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Author: TMFJeanie Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 59084  
Subject: Re: Man exposes crooked health insurer (Aetna) Date: 2/21/2008 1:59 PM
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that's truly bizarre .. in five years, prices went Down?

one possibility ... Providers charge private ins. a slightly inflated number, not knowing what they'll get. But charge Medicare what they know they will get.


You got it. But it's mostly the ancillary charges that are grossly over-billed. I'm convinced that's the answer because those providers try to make up the losses they sustain from the indigent and uninsureds who will never pay their bills.

The saddest victims are those who are uninsured or under-insured who *do* attempt to pay these medical bills, putting their families in financial jeopardy while enduring the stress of predatory collection agencies and risking bankruptcy to do so.

The downside of that could be the Providers aren't getting enough from Medicare ...

I've been studying these bills more carefully since we began this conversation. DH's surgeon (a leading orthopod in this area and in great demand) billed exactly the same amount as Medicare approved for the actual surgery plus each office visit pre- and post-surgery. Those amounts aren't all that different from what he was paid 5 years ago by our private ins.

The big difference was in what the hospital and the labs were billing.
One that stood out was a $1250 charge for something I can't identify, but whatever it was, Medicare paid $238. My first thought was, "oh, they got screwed out of a thousand dollars for that procedure". My second thought was that, a private ins co may have paid $900 - thus paying for four indigent patients who got it for free.
The sad result is that the insured person would get charged the $350 difference between that $1250 and the $900 -- and the uninsured person would have been dunned mercilessly for the whole $1250.

How much better would it be if every person was covered for the $238 under a national health care system?
Anyone who thinks we aren't *already* paying for poor people's health care, is kidding themselves.

but no telling --my Drs are happy with Medicare, so i guess they're doing alright

Yes, I think most doctors are happy with Medicare. They get their money quickly, they don't have to dedicate a staff member to deal with the paperwork or spend their own valuable time on the phone haggling with some clerk over why a heart monitor was ordered for a hip operation.




Jeanie
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