Medicare Supplement Plan N

[somarco]

the 15% would not be that significant for lesser charges, but could potentially be significant with more expensive services.

What kind of "more expensive services" do you anticipate that will be subject to xs charges?

Medicare assignment being scaled back as the under 65 moves toward a single payer system

What does single payer (assuming it happens) for U65 Obamacare plans have to do with providers refusing to accept Medicare assignment?

 

[cladams]

What kind of "more expensive services" do you anticipate that will be subject to xs charges?

I have a list of ambulatory OP surgeries that I use to illustrate potential part B costs. The costs of those surgeries range from $300 - $30,000. 15% on top of $300 is only $45, and is not a big deal. 15% on top of $30K would be $4500.00 - that would be "more expensive," and would not be the "15% surprise call" that I want to be on the other end of.

What does single payer (assuming it happens) for U65 Obamacare plans have to do with providers refusing to accept Medicare assignment?

Since CMS currently oversees the ACA compliance, if the Guv was looking to consolidate the system, the most likely scenario that I could see would be a single-payor Medicare-for-all-system. If that were the case, and healthcare costs continue to rise, then I can see where the assignment to the providers would be a logical cut. In that case, I could see where more providers would elect to be non-participating, and would charge the adtl 15%. I might be off - just what I think, based on the current climate of Obamacare.

 

[sman]

What outpatient procedure has a Medicare approved amount of $30k? Additionally, the 15% isn't on the Medicare approved amount.

 

[yorkriver1]

What outpatient procedure has a Medicare approved amount of $30k? Additionally, the 15% isn't on the Medicare approved amount.

Shoulder surgery 8 years ago was billed at $30K to under 65 plan. After Anthem's
network reduction, paid about $10K. As I understand it, Medicare rates can be lower than the average HMO/PPO network negotiated rate.

I am interested in comments about actual surgeries and Medicare allowable charges, too.

 

[somarco]

I have a list of ambulatory OP surgeries that I use to illustrate potential part B costs. The costs of those surgeries range from $300 - $30,000. 15% on top of $300 is only $45, and is not a big deal. 15% on top of $30K would be $4500.00 - that would be "more expensive," and would not be the "15% surprise call" that I want to be on the other end of.

Care to share that list?

Of course for your $30k scenario it would be necessary for all providers involved to be non-par (don't accept assignment). That's a bit of a stretch, don't you think?

I suspect the higher the average bill the less likely providers are willing to play the "collect from the patient" game.

 

[cladams]

Care to share that list?

Of course for your $30k scenario it would be necessary for all providers involved to be non-par (don't accept assignment). That's a bit of a stretch, don't you think?

I suspect the higher the average bill the less likely providers are willing to play the "collect from the patient" game.

The list for OP costs that I referenced was from an HMO - so the 30K example that would be in that list would not be an example of a "Medicare Approved" amt. (I stand corrected) The 30K example that I was referencing was a certain stent procedure.

So the OP list of surgeries that mentioned would not be a good gauge, but even if a beneficiary were to have one of the following stent procedures done inpatient, they could have a excess charges from a non-par physician.


Here's some inpatient Medicare Approved stent proceedures with Abbott Vascular:

Medicare Hospital In-Patient Payment
Medicare hospital inpatient information is effective for the fiscal year (FY) (October 1 through September 30)
MS-DRG1

FY 2015 National Base Payment1
034
Carotid artery stent procedure with major complication or comorbidity
$21,707 (15% = $3256.05)


246
Percutaneous cardiovascular procedure with drug-eluting stent with major complication or comorbidity or 4+ vessels/stent
$18,985 (15% = $2847.75)




Here's some OP Medicare approved listed stent proceedures with Abbott Vascular:



Medicare hospital outpatient payment is effective for the calendar year (CY) (January 1 through December 31)

APC
CY 2014 National Base Payment2

0083
Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization of the Lower Extremity
$4,410 (15% = $661.50)



0104
Transcatheter Placement of Intracoronary Stent
$6,364 (15% = $954.60)



0656
Transcatheter Placement of Intracoronary Drug-Eluting Stents
$7,714 (15% = $1157.10)




I realize most providers accepting Medicare patients are participating as of now, I am just more comfortable knowing that if "assingment" is scaled back in the future, and more providers elect to be non-par, then clients would not be surprised with a Part B excess charge.

 

[axeman462]

The list for OP costs that I referenced was from an HMO - so the 30K example that would be in that list would not be an example of a "Medicare Approved" amt. (I stand corrected) The 30K example that I was referencing was a certain stent procedure.

So the OP list of surgeries that mentioned would not be a good gauge, but even if a beneficiary were to have one of the following stent procedures done inpatient, they could have a excess charges from a non-par physician.


Here's some inpatient Medicare Approved stent proceedures with Abbott Vascular:

Medicare Hospital In-Patient Payment
Medicare hospital inpatient information is effective for the fiscal year (FY) (October 1 through September 30)
MS-DRG1

FY 2015 National Base Payment1
034
Carotid artery stent procedure with major complication or comorbidity
$21,707 (15% = $3256.05)


246
Percutaneous cardiovascular procedure with drug-eluting stent with major complication or comorbidity or 4+ vessels/stent
$18,985 (15% = $2847.75)




Here's some OP Medicare approved listed stent proceedures with Abbott Vascular:



Medicare hospital outpatient payment is effective for the calendar year (CY) (January 1 through December 31)

APC
CY 2014 National Base Payment2

0083
Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization of the Lower Extremity
$4,410 (15% = $661.50)



0104
Transcatheter Placement of Intracoronary Stent
$6,364 (15% = $954.60)



0656
Transcatheter Placement of Intracoronary Drug-Eluting Stents
$7,714 (15% = $1157.10)




I realize most providers accepting Medicare patients are participating as of now, I am just more comfortable knowing that if "assingment" is scaled back in the future, and more providers elect to be non-par, then clients would not be surprised with a Part B excess charge.

Keep in mind if the provider doesn't accept assignment, Medicare pays them at a 5% discount...

 

[somarco]

I don't believe I have ever run into a hospital that does not take assignment. Pretty sure they have to take assignment if they receive any federal funds which would include from Medicaid patients.

Also, I don't think an HMO list of procedures is a good place to start since they typically are working from a much smaller universe of providers than Medicare.

FWIW I still don't buy into your argument about Obamacrap expansion leading to fewer docs taking assignment. You are entitled to your belief but I think it is overstated.

 

[kgmom219]

I don't believe I have ever run into a hospital that does not take assignment. Pretty sure they have to take assignment if they receive any federal funds which would include from Medicaid patients.

Let me throw this into the mix....Physician owned hospitals, who are allowed to turn away patients based on need. They don't have to take assignment.

There's a new one connected to the largest hospital in Dallas and requires payment prior to entrance. The Plan F/G cards are well-loved. Those stupid Advantage cards....not so much.

 

[cladams]

I don't believe I have ever run into a hospital that does not take assignment. Pretty sure they have to take assignment if they receive any federal funds which would include from Medicaid patients.

Aren't "physician's services" billed to Part B, even as an inpatient?

Also, I don't think an HMO list of procedures is a good place to start since they typically are working from a much smaller universe of providers than Medicare.

Agreed - I already conceded this point

FWIW I still don't buy into your argument about Obamacrap expansion leading to fewer docs taking assignment. You are entitled to your belief but I think it is overstated.

I think it is valid, but you are entitled to your belief.