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I received radiation therapy for prostate cancer. Thirty eight sessions. My co pay was low but the total bill was $50,000 Does medicare pay the whole amount of what a reputable hospital charges or do they have deals to pay just a portion.
How much and how much of what Medicare will pay depends on whether it is "traditional" (also called "original") Medicare or a Medicare Advantage plan and, if the latter, what the plan documents say. The first 20 days of the hospital stay itself are covered by traditional Medicare while a copay is required for the first four days by Medicare Advantage plans. Most Medicare Advantage plans pay 80% of "reasonable and necessary" services "in network" (by contracted providers and hospitals) and 40% for those "out of network." Examine the bills and get a copy of "Medicare and You 2016" from the Center for Medicare and Medicaid Services (CMS). If the plan is