MAPD out of network radiologist question

[Midlevel]

There are 4 situations where I can see that happening and the patient is not billed for anything other than the hospital inpatient charges.

The surgeon, assistant surgeon, anesthesiologist, etc. were all on staff at the hospital and are paid by the hospital as regular employees.

The surgeon, assistant surgeon, anesthesiologist, etc. failed to bill the patient for their services . . . or they decided to work for no charge.

The patient is clueless.

The agent is clueless. Also, an agent that gives the client a definitive "this is all you will pay" statement, should anticipate an E&O claim to occur.

Note . . . services incurred while in the hospital and billed by the hospital are covered by Medicare Part A . . . regardless of whether the patient has original Medicare or an MAPD. If the patient has original Medicare, the patient is responsible for the Part A deductible ($1600 per admission in 2023), but may not have to pay it if they have a Medigap G plan. If they have an MAPD plan, they are liable for the daily copay up to the plan limits.

Charges for services incurred while in the hospital but not billed by the hospital, fall under Medicare Part B. If the patient has original Medicare, the patient is responsible for the Part B deductible ($226 per calendar year in 2023), but may not have to pay it if they have a Medigap G plan, and they have satisfied their Part B deductible for the year. If they have an MAPD plan, they are liable for copays and deductibles up to the plan limits.

Weird there are only 4 ways it can happen yet it happens with 100% of my MA clients. 20 years with no E&O claim. How can that be? Sometimes I think you are stuck back I the 80’s with all your managed care advice you give.

Same goes with the ER, they go to ER with chest pains and they do EKG, stress test etc they come out with 110.00 copay every time. My Mother fell at public store and hit her head on pavement. She had to go to ER for all kinds of tests, CT scan etc and she was worried what her bill was gonna be. I said it will be 90.00 which was the copay back then and guess what? She got a bill for 90.00 on an 18000.00 ER bill.

Bottom line, all the Med Sup only people love to bad mouth MA plans when in reality they have never had someone on them to see how they work.

 

[somarco]

@Midlevel, you might want to read post #9 in this thread. It is chocked full of credible, third party explanations regarding par and non-par claims associated with hospital care, all with citations.

Of course, that material may be too complicated for you to comprehend.

Ignorance of the rules and policies does not grant you, or anyone else, immunity.

 

[Midlevel]

@Midlevel, you might want to read post #9 in this thread. It is chocked full of credible, third party explanations regarding par and non-par claims associated with hospital care, all with citations.

Of course, that material may be too complicated for you to comprehend.

Ignorance of the rules and policies does not grant you, or anyone else, immunity.

All from the 80’s I’m sure. Welcome to 2023!

 

[goillini52]

Weird there are only 4 ways it can happen yet it happens with 100% of my MA clients. 20 years with no E&O claim. How can that be? Sometimes I think you are stuck back I the 80’s with all your managed care advice you give.

Same goes with the ER, they go to ER with chest pains and they do EKG, stress test etc they come out with 110.00 copay every time. My Mother fell at public store and hit her head on pavement. She had to go to ER for all kinds of tests, CT scan etc and she was worried what her bill was gonna be. I said it will be 90.00 which was the copay back then and guess what? She got a bill for 90.00 on an 18000.00 ER bill.

Bottom line, all the Med Sup only people love to bad mouth MA plans when in reality they have never had someone on them to see how they work.

I'm surprized that the store wasn't liable.

 

[somarco]

I'm surprized that the store wasn't liable.

That is a red herring argument, intended to distract from the facts.

Singing lessons are over for today . . .

 

[LostDollar]

Same goes with the ER, they go to ER with chest pains and they do EKG, stress test etc they come out with 110.00 copay every time. .

So....
In 2022 I went to the ER for chest pain.

HCA billed me 12K+ for ER visit.

IN ADDITION, there were separate bills for the Doctor, EKG's, and a radiologist.

You're saying if I'd had an MAPD I would only have received the bill from HCA and the other bills would magically have disappeared?

That does not sound credible to me.

 

[LostDollar]

My experience with hospital stays for my clients on MA plans has been whatever the daily hospital copay is that is what they get billed. Copay is 350.00/day days 1-5 then they get a bill for 1750.00. If they are in there 2 days then 700.00, etc. Guy had quadruple bypass surgery and wanted to know what he could expect for a bill. I said 1750.00 and that’s exactly what he got. Then of course he got reimbursed 1500.00 from GTL so the entire 150000.00 procedure cost him 250.00.

plus the gtl premiums.

Caveat, an agent:

Whopping 30.64/month. Come up with something better then that.

The point is that you guys sell the free MAPD products and forget to mention costs of the stuff you add on for the buyers to pay for.

The point is that there is an additional health insurance premium to be paid to obtain the savings you talk about. There may still be a savings to the policy holder, but you need to present the entire picture, rather than hiding it.

Also, since I am not an agent, I have no access to premium information, but it whatever product you are discussing is priced like GTL's home care product, a policy for someone in the 60's may seem affordable, but when they move on up into 70's and 80's the premiums skyrocket. If that is the case with the supplementary product you are talking about, that is another hidden consideration you are not disclosing in your discussions here.

 

[goillini52]

The point is that you guys sell the free MAPD products

Since you're not an agent, you're allowed to say that.

 

[somarco]

You're saying if I'd had an MAPD I would only have received the bill from HCA and the other bills would magically have disappeared?

Just like Forrest Gump's shoes . . . your MAPD can take you to a land where par and non-par provider bills disappear . . . like magic . . . . .

 

[Midlevel]

The point is that you guys sell the free MAPD products and forget to mention costs of the stuff you add on for the buyers to pay for.

The point is that there is an additional health insurance premium to be paid to obtain the savings you talk about. There may still be a savings to the policy holder, but you need to present the entire picture, rather than hiding it.

Also, since I am not an agent, I have no access to premium information, but it whatever product you are discussing is priced like GTL's home care product, a policy for someone in the 60's may seem affordable, but when they move on up into 70's and 80's the premiums skyrocket. If that is the case with the supplementary product you are talking about, that is another hidden consideration you are not disclosing in your discussions here.

Didn’t say they disappear. If 12000.00 is approved then client pays 110.00 and MA plan pays 11890.00. Not sure why it’s so hard to understand what a copay means.

As far as GTL premiums they haven’t raised a client’s premium for the HI plan since I started selling it many years ago. They started at age 65 paying 30.64/month and that’s exactly what they pay now.

Funny how 48% of all Medicare recipients have MAPD’s and are plum happy with them but all you haters along with Nurses, Skilled nursing, etc bash them nonstop.

I wonder who is right, all the people who have it or all the people who are on the outside that want to bash it every chance they get.

Memo: it’s here to stay and growing every year.