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Thread: How can a Dr's office do this?

  1. #11
    Does all this mean that I may meet a problem in finding a new internist? I have both Medicaid and Medicare. There have been some changes when I have gone to have Rx filled but since I have remained with my doctors for several years am not sure what I may find now. Fell so lost now.

    Raven

  2. #12
    Quote Originally Posted by marmalady
    Bob, I don't think the docs get the complete balance after your deductible and copay. They have accepted pay scales, and Medicare pays them a percentage - sometimes it's ridiculously low what they get paid.
    Hi MarmaLady,

    Inexcusably, I hardly ever check or even open up the billing statements that I receive from Medicare after each doctor visit. They're to make sure that the doctors aren't submitting false claims so I should do my part and keep an eye on them.

    Anyway, after 15 minutes of searching through piles of old "important" mail stashed away in THAT drawer I found three unopened Medicare billing statements from "First Coast Service Options, Inc. A CMS (Centers for Medicaid and Medicare Services) Contracted Carrier & Intermediary".... Medicare's outsourced billing service.

    During my first visit I remember asking the billing clerk at the front office billing department how much the annual Medicare deductible was because I knew it had increased up from $100 (the last time I went.... years prior) but since I don't visit doctors very often I didn't know myself. She told me that she didn't know either... I was shocked!!! It's Medicare and I live in Florida... the Medicare Capitol of the USA! So I just wrote her a check for $170.00 and agreed that we'd figure it out on my next visit after I looked it up on the Internet and did some calculations for her. This is the same front office that took 6 months to "attempt" to receive and send a simple fax order but couldn't and was the reason why I had to wait six long months to get my new wheelchair and cushion. After I filled out all the paperwork, (her damn job) and just had her sign it, I then hand delivered it to the DME. She (the doctor) wanted to personally charge me (not Medicare) $10.00 a page to fill them out... five pages (Functional Mobility Evaluation) that I filled out in 15 mintues. It's one crazy operation there.

    Anyway, here's the billing statement for my first (always costs more... paperwork, history, etc.) and then the subsequent visits which are all the same except one when I had blood drawn.

    01/11/06

    Amount Charged-Medicare Approved-Medicare Paid Provider-You May Be Billed

    $245.00--------------$171.42-------------$37.94----------------$133.48

    So she received $171.42 for a first office visit. She must be eating dog food on that pittance.

    Since I paid too much in the beginning and there's a lag time with Medicare things got screwed up a bit (I had to figure out the bill myself and tell them how much I owed!!) but here's a normal office visit bill.

    6/28/06

    Amount Charged-Medicare Approved-Medicare Paid Provider-You May Be Billed

    $116.00--------------$80.56--------------$64.45---------------$16.11

    On my mother's life the front office charges me $18.00 for a visit. After looking at the Medicare paperwork, I should only be paying $16.11.... I guess they round it off to the nearest higher two dollars! I'll have to mention this when I go back there in a couple of weeks for my calf squeeze, back glance and the writing of two scripts. Hey, give me the script pad and I'll gladly do that paperwork. But how I dread going there. Why are mistakes or oversights always in the favor of the "big guy"?! It would be kinda hilarious if it weren't so true.

    So my doctor charges $116.00 for an office visit and with Medicare she's only been getting $82.44.... not bad for a few minutes work. But she should only be getting $80.56.... still not a bad deal for the work she does for me.... writes me two prescriptions and does that calf squeeze thing and glancing at my back act. Hey, if I were getting some kind of neurological massage or acupuncture or some type of time consuming physical work-up/workout I could understand the reason for a high payment. But for the time she spends with me and for what she does I think she's overpaid.... but maybe I'm still living in the 70's.

    Bob.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  3. #13
    BobKat,
    Medicare Approved is NOT what they receive....it's Medicare PAID Provider....a far smaller sum. I have never ran into a doc that did not accept medicare, TX or TN. I have paid out of pocket to expedite a NOW appointment, rather than wait a week once.
    My home health company received 1 tenth !! what they billed for. Medicare OVERPAYS for equipment and UNDERPAYS doctors.... yepper, that's Uncle Sam hard@work.
    Make me president for a year and I'd fix it quick. You just might have to have elections for all the missing congress, but we'd be in FINE shape real soon. Less people to feed too

