Medicare EOB Statment

EOB (explanation of benefit) for those that don't know...

My mom went into the hospital for major surgery nov. 24...
I got her first bill for the surgery and 3 days in the ICU...
Total billed $235,289.09 :shock:

Amount you do not owe $28,073
Amount paid by BCBS $1,184.00
Amount provider may bill you 0.00
(provider is under contract and has to take what they pay and cannot bill you the difference)

I take it Medicare paid $28,073
Her supplement paid $1,184.00

Total $29,257.00

I can understand that what I don't understand is why bill $235K knowing all you are going to get is 29K....

She was there for 30 days and in rehab 30 days its going to be a nice bill... This is all because of a bladder tack that went bad there's no question the surgeon has it documented in her discharge papers and looked me in the eye and told me... I am not head hunting its more of a question of why 235K is billed...... I have been down this road with my wife and the outcome payout seams to be 10 to 15% of what is billed....

Hobo,

Perhaps a write-off?

I don't honestly know.

D.

It is always amazing what the "allowable" is compare to what they will try to get. I'm sure there are lots of folks who have had to pay that amount in the past due to lack of insurance. I'm sure that they could get that money from the government.

That is the amount they would initially bill you if you just showed up without insurance and wanted to pay cash for their services. Of course you would negotiate that price down greatly too but they have to start somewhere. All of the health insurers negotiate a contractual schedule of fees for various services that they will pay when one of their insureds is hospitalized at that hospital. Since the hospital is much more certain that they will be paid promptly by your insurer, they agree to vastly lower prices because they really want to get your business and know that they have to be on the insurance company's approved list or you will be steered to a different hospital.

Part of the reason is so they can make a big pile of these short paid bills, go to their congress critter and demonstrate how they lose money

I don't see how they can wright it off they gave her noting... It is not tax exempt.... Wright offs are miss understood,,, example...

If I gave you a qt of oil and it cost me $1.00 but I sold it for $4.00 I could not wright off 4,3 are $2.00 my wright off would be $1.00 because it would come out of my parts expense...

Its dollar for dollar not what i can dream up...

Medicare/cade does not pay any bill anywhere close to 100% -- 10-25% is the norm, providers bill at stupendous rates knowing a heavy discount is coming, private insurers do the same thing whether it is previously negotiated or not. There are actuarie tables for every imagiginable procedure and they are used as a basis for starting negotiations. A major reason that many private clinics and Dr's offices are closing around the country is because Zerocare took even more money out of the medicare system and diverted it to paying premiums for bums and leeches and now the reimbursements are to low for many clinics to stay in business.

I had a Medicare Advantage Plan last year (Humana) Went to a specialist for a procedure, gave them my card and they said we don't take that insurance. I ask if they took cash, of course they did. The rates were posted on the wall. Office Visit: $60, procedure that I was having: $360. I ask no questions, needed the procedure done. When I went to pay the total bill was $180.

I get a blood test every 3 months for my sugar.The bill is 478 bucks for the blood test.I have 6000 deductible so my insurance company doesn't pay.I send the bills through insurance anyhow and the bill comes back 20 bucks.

I just went thru a deal with a foot doc that thought he could con me into paying the full amount... He was on the provider list and agreed to what my insurance paid... He never bill BCBS and billed me 6 mo later stating BCBS denied payment... He then bills BCBS and they denied payment based on he did not bill it with end 180 days...

BCBS told me don't pay and foreword any statements he sends me to them... He is under a contract and can not directly bill me are call me...

There's a local doc's that has down sized and takes $20 upfront and don't mess with insurance... Folks have told me its cheaper than what they usually pay for there copay....

Like was stated earlier. The hospital
knows what ins will pay so they raise the
price accordingly and after ins pays they
just write off the remainder usually since
what they were paid is what they needed to
be paid. Just a way of working the system,
not saying good or bad just the way of
doing things.

Think about the poor SOB that has no insurance, his bill is 235K

Check this out for weird hospital bills.
Snake Bite

This is a game that hospitals and insurance play. The hospital knows up front how much insurance or Medicare will pay. Billing an excessive amount ensures they will get paid the full amount insurance will allow. My guess is they also write off the excess so it appears they're not running a profit.

I had a knee surgery a few years ago. I was billed for three surgeries, even though I only have two knees and they didn't touch one of them. Insurance paid the full amount for one surgery.

And when you question the amount they won't give a straight answer. "Emergency room is expensive" blah blah woof woof.
Short time ago Puppy got carried away & nipped my thumb. Since I couldn't remember the last one, I decided to get a tetanus shot. They gave me the shot & put a dab of ointment on the tooth mark. Price was 9 bucks for 1/10 gram ointment plus 25 bucks to smear it on. There were other outrageous charges that I bargained down to 25%. Minimum of $1800 to walk in the door, whether or not they actually do anything. Tetanus shot was somewhere around 350 bucks, don't remember exactly.
Retail price of the same ointment is $2.90 per ounce, 28 grams, 280 doses. That's $2520 per ounce, or 900 time the retail price.
No need for emergency room, I walked in the door bright eyed & bushy tailed at 9am, no big hurry.
Any time there is a chance insurance can be involved is the same. If you take your car to body shop for a few dents or sctatches not covered, watch the price. It was a few years ago & I'm sure rates are higher now, but when I had mine in for accident repair i was floored. Sign said - IF insurance covered, rate was $49 per hour. Owner cash payment rate was $ 78 per hour. A city owned vehicle had hit me in the side, their insurance paid, actually sent check based on written bid.. When done, the bill was almost double the written bid. I told them to take it up with the City if they wanted more.
Willie

I totally agree with working the system.

If you go into the lobby at a cancer treatment center lobby it is FULL of white heads; nar a dark hair amongst them. A $150k cancer cure treatment goes for about $30k.

If you are smart/lucky enough to have backup insurance for the 20% MC doesn't pay, they literally pay nothing until you have paid your annual deductible and co insurance minimum. Mine was $100 and $1750 respectively. Once I had met those minimums I paid nothing.

Now. If the center didn't go along with MC's decision guess how many patients would be sitting in the lobby?????????????j

They obviously make it on volume if nothing else and since they remain in business and keep expanding (Texas Oncology for one) they must be making their financial goals. In addition to that they know their business and get the desired result for the patient. I'm one of their success stories!

Mark

Health insurance billing if just GOOFY. I may have a $1000 bill, insurance adjust the bill to $500. They pay $400 and I pay $100. If I don't have insurance, I'd pay $1000.

I've learned one hospital has a 7% reduction in emergency room visits in January. They think it's because of the new health care. That sounds Goofy too. He says in Indiana, he has 4 choices for insurance, all BCB Shaft.

My insurance company canceled me, because yesterday, like it or not, I'm on Medicare, Part A, B and D. Looks like it will be cheaper for me to be on Medicare. I'll wait and see just how good my part D is.

On the other hand, my son-in-law, who is one of the young rich healthy kids, is going to pay twice as much for his insurance and get half the coverage. That sounds Goofy too.