Medicare Allowable Causes Increased Costs

[GreenSky]

Yes, it's is the artificially low reimbursement rate from Medicare that forced providers to seek higher reimbursement from private insurance. Once again it is the government that has destroyed the best medical system in the world.

Case in point. My mother went to see her doctor for a brief office visit. The doctor billed $100 (and I suspect that's why my private insurance would allow). Medicare reduced this to their allowable of $21.30. Medicaid and payments through the exchange are similarly low.

Yes children. $21.30 for an office visit to see a doctor. After costs that's probably not much more than the idiots in Seattle require for minimum wage.

In order for a doctor to keep his/her doors open they must receive a higher reimbursement from other sources. They must run test after test just to make enough to pay their staff.

I primarily sell Medicare plans, both supplements and MA. However I would gladly change my focus to get the government out of insurance. Social programs don't work. Medicare has no trust fund. Social Security is bankrupt. Our roads are crumbling and money spent on the drug war is a waste.

Now I know there are those on the forum that think agents are opposed to Obamacrap and other government insurance programs because we don't make enough commission. Those agents are also known as (and I'll be very kind) uninformed.

Rick

 

[midwestbroker]

What I see occurring in the field are providers billing for additional test that may or may not be needed or even performed.

The challenge to Medicare is proving this. I have seen statements that have been false and my clients have not cared because they did not have to pay anymore nor did they want to lose their provider or get them in trouble.

 

[insuranceconceptscindy]

This is just the beginning. It's going to get so much worse before it gets better. There was another article here about patients walking into doctor's offices, flashing their new insurance cards like an Amex Black. Get all the tests done, and conveniently forget to pay their premium- doctors will be screwed.
What's the alternative?

 

[Todd King]

The waste and abuse in Medicare alone has been going on for many years now. Many doctors have run un-needed tests for a long time now. It is how they make more money, that's for sure.

 

[insuranceconceptscindy]

This is just the beginning. It's going to get so much worse before it gets better. There was another article here about patients walking into doctor's offices, flashing their new insurance cards like an Amex Black. Get all the tests done, and conveniently forget to pay their premium- doctors will be screwed.
What's the alternative?

 

[VolAgent]

You should read your own EOB more often.

I have seen private insurance do similar slashing to doctor's bills. It may not be so severe to the main portion, but they routinely disallow or greatly reduce all the "add-ons". A big one I see are fees related to testing.

It takes two to tango. Billing adds on numerous fees they know they won't be paid, and the insurance company goes through and disallows them and you end up with the negotiated rate.

 

[somarco]

Most insureds (including Medicare) beneficiaries view fraud as a victim-less crime. It's not THEIR money being wasted, it's the insurance carrier or Medicare and everyone knows they have deep pockets.

Until the patient has some skin in the game there is no interest in reading EOB's and reporting fraud.

 

[VolAgent]

Most insureds (including Medicare) beneficiaries view fraud as a victim-less crime. It's not THEIR money being wasted, it's the insurance carrier or Medicare and everyone knows they have deep pockets.

Until the patient has some skin in the game there is no interest in reading EOB's and reporting fraud.

How would you even know it is fraud? The EOB is generally coded so unless you know medical coding, you don't have a clue what half the charges are.

 

[unic.consulting]

Most EOBs now have the description next to the code, and if someone's really interested, they can easily look it up online in a minute.

 

[sman]

This is just the beginning. It's going to get so much worse before it gets better. There was another article here about patients walking into doctor's offices, flashing their new insurance cards like an Amex Black. Get all the tests done, and conveniently forget to pay their premium- doctors will be screwed. What's the alternative?

It's going to get better?