INR Test Charges and Payments

[ALCapshaw2]

The numbers I quoted came direct from my Medipak (Blue Cross) statement. I get a detail statement on all charges.

I have no idea how you can verify it. Why would you wish to verify it?

I have no ideal why the others reported a different Medicare payment other than....you can not compare Medicare/Blue Cross with a Medicare HMO.

The story I heard was that (Original) Medicare paid the Lab Fees 100% with ZERO payment from either the Medicare Supplement Provider or the Patient which came to $5.74 at our Coumadin Clinic. The Clinic "wrote off" $45.26

Could it be that Medicare pays different amounts in different states?

 

[Ross]

Could it be that Medicare pays different amounts in different states?

Actually Al, they pay different amounts in different regions of the state. I know they pay more in Akron OH then they do here in Canton.

 

[Ross]

d


when the Medicare Advantage plans were coming along, my supplemental insurance company advised me to not sign any of their forms until I spoke with the supplemental first because Medicare Advantage was misleading. I threw all the Medicare Advantage mail away. I'm in a small area where traveling would be involved for dr/hosp care with Advantage plans but all our local in-town drs accept Medicare.

That's not true. You may or may not be as well covered with the supplemental insurance, but your sure as heck paying way more for it. All advantage plans have to supply the exact same services as Medicare does and most go even further then that.

 

[Herb M]

The facts are that the malpractice suits acount for about 0.5 percent of medical costs.

Much of the real costs involve the paper shuffling that goes on. A doctor has to submit bills to dozens of insurance companies. These dozens of insurance companies need to pay the doctors. Then the doctors need to bill the patient for the balance. They often will not get paid by the patient. They then have to get a collection agency to harass the patient.

 

[dick0236]

You may or may not be as well covered with the supplemental insurance, but your sure as heck paying way more for it. All advantage plans have to supply the exact same services as Medicare does and most go even further then that.

Ross, I agree with your first sentence that medicare supplement plans are seriously overpriced for the additional benefits you get beyond Original Medicare. I am not convinced that your second sentence is true......that is the way it is SUPPOSED to work, but my experience with my own Advantage Plan...leaves me with a lot of questions. I will take a hard, hard look at whats available in 2010 and seriously doubt that I will fool with Advantage Plans again......but who knows?

 

[KristyW]

The facts are that the malpractice suits acount for about 0.5 percent of medical costs.

That's probably true for malpractice suits, but what about Malpractice Insurance? I work for a general dentist (no surgery, no general anesthesia, no "conscious sedation"), and his malpractice insurance is not a small bill.

 

[Ross]

Ross, I agree with your first sentence that medicare supplement plans are seriously overpriced for the additional benefits you get beyond Original Medicare. I am not convinced that your second sentence is true......that is the way it is SUPPOSED to work, but my experience with my own Advantage Plan...leaves me with a lot of questions. I will take a hard, hard look at whats available in 2010 and seriously doubt that I will fool with Advantage Plans again......but who knows?

Like I said, it depends on what's availble in your area and what hospital you choose to use. I could choose an Akron hospital, but they are much further away from me, even though my cost would be near $0. When something goes wrong for me, it REALLY goes wrong. I want to be as close to home as possible.

 

[ALCapshaw2]

That's not true. You may or may not be as well covered with the supplemental insurance, but your sure as heck paying way more for it. All advantage plans have to supply the exact same services as Medicare does and most go even further then that.

During the last Open Enrollment Period (Nov 15 thru Dec 31) there was a LOT of advertising by the various Insurance Companies / Plans in /on our local media.

It was my understanding that the Advantage Plans covered most of the Hospitals and Doctors IN Alabama but NOT outside of the state (i.e. Cleveland Clinic or Atlanta would NOT be considered to be "In Network"). I also had the impression that you had to go through your PCP who acted as a "Gate Keeper" to Specialists.

The Medicare Supplement Companies / Plans made a BIG DEAL about the fact that patients could see ANY Doctor ANY Where for ANY Reason with NO Referal Needed.

