A client living in the State of Kansas shared a Medicare incident that occurred during February 2011 involving a large regional hospital. She complained of having a persistent abdominal pain in her left side. The doctor ordered a 1.0 Ct abdominal and pelvic image w/contrast. The hospital administered the test on February 11, 2011, which took no more than 15 minutes. A few months later she received a notice from Medicare that the total billing amount of $4,675 was denied. She contacted her doctor’s office inquiring why the hospital charged such an outrageous amount for the test. She never heard back from her primary doctor’s office.
Since no one replied and no more statements were sent, shewondered who paid it, if anyone. Then to her surprise she received another Medicare Summary notice earlier this month saying “time limits for filing the claim has expired therefore appeal rights are not applicable for this claim.” She was curious as to why the hospital never followed up so she called Medicare, and asked what was the allowable charge for her procedure. She was told that the allowable charge for a CT scan in Kansas ranged from $241.94 up to $264.30, but the Hospital never submitted an appeal on the claim and the time limit had expired.
My client was still not satisfied and wanted to know if the hospitalmade a mistake on the initial charge. She called the hospital’s billing person and was told, yes the charge of $4,675 is the correct charge for your procedure but when we received the Medicare notice that the time limit for filing an appeal on the claim had expired, we just wrote it off and you owe nothing. My client was relieved to know she did not owe anything, but she is still perplexed why the hospital had the audacity to bill Medicare for $4,675 when the hospital was a participating Medicare hospital meaning that they already have an agreement to accept Medicare’s assigned amount for this procedure which is no more than $264.
This may be an isolated case, but I hardly doubt it. If you wonderwhy we have some major issues with medical costs, this case brings up an interesting example of how some hospitals overcharge for services in certain situations. Be vigilant with your Medicare bills, and don’t be afraid to question outrageous charges like this one if you are ever confronted with a similar situation.
Word to the wise: Read your Medicare Summary Notice. Or betteryet, if you have questions about a bill that seems excessive, call Medicare at 1-800-633-4227 and ask for Doctor Services. My client says she feels much better knowing that she doesn’t owe anything on the bill, but she’s concerned about these excessive costs because the hospital billing department told her that this $4,675 amount billed is a customary charge for the CT scan. She wonders now if other Medicare beneficiaries were ripped off by the hospital with bills for other services provided, especially since she never heard back from her primary doctor who referred her to the hospital in the first place. I’d call this sloppy medical bookkeeping and not good follow up to a patients question about a bill that seemed out of line.
Don’t be afraid to ask your doctor, What is Medicare’s assignedamount for this service before you have it done. The billing department should be able to tell you, but very few of us ever ask what anything costs. We just sign in, and the receptionist says this bill will be sent to Medicare. Start asking all of your medical providers, how much will this cost? We are living in a “credit card” mentality world with Medicare ,believing someone else will pay this, not sure who, but it’s not me. That kind of thinking in my opinion is one of the major weaknesses of our health care system in America.
I believe if everyone knew they were required to make an out ofpocket co-pay right up front, no matter how small and based on ability to pay, we’d start asking, “what does this cost”? Or we might even decide that this expensive procedure may not be necessary. This is why I am promoting the high deductible Medicare Supplements to my clients who don’t have ongoing excessive co pay medical situations prior to their entry into the Medicare system. I see High Deductible Medicare Supplements on the horizon to alleviate some of the credit card mentality that persists with many Medicare beneficiaries, and until we put some “skin in the game” in the form of a co-pay, we’ll go on not knowing what was charged and what was paid as long as it didn’t come out of my pocket.
Coach
