very painful xrays that took 5 minutes to take and 5 minutes to look at. Nothing to worry about, just "overlapping tissue". Even though I have insurance, the bill was 725 bucks, negotiated down to 510 which I have to pay because I never meet my deductible. This is the third time I have been called back for a redo and all it tells me is they did not do the first x-rays right. Makes me mad, especially when I think about a woman who does not have that 725 bucks.

[Ron Obvious]

44. Frankly, $1000 would already be criminal if it were the whole bill, let alone your portion

Our medical system is deeply messed up, and it's one of the main reasons my wife and I are strongly considering leaving the country. I've been hospitalised in other industrialised countries and the cost differences are humongous for the same level of care.

[guillaumeb]

48. The US healthcare system is ranked 37th for many reasons.

This is only one of them.

And if you were uninsured, the hospital would demand $18,000 from you.

[MiniMe]

59. I had surgery in November

The surgeon charged me $10k, I had to pay him $30. I'm still getting bills in. I've been pretty lucky, my insurance is pretty good. I would hate to be without insurance! Thank God for Obamacare!

[tavernier]

60. Yes, absurd.

My daughter took my x husband to hospital and he died at her home 2 hours later. He had cancer. If he had died of a car accident, his insurance would have not just covered, but paid him money. She laughingly said that dad would have probably preferred if she had opened the door and pushed him out, and they would have been debt free.

Yes she joked, but truth in comedy.

[Demovictory9]

62. made up prices, they pull numbers out of their rear..