 

[Ross]

During the last Open Enrollment Period (Nov 15 thru Dec 31) there was a LOT of advertising by the various Insurance Companies / Plans in /on our local media.

It was my understanding that the Advantage Plans covered most of the Hospitals and Doctors IN Alabama but NOT outside of the state (i.e. Cleveland Clinic or Atlanta would NOT be considered to be "In Network"). I also had the impression that you had to go through your PCP who acted as a "Gate Keeper" to Specialists.

The Medicare Supplement Companies / Plans made a BIG DEAL about the fact that patients could see ANY Doctor ANY Where for ANY Reason with NO Referral Needed.

With some plans, this is true. Most of the better ones will, with referral from the specialist physician, allow you to go to other places. Just like Tbone and I have the same company. Cleveland Clinic is not listed as an in network facility, but they will pay if referred to them by his or my cardiologist, surgeon, etc.

Thing you have to watch out for is, will they cover it at in network pricing structure. If they won't, it leaves you with a nice chunk to pay on your own.

Just like my teeth being removed. My hospital does not have a dental program that would do what was done for the price. Medicare doesn't cover squat for dental, but will pay for hospitalization if your someone that needs close monitoring, such as myself. They paid the out of network hospital at the in network price for my hospitalizations and my 2 subsequent emergency hospitalizations. I have a better plan then most offered. I might not have pulled that off without some major advocation from the Medicare rights organization. There is something about having lawyers behind you that makes them stop and think a bit.

If anyone needs to use them, whether they are on an advantage plan or traditional Medicare, they will help you at no cost to you:

http://www.medicarerights.org/ I had Dillion Conrad helping me. [email protected]

over 4 million who qualify for Extra Help remain un-enrolled. Millions of others do not receive the help they need because a modest nest egg or financial assistance from a family member disqualifies them

Please don't misunderstand me. You must do what is right for your particular situation. For some, having supplemental insurance and Medicare is appropriate, but for others, the advantage plans are the way to go. Just depends on your circumstances.

 

[Herb M]

The hospital lab bill sMedicare $71 for the INR test. It was $57 a few months ago. Medicare pays $8.74 and my supplemental pays 0.0 . I pay nothing.

The hospital must be losing money on this because it takes more than 8.74 in labor and materials. The hospital must be able to write off it loss on this service.

 

[olefin]

The Medicare Supplement Companies / Plans made a BIG DEAL about the fact that patients could see ANY Doctor ANY Where for ANY Reason with NO Referal Needed.

Yep, It's a big deal to me. I was once in a HMO.... only long enough to learn that HMO's were not for me. Maybe I had the wrong HMO, that I don't know. But I do know that right now I have a choice, with what's going on in Washington I may soon not have a choice.

 

[INRtest]

This whole thread is almost funny to me. I increased my Blue Cross deductible to $5000 (plus 80% of the next $2500) 5 1/2 years ago, only months before I spent 2 months in ICU and another 4 months recovering.

Other than 2004 when I easily met my deductible, I pay almost entirely for any procedure that I receive. I paid out-of-pocket for my INRatio, pay for my own test strips, and pay my dr's office visits (though the visits, excluding any testing, are $40.). Stress tests, blood tests, ct scans, whatever are 100% out-of-pocket.

I have to go in for a colonoscopy again. A year and a half ago they found a polyp, but couldn't (or wouldn't ?) remove it because of my warfarin. Now the dr. is saying that he may be able to remove it even anti-coagulated. I think my cost 1.5 yrs. ago was about $3800. Wonder how much it has increased.

If you're complaining about paying $20, $30, $40 per procedure. Don't complain. I hear about people who aren't insured, but what about those of us who have inadequate coverage? I only have 10 more years and then I'm eligible for MediCare. Can't wait.

 

[catwoman]

Jess:

You apparently chose low premiums & high deductible over higher premiums and lower deductibles. We have that option at my workplace. I chose the middle of the road plan.