  4. #14
    Quote Originally Posted by CapnGimp
    BobKat,
    Medicare Approved is NOT what they receive....it's Medicare PAID Provider....a far smaller sum. I have never ran into a doc that did not accept medicare, TX or TN. I have paid out of pocket to expedite a NOW appointment, rather than wait a week once.
    My home health company received 1 tenth !! what they billed for. Medicare OVERPAYS for equipment and UNDERPAYS doctors.... yepper, that's Uncle Sam hard@work.
    Make me president for a year and I'd fix it quick. You just might have to have elections for all the missing congress, but we'd be in FINE shape real soon. Less people to feed too
    Hi John,

    Mark and I miss you on the battlefield. We flew 2 nights ago. I hope you're at least getting into the Mission Editor and creating us some interesting missions. You should be good at that with all your computer skills. I've made a few in the past month (I think I sent you one or two) and they're fun to fly. There's that video: Getting Started Part 1: The GUI and Mission Editor that will help you get going.

    I have only been to one doctor (urologist) who didn't accept Medicare. He said it cost him too much to do the paperwork and to get paid in a timely manner. He said he'd have to hire another billing clerk just for Medicare. He told me to pay whatever I could afford and I paid the whole amount but never went back to him. I didn't think it was fair for the both of us since I wouldn't keep paying out of pocket since I have paid into the FICA system for years and earned my Medicare policy.

    My DME still hasn't been paid for my wheelchair and cushion that I received 7 months ago. We even had a 3 way conference call with Medicare before it was ordered and everything was agreed upon upfront. But I guess getting paid for it is another story. I feel bad for my DME... it isn't fair. And the damn backrest has been sagging for 5 months. Online they say:

    Sunrise Medical (Quickie) offers the most dependable wheelchair on the market today. Sunrise guarantees the frame for the lifetime of the original purchaser and includes a 2 year warranty on Sunrise made parts and components against defects in materials and workmanship. Please reference the User Instruction Manual for detailed warranty information.
    Well I guess I should have read the fine print in the User Instruction Manual because the upholstery is only warranteed for 90 days... not two years. I wanted the adjustable backrest but Medicare considers that a "luxury" item I guess so had to settle for just the "reinforced" backrest, which is a joke. I'm fighting Sunrise over it and want them to replace the sagging backrest. If they don't then I'll just bend the upright posts out an inch on each side and void that part of the warranty. They offer "the most dependable wheelchair on the market today" but only trust their reinforced backrests to last 90 freakin' days!

    But back to your post. I know it's the "Medicare Paid Provider" amount that my doctor receives from Medicare. In my above post I wrote the amounts just as they are typed on my Medicare Billing Summary. Medicare pays my doctor $64.45 and I pay her $18.00 per visit for a total of $82.45. She "normally" charges $116.00 per visit.

    My question is how much do most private insurance companies pay of the $116.00? I don't believe they pay the full amount either... they have a deal worked out. I know they have deals worked out with the pharmaceutical industry and certain pharmacies too. I know at my dentist's office I was paying the full amount ($2,700.00 over a two month period.... still got 'em all!) but those with dental insurance got a big discount. They had different billing schedules for the different dental insurance companies and plans. Poor ol' me was in effect underwriting the dental insurance industry.

    I'm going to the doctor on the 2nd of next month and to the dentist in May. I told the dentist's receptionist that I wasn't in any rush (I hate going there) so she gave me an appointment quite far into the future. Give me some time to hand wring and worry about it! Maybe I'll get lucky and die before then, one can hope.

    How has your latest encounter with the medical establishment gone? Spending lots of time in bed and healing? Eat a big freakin' piece of medium-rare steak and get some good protein in you. It'll heal you right up. And put a nice set of tits on you from all the hormones in it.

    Bob.
    Last edited by bob clark; 03-25-2007 at 09:49 AM.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  5. #15
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    Hey Bob

    Did you know that you can bill your own medicare? It involves a form(of course) but you can see a doctor that doesnt accept medicare and bill it yourself.

    Here is my story (and Im sticking to it LOL):

    For years my doctor didnt accept Medicare. If you are private pay(without insurance), most times they charge you much less than they charge an insurance company. My doctor charges $75.00 to someone without insurance.

    My doctor told me at first she was not going to accept my Humana Goldchoice which is a Medicare advantage plan. They go by the same rules as medicare and call it insurance. I think Humana made a deal to the government thinking they could manage the program better than our goverment. I only pay my $93.50 a month that I would pay Medicare for part A and B but Humana offers me slightly more better benefits....

