Chemo and Excess Charges

somarco

GA Medicare Expert
5000 Post Club
36,601
Atlanta
Reading an online comment by an agent who sells Medicare supplements and (presumably) had cancer a few years ago. He goes into a lot of detail about the 10 plans then focuses on the two that cover xs charges.

His comment is as follows.

the focus is on the two that cover "excess charges". I ask if they would want to eliminate the risk of having to be out-of-pocket tens of thousands of dollars where a provider does not accept assignment. To make this crystal clear they are then shown what my monthly charges were for chemotherapy in 2009, which were $ 35,000 per month for a treatment period of six months.

I explain that my responsibility could have been $ 31,500 had the facility not accepted Medicare assignment. At that point, they are asked if they would like to eliminate that risk and the answer is always yes.


He did not post MSN's or EOB's but I am curious how he calculated the xs.

It is my understanding that outpatient chemo (or radiation either) is not subject to xs.

But I could be wrong.

Little help, please.
 
It is my understanding that outpatient chemo (or radiation either) is not subject to xs.

But I could be wrong.

Little help, please.

1. I think the agent is full of it (and selling against N. He needs the extra 20 cents in commission selling G)
2. You are assuming chemo/radiation was received at a facility that takes assignment. While I would go with 99.9% take assignment, you never know. Maybe he found one that doesn't take assignment?

Chemotherapy | Medicare.gov

Specifically states "takes assignment" in the note section.
 
Yes, I agree. The agent is a bit uninformed.

Could have sworn Wes (W C Mason) our resident guru gave a list of codes where xs charges could apply. Do not recall any where the pt was getting therapy (chemo/rad).

And maybe yes, the folks that treated him might not take assignment.

But I also think he uses his ignorance to upsell folks and scare them away from other plans that might fit.

FWIW, I have quite a few N plans on the books. Most are still G but adding more N plans almost every month. The only time I try to steer people away from N is when they live in south GA and may pop over the line to Mayo.
 
Agreed.

I don't have an issue with N. Its not my favorite, but I don't have a problem with it, either. My biggest thing is making sure they understand the $20 copay and by the time the numbers don't work, they are probably aren't going to be able to move to G.

Plus, there is NO way my Grandma can deal with a copay at age 91. She has the money. She doesn't have the cognitive ability to write checks and pay bills. And everything is based on Grandma.
 
He is calculating the $31,500 at 15% maximum excess charge that is allowed non participating providers. Total Charges $35,000 X 6 = $210,000 .. Here is where is math is fogy. Apparently, he is assuming that Medicare approves $182,000 which would be paid at 100% by medicare and the supplement. That would leave the 15% excess as his responsibility which would be closer to 28,0000 out of pocket. His figure might not be exact but is he not right in principle?
 
He is calculating the $31,500 at 15% maximum excess charge that is allowed non participating providers. Total Charges $35,000 X 6 = $210,000 .. Here is where is math is fogy. Apparently, he is assuming that Medicare approves $182,000 which would be paid at 100% by medicare and the supplement. That would leave the 15% excess as his responsibility which would be closer to 28,0000 out of pocket. His figure might not be exact but is he not right in principle?
Sounds like he's using that there Mississippi Math. :laugh:
 
He is calculating the $31,500 at 15% maximum excess charge that is allowed non participating providers. Total Charges $35,000 X 6 = $210,000 .. Here is where is math is fogy. Apparently, he is assuming that Medicare approves $182,000 which would be paid at 100% by medicare and the supplement. That would leave the 15% excess as his responsibility which would be closer to 28,0000 out of pocket. His figure might not be exact but is he not right in principle?

Sure.

And please find me a chemo provider that doesn't accept assignment. ;)
 
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