Can you change your premium/deductible plan during the next enrollment period? My husband has BC/BS and I believe they can change their elections every year.

 

[ShezaGirlie]

Blue Dogs revealed..

Blue Dogs revealed..

If H.R.3200 passes as it stands, you won't be very happy and neither will the rest of us.

Throw some real facts out there for me Ross and make me believe that..!

Like Jess, I couldn't wait for Medicare and post OHS paid expensive private insurance premiums out the kazoo for ten long years. Medicare is the best thing since sliced bread.. I don't know many folks who aren't satisfied with Medicare, Tricare, the VA System of healthcare and/or Medicaid - all government programs paid for by taxpayers.

Wanna listen to a hoot of a guy. You have to suffer through the 15 second advert first, but it's worth it. Hey Dayton - who is this Sen. Mike Ross of Arkansas? http://www.msnbc.msn.com/id/3036677/#32277034

My cardio's office charges $15 for a CoaguChek INR test = self pay, otherwise Medicare pays them around $8 for a test. Both reasonable.

 

[dick0236]

Mike and 20 other Blue Dog Democrats recently voted with the Republicans on a right to carry bill that would have made it legal for CCW permit holders to carry in all states. It failed by two votes. Sad to sad, they were the only 2 Republicans that voted against.

We don't need a CCW in Kentucky. I just carry my AK-47 in the rear window of my pick up truck....nobody will mess with me.

 

[Lisa in Katy]

Well, in Texas, you can carry your shotgun in your truck window, or you can carry your concealed handgun. The Houston area is getting crazier and crazier, so I'm about ready to go back to the Wild West and take lessons from The Rifleman. Unfortunately, he's dead, but it wasn't a gun that got him!

This Mike Ross sounds like a heck of a guy. I might change from Republican to Blue Dog Democrat simply because it sounds cooler! As I said in the other thread, if and when something passes, I doubt it will be as bad as I fear, I know it won't be as good as Obama and his cronies would like us to believe, and I'm sure it will cost a great deal out of my pocket, at least until I lose my job and my husband and I are no longer "rich". Maybe my kids will be able to get more college money then. You can bet I'll be taking advantage of the system!

 

[INRtest]

I must say that the insurance companies have it made today. I can't change my deductible because I have a (significant) pre-existing condition and my wife and I are self-employed. One could say that I'm lucky that I already had insurance before I got sick, but now most of us are just scrwd.

Yeah, my premiums are "only" about $8400. per year with BC, plus a $5000 + $2500. deductibles, but I have absolutely no option. Medicare, here I come (if I live that long).

 

[catwoman]

The clinic visit takes two minutes; the finger-poke and blood transfer to the little gizmo (which initially costs about $3500 but amortizes pretty quickly in a large clinic) takes one minute; 30 seconds to put the band-aid on; and another minute (tops) to have the computer read the results and prescribe the dose. "All" that is worth over a hundred bucks?

$3500? Not sure where you got that figure...... POC testing machines cost far less than that for the medical profession. I'm sure hospitals owned by a large health care system pay only several hundred dollars. After all, I paid $1495 (plus a little extra for the wall charger and some strips) for my INRatio. I'll bet that health care systems pay less than that, since they purchase equipment and supplies in quantity.

 

[Lisa in Katy]

We need to stop fussin' about stupid stuff and start holding insurance companies accountable for ridiculous and unrealistic charges.

I'm confused here. The insurance company doesn't decide the charges. They negotiate the allowable charges. My last INR was around $54 and my insurance company allowed $2.02. You're getting screwed but it's not by the insurance company. It's by your provider. Chances are they refuse to negotiate a decent rate with the insurance company, and your insurance company would much prefer you go to a large lab - LabCorp or Quest - where they will have a much better contract.

 

[wcasey5]

The problem is that those with no money and no insurance want to be able to go to whoever they want, whenever they want, not have to wait and not have to pay. Those of you in countries with government plans know that it doesn't work that way in your plans.

Ummm, in Canada it works exactly that way. You need to do some homework.