- 6,986
I would be pretty stressed right now if I didn't have medicare and had used docs and facilities that did not take medicare.
Very preliminary full charge info at this point-hospital charge $142K + some of the docs at around $8K.
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I would be pretty stressed right now if I didn't have medicare and had used docs and facilities that did not take medicare.
Very preliminary full charge info at this point-hospital charge $142K + some of the docs at around $8K.
- 4,743
I thought you had HD Plan F?
- 6,986
Yes, I do.
That was the point of my post. Hospital system charges just hit my medicare account to the tune of $142K. Because of the weird way Medicare posts the hospital charges on those preliminary claim forms in the my medicare account, I can't tell yet what the final allowed amounts will be (until I get the actual MSN). (That is something I want to ask somarco about when I get all the information to make a specific question.)
But the point of my post above is that I am grateful to have the medicare coverage and providers and facilities that will accept it, BECAUSE the starting bill, just for the hospital system is $142K. I know there are going to be some charges unapproved by Medicare that I will have to pay, but most of it will get adjusted way down. I know this is old hat to you guys who talk with clients all the time-it is a new deal to me and it allows me to afford a medical treatment that will affect the entire rest of my life.
And also, I appreciate having Medicare vs MA. My surgery was done in a facility under an HCA system. I had tests in clinics associated with the HCA system, the Ascension system, and an out of town hospital system. Two different specialists, a family doc, and however many operating room specialties will pop up. I have to think some of those things may have presented some approval challenges in the MA system.
For example, around noon on the Friday before the 4th of July weekend, I presented to my PCP. He took one look at my leg and wanted a sonagram for blood clots and for me to see my hip doc that afternoon. Hip doc was at a satellite town clinic that closed at 2 pm Fri. Because of that, PCP could not get me a clinic appointment in the out-of-town system he is affiated with. They got me a sonagram appointment around 4 in the afternoon at a local Ascension (not HCA) affiliated clinic. We had to drive across our metropolitan area twice to get to hip doc and then back to sonagram clinic, but it all got done and there were no MA type approval issues which might have occurred if I had had an HCA based MA plan while trying to get into an Ascension clinic.
It doesn't work that way. Part A charges denied by Medicare are not your responsibility.
My wife had hip surgery to repair FX,in 2019, pins implanted, not hip replacement. Without pulling the claims I can't tell you what was approved, what was denied, and what was the allowable charge.
Hospital gross billed charge (4 days inpatient) was $52k, allowable charge was $23k, amount paid by insurance $20k.
Gross billed charges, inpatient & outpatient have major discounts that are "written down".
In addition to the $52k billed by the hospital, she had another $30k outpatient (asst surgeon, anesthesia, PT, etc) . . . most of those were also repriced and written down.
Your OOP for Part A & B should be $0 after the HD deductible is paid.
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- 6,986
All I can tell you until I get the actual MSN in another month or two is that there are over $142K Part B gross charges from the hospital, and I will owe some of them beyond what is applied to my HD deductible amount.
Also, when I get the actual MSN so I have the information to make a clear question, I am going to have a specific question for you to see if you have any idea why Medicare records Part B charges from hospitals differently than the Part B charges from other providers. Not an attempt to be nasty or to test you, just a question I would genuinely like to know the answer to if you have been exposed to it and figured out the answer.
(Note: in my case Medicare equals the WPS contractor)
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Hospitals usually don't bill Part B charges . . . those come direct from the provider. That is why a hospital stay generates multiple bills after the fact from multiple providers.
In my wife's case, in addition to her hospital bill, we also received bills from the surgeon, assistant surgeon, anesthetist, radiologist, PT
Ignore the initial bills. You can see a claim summary once the claim is adjudicated . . . the MSN won't show for another month or so . . . it merely duplicates the claim summary in a different format.
Your claim summary/MSN and carrier EOB gives the full picture.
Chill . . .
In my wife's case, in addition to her hospital bill, we also received bills from the surgeon, assistant surgeon, anesthetist, radiologist, PT
Ignore the initial bills. You can see a claim summary once the claim is adjudicated . . . the MSN won't show for another month or so . . . it merely duplicates the claim summary in a different format.
Your claim summary/MSN and carrier EOB gives the full picture.
Chill . . .
- 4,743
Lost Dollar, you are getting excited over nothing. Once the dust settles, you will write checks for up to $2490. It’s quite possible you might not even reach your deductible. Also, you don’t have to wait for you MSN to be mailed. Go online and view.
- 6,986
Again, all I can tell you is that our local HCA affiliated hospital chain has directly billed me for Part B charges on 3 separate occasions for 3 different services at 3 of their locations over the past 5 years.
The last hospital billing that has also gotten to the Medigap carrier has been entertaining because the hospital has somehow managed to to destroy the Medicare to Medigap crossover flow and get a bill submitted to a Medigap carrier I no longer use. I am just shaking my head and watching to see what happens next.
I have 2 specialist providers that incorrectly recorded my Medigap carrier in their records, but the Medicare to Medigap crossover caused the correct Medigap carrier to receive and process the claim and I have paid both providers. The hospital billing process has worked differently, they will just wait awhile for their money until they straighten the billing out.
It's all very interesting to watch.
- 6,986
You are attempting to make me say things I did not say.
I will, as I did in 2017 in the same situation with the same hospital system, be writing a check for amounts in addition to the liabilities under the HDF deductible.
Yes, I am seeing that. That is why I stated the charges I have seen so far and said I was pleased that I had Original Medicare and Providers that took it. It is staggering to think that a person can receive medical bills of $150K or more and then get to a point with Medicare where they might not even owe $2500 on them. It causes me to feel very sorry for people that have to approach these types of situations with no health insurance.
I am aware that I can view some information online. At this time, while there is a claim posted, the information available online is incomplete and does NOT show what the MSN will show.