    Anyway back to my story. I would have paid my doctor $75.00 out of pocket. Humana would have paid them the 82.00 (on paper anyway)and some cents that Medicare allows plus I would have had to pay my $15.00 copay on top of that. So the doctor would have on paper looked like they collected $97.00 in all for my visit. However....the doctor only collects a certain percentage (I cant remember the exact percentage as I have been out of the loop for a while) of the $82.00 and the rest is written off just like commercial insurance. So they only really collect about $75.00 with my copay and insurance. So it equals out...I think I figured it out at the time and I would have made a few cents if I hadve billed it myself.

    It doesnt take an extra person to work with Medicare. It just takes someone knowledgeable and willing to keep up weekly with all the changes. I used to do that when I worked my full time job.

    I once saw a urologist whose office staff did not know how to bill Medicare and did not get paid. I called to make another appointment and the girl said they were no longer accepting Humana because of billing issues. I tried to explain that if they accepted Medicare the billing principals were the same. Well to no avail I had to find another urologist after already going through a battery of tests for an anticipated surgery. To make a long story short the new urologist had to perform the exact same tests AGAIN. I had to have a surgery. Well when I got the EOB (Expanation of Benifits) for both visits. The first doctor got paid $100.00 and some cents(billed incorrectly). The second doctor got paid well over $3000.00 for the exact same tests(billed correctly). I sent a detailed letter to the first urologist regarding his choosing not accept my Humana. I also explained that his problems werent his patients fault that it was his incompetent billing staff. I also sent copies of both EOB's so he could compare the two...

    Do you know he still does NOT accept Humana? He still thinks they just dont want to pay....but he accepts Medicare. It makes no sense to me....
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  6. #16
    Senior Member reedyd's Avatar
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    Quote Originally Posted by Raven
    Does all this mean that I may meet a problem in finding a new internist? I have both Medicaid and Medicare. There have been some changes when I have gone to have Rx filled but since I have remained with my doctors for several years am not sure what I may find now. Fell so lost now.

    Raven
    From my experience it depends on where you live. In the bigger cities and towns you should not have a problem. I just moved back to my hometown and it has always been a challenge finding a MD to take mine. I was lucky to find a young MD that was just opening his new practice that accepted me. So far so good.

    Good Luck
    David


    Association of American Physicians and Surgeons, Inc.
    SURVEY CONCLUSIONS:
    1. INCREASING FEAR OF PROSECUTION OR GOVERNMENT RETALIATION HAS HAD A NEGATIVE IMPACT ON MEDICARE PATIENTS' ACCESS TO DOCTORS AND THEIR ABILITY TO RECEIVE CERTAIN SERVICES SUCH AS SURGERY:
    • Almost 25% of doctors refuse to treat new Medicare patients;
    • 20% of those who refuse to accept new Medicare patients, do so because of hassles and/or threats from Medicare carriers;
    • More than one-third of doctors have trouble finding referral doctors for Medicare patients;
    • More than one-third of doctors surveyed are restricting services to Medicare patients;
    • Almost one-fifth of doctors give Medicare patients a lower priority for appointments;
    • More than 80% of doctors have an increased fear of investigation or prosecution;
    • More than one-fourth of doctors are restricting services to Medicare patients because of hassles/threats from Medicare.
    Last edited by reedyd; 03-26-2007 at 12:13 AM.

  7. #17
    Senior Member Jadis's Avatar
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    Quote Originally Posted by marmalady
    Bob, I don't think the docs get the complete balance after your deductible and copay. They have accepted pay scales, and Medicare pays them a percentage - sometimes it's ridiculously low what they get paid.
    yup. we get paid $7 from a medicare on a $60 visit. We can't bill the patient for the difference either; it has to be written off. It doesn't take much to figure out why doctors limit the number of MCR/MCD patients they have. If thye didn't, they wouldn't be able to keep their doors open.

    One of the GI docs here won't accept patients who don't have insurance unless they pay for their procedures in full first. IE, colonoscopy,etc.

    Edit: I need to add that we have routinely 5-20 of these types of visits a day.
    Last edited by Jadis; 03-25-2007 at 11:23 PM.

  8. #18
    Quote Originally Posted by darkeyed_daisy
    If you are private pay(without insurance), most times they charge you much less than they charge an insurance company. My doctor charges $75.00 to someone without insurance.
    If you are a cash paying customer, always, always, ALWAYS ask for a discount. I've gotten anywhere from 15-75% off of the up front pricing for everything from an office visit to surgery.

    C.

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