Hospitals / Doctors now refusing to take Medicare

[Excaliber]

Are we standing by for "Patient Dumping" accusations to hit the fan any day now?

[Joe Wicked]

Originally Posted by Excaliber

Are we standing by for "Patient Dumping" accusations to hit the fan any day now?

We should be. I fully expect that the Dems will stand up and "point out" that this is why the government needs a public option, and the Reps will stand up and "point out" that this is why the public option will not work. As far as I am concerned, if doctors are actually LOOSING money (as claimed) then they have the right to not see those patients unless they agree to pay cash or have other payment.

[Ron61]

Joe,

My doctor stopped taking any new Medicare patients about 3 years ago. He will still see the ones he had before then but they are dying or moving to other states so he doesn't have many left and he said he was really going to be happy to be out of that mess. He used to have one woman that had to come in once every two weeks for some kind of a shot that back then cost about $9. Medicare would only pay $1.07 on it. So Niki, his wife called them and they told her there was a more expensive version of that show which cost around $20 and for her to turn that in and they would pay $17 on it. Now this is straight from the head of the Medicare department for Northern Calif. And they cry about fraud.

Ron

[cdnus]

I know this sounds simplistic---But why can't the Hospitals/doc's just charge their patients a Top Up fee rather than drop them stone cold to fend for themselves????
Or does medicare not allow for this practise.

Just asking

Craig

[Ron61]

Originally Posted by cdnus

I know this sounds simplistic---But why can't the Hospitals/doc's just charge their patients a Top Up fee rather than drop them stone cold to fend for themselves????
Or does medicare not allow for this practise.

Just asking

Craig

I am not sure about how other places do it, but I pay my doctors bills in cash and get a pretty good break on the charges. Saves them the work of submitting papers and then waiting to see what amount they may get. Plus all of the laws this state has added are adding to the cost. A good example was when I went in last year for blood work. Mary brought the two capsules and needle in to take my blood and they were sealed in plastic. They were on a tray about 10" from me and Ron stopped and asked her a question and she was never more than a foot from the tray. But because she had taken her eyes off the darn things for that second or so, she had to throw them in the waste bin still sealed in plastic and get another set. I asked Ron about it and he said it just wasn't worth taking a chance on having his license pulled if anyone happened to see she wasn't looking at them every second and told the medical board. Basically the same for my dentist. He can only use certain tools more than once, and once that law went into effect the manufacturers immediately tripled the price of those tools. Then he had to pay a ton of money for some kind of ultra sonic oven to clean other stuff with and keep a log which has to be sent in monthly.

Ron

[Anthony]

Originally Posted by cdnus

I know this sounds simplistic---But why can't the Hospitals/doc's just charge their patients a Top Up fee rather than drop them stone cold to fend for themselves????
Or does medicare not allow for this practise.

Because that would then be fraud. Every medical service has a code associated with it, and each code is reimbursed by medicare for a set fee as determined by them. To "up-Charge" would be to bill for a higher reimbursement code that was not actually provided, and therefore be considered fraud. If you are audited by medicare, they go through your charts and billing to see if you have the proper documentation supporting your charges. If there are discrepenceies, favoring the doctor, they are considered fraud, and I think are subject to a $5000 fine for EACH OCCURANCE.

When a hospital or doctor signs up with Medicare, Medicaid, BWC, or any insurance company, what they are doing is agreeing to accept a set reimbursement fee set by the insurance provider such that the medical provider cannot bill the patient in excess of this. The only way to get around this is to "opt out", that is, terminate the agreement making the patient fully responsible, with the exception if the insurance provider provides "out-of-network" benefits, then the insurance will pay part of the bill. Medicare, Medicaid, BWC have no out of network benefits, as with some other insurance plans, and therefore the patient owes the full balance unless the medical provider grants a discount for cash pay.