This is why no one understands medical billing

[spinbaby]

I recently had a diagnostic mammogram—a little fancier that a regular mammogram. I have a Medicare advantage plan. The mammogram resulted in:

A bill from the hospital for $33.25.
A check from the hospital for $15.00.
A Visa gift card from the insurance company for $50.

I have no idea why any of this happened. The mammogram was fine.

[Rorey]

1. My advantage plan is always throwing out incentives

I saw that offer of a Visa gift card. I guess I should get around to making an appointment. I just hate mammograms so much that it's hard to motivate myself, even though I know I should.

[doc03]

2. Glad everything was ok and you made a profit. Mine

are always something like hospital billed $5000 - $3000 contract agreement - $1500 discounts. Insurance paid $450
you responsibility $40. Who pays the $5000 they billed in the first place, anyone?

[lark]

5. Medical Insurance is crazy, I know I worked in the field for 20 years.

They overbill the price because 1 insurance co. will pay more and they can't bill differing rates for the same procedure. They just w/o the difference, they never expected to collect it from most of the companies anyway. It's really stupid but dumb laws drive dumb practices and the legislators writing the laws know nothing at all.

[yellowdogintexas]

7. same here. All kinds too

We are so screwed until we are all on the same plan (whatever the hell it is) and things are consistent across the board.

It. Is. Insane.

Except for original Medicare It is very straightforward. Once you get past actually getting set up it's good

I have original Part B and a MedSup.

[yellowdogintexas]

8. uninsured patients. The prices are jacked up & the hospital writes off the balance between

the billed amount and the allowable. This helps offset unpaid bills by the uninsured or those with inadequate coverage. These writeoffs result in significant tax exemptions for the facilities and physicians.

Remember the $100 aspirins? Same thing.

All participants in a given plan have contracts with every insurance company that they are willing to work with. The contracts establish the allowable charge for any particular service the patient may receive.

Medicare is a total failure in these situations, because you have to divest yourself of any assets five years prior to the actual need for government funding of long term care.

[ret5hd]

3. If I brought my vehicle in for an oil change...

and I got a separate bill for:

1) Vehicle Relocation Fee
(move vehicle from lot to rack)
$50 — Pay to Steve’s Relocation, Inc

2) Fluid Removal Fee
(drain used oil)
$123 — Pay to Mike’s Fluid Removal Service, Inc

3) Fluid Installation Fee
(fill with new oil)
$1,537.50 — Pay to Mike’s Flyid Installation Service, Inc

etc etc etc

How long would we accept this???
But we have NO choice.

[lark]

4. Ha, that never happens here.

We did get a copay reduction this year, but there was an included increase on some pharmacy costs. Luckily it won't affect me because I only take a blood pressure pill regularly. I have a Medicare Advantage plan. Oh, I forgot, I did get an increase in my dental coverage, they sent me a $300 card to pay for dental and vision out of pocket expenses. That was a 30% increase over last years' coverage and was much needed! Money back or gift cards - nah, not here anyway.

[Pobeka]

6. If medical costs were clear and you could literally shop around for non-emergency care, prices drop.

What is still hidden is the actual cost for the mamograph -- equipment depreciation, lab space, personel etc.

Glad your mamogram turned out good!

[yellowdogintexas]

9. the ACA rules re: mammograms allow 100% coverage

no deductible and no copay for a routine screening mammogram

If your mammogram is for deeper examination it has to be processed according to contract and you get all those ancillary bills.

I will never in my life figure out why we keep getting refunds from our providers!!!

I pretty much think it is bad bookeeping

[lark]

10. Yes, there is a ton of bad bookkeeping.

I was over the Quality Control group and we had two billing systems during the 20 years I worked there. When I first started, the billing error rate was amazingly about 55% - outrageous! I implemented a bunch of steps, working with the Practice Administrators, and we got it down to around 22%. It would have been lower but every new release of the billing software always had new problems which we had to work through and that happened about every other year.

I'm seeing it now as a patient, my payments not applied to the right date of service or to the right person, creating credits and debits and I get a statement only showing the debits as due when the balance is actually zero. The rehab center I was going to is fantastic, their therapists are the bomb and they have a great facility - but the billing wasn't great and I had to call them 4 times regarding already paid visits they were billing me for. Every time it was their error. Sheesh!