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How do these medical bills get paid ? |
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steve(ill)
Orange Level Access Joined: 11 Sep 2009 Location: illinois Points: 80038 |
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Posted: 19 Aug 2024 at 9:30pm |
Wife broke her ankle.. or the bone above the ankle a couple weeks ago. Local hospital took xrays, put her in an ambulance and shipped to THE BIG CITY Hospital.. They did the surgery and kept her a week, then sent her to rehab for a week to learn to walk on one foot with a walker / wheel chair.
We have AETNA with Medicare for coverage.. Started looking at the Bills and Payments ONLINE today.. Surgery bill is $8000. and Aetna/ Medicare payed $1500. I pay ZERO.... Hospital bill was $3500. Aetan/Medicare pay $1200. I pay ZERO.. OK, i know that "emergencies" are normally covered 100% and "I dont pay"... but how did Aetna/ Medicare get the APPROVAL for 20- 30% payments to be ACCEPTABLE ?? Did the hospital just LOOSE OUT, or how does this work ?? Does anybody REALLY KNOW ?
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Like them all, but love the "B"s.
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Tbone95
Orange Level Access Joined: 31 Aug 2012 Location: Michigan Points: 11536 |
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Years ago before my wife became a nurse, she was a medical secretary for a surgeon. She did a lot of the billing to the insurance companies. They would purposely bill much higher than they KNEW the insurance was going to pay because if they billed closer to what they thought would be paid the insurance would simply pay much less than that. Total cat and mouse game!
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tadams(OH)
Orange Level Access Joined: 17 Sep 2009 Location: Jeromesville, O Points: 10005 |
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Like my old doctor used to talk, it's a game the medical people have to play with insurance companies
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AC7060IL
Orange Level Joined: 19 Aug 2012 Location: central IL Points: 3322 |
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First hand experience ~ If patient is “cash pay”, meaning they have no insurance, then medical has entirely different payment schedule that usually reduces by huge percentages.
Why so low? Here’s probably the main reasons. 1. Medical gets payment faster thru cash. Insurance/coding can delay payments for years. 2. Excludes middle people. No “medical coding” to be performed, evaluated, re-evaluated, etc… 3. No expense for Doctors/Medical groups to hire coding group. 4. No insurance expense to Doctors/medical group to have their accounts payable / accounting / liaison persons interacting with coding & insurance group to concur about prices. Samaritan Ministries is a Christian health share group. We have been members for 5+ years. Members monthly share (their dollars) get mailed directly to other members who have medical needs for 11 months of the year. Some months our dollars get mailed to Texas, or South Dakota, or California, or wherever. One month a year, all member’s monthly share goes to Peoria IL’s staff to pay administrative salaries, website expense, etc. Administration coordinates all needs & shares. Mails each member a monthly notice that explains which household is in need, which person in that household is in need, briefly describes their need, gives a dollar amount that we should mail to that family’s address. Pretty simple. Wife & I have both been on receiving end of shares (members checks) which arrive by mail with thoughtful prayer from faithful members If you’re interested, go to this link [URL=[URL=https://samaritanministries.org/resources/classic-basic-guidelines%5d]https://samaritanministries.org/resources/classic-basic-guidelines][/URL]https://samaritanministries.org/resources/classic-basic-guidelines[/URL] Edited by AC7060IL - 20 Aug 2024 at 3:25pm |
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NDBirdman
Orange Level Access Joined: 30 Jul 2011 Location: ND Points: 1376 |
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It's a game of screw the guy without insurance! I've recently underwent 2 surgeries, hospital billed in several different charges, about 15k for each. My insurance sends copies of these bills to me showing what they want and what's actually paid. Hospital gets paid on each around 1.6k. Insurance says I don't pay anything as I'm 100% covered. If I didn't have this insurance, the hosp. would come after me for those bills. What I get from the bills is what's paid is what is allowed by medicare, eat the rest even though I'm not covered by medicare they (VA) go by their schedule of charges allowed.
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1955 WD45 S#205467, 190XT #6652 DXT
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Coke-in-MN
Orange Level Access Joined: 12 Sep 2009 Location: Afton MN Points: 41466 |
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It's a big game : In last 8 months of my wifes life , in the first 2 months she used 100% of drug and donut hole prescription coverage of policy
3 trips to hospital and 2 stays in recovery facilities for 2 weeks each time semi-private room Then in 8th month Hospice - which is total on Medicare or not part of insurance Total bill was $980,000 - Medicare said most hey would pay was $550,000 Final bill insurance paid $220,000 My total out of pocket was $3,000 and that was for the drug coverage in the first 2 months Now figure what a person with no insurance would pay or with Standard Medicare which is a 80/20 type paying system |
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Faith isn't a jump in the dark. It is a walk in the light. Faith is not guessing; it is knowing something.
"Challenges are what make life interesting; overcoming them is what makes life meaningful." |
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steve(ill)
Orange Level Access Joined: 11 Sep 2009 Location: illinois Points: 80038 |
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Thats my question.. Do you think the guy WITHOUT insurance is really paying that HIGH COST ?? Like mentions, if you pay CASH , you would expect a discount... If the hospital accepts 25% payment from the Insurance Company, WHY not do the same for individual ??
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Like them all, but love the "B"s.
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Lars(wi)
Orange Level Access Joined: 14 Sep 2009 Location: Permian Basin Points: 7050 |
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Probably a tax evasion move on the part of the hospital. If you have someone without the ability to pay, seeking care, charge the living daylights for the care. $15.00 for an aspirin, $1000.00 for a check-up, no pay no problem, the hospital has $1015.00 they put down as ‘bad debt’ against earnings.
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I tried to follow the science, but it was not there. I then followed the money, and that’s where I found the science.
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steve(ill)
Orange Level Access Joined: 11 Sep 2009 Location: illinois Points: 80038 |
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Got 3-4 more BILLS approved.. So far AETNA/Medicare has paid EVERYTHING... Not a dime on my part ( except gas to get back and forth to the hospital !!)
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Like them all, but love the "B"s.
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Tbone95
Orange Level Access Joined: 31 Aug 2012 Location: Michigan Points: 11536 |
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Aren’t most hospitals “not for profit “ and therefore does this action really mean anything? I don’t know, I’m not a tax expert especially for nonprofit. There’s a guy here at work whose wife is a medical train wreck. Numerous exotic expensive surgeries, drugs, therapy…. His medical expenses are in the 100’s of thousands, probably pushing a million now since I haven’t talked to him about it in a few years. This is AFTER our insurance has paid. He gets bills in the mail, huge balances, threats of collection agencies, etc. He just laughs and sends them $50. Will never be paid off. Not remotely possible. But if he sends them money every time they ask it just rolls over to the next month. So there’s this and the whole can’t refuse treatment thing in this as well. Lots going on. |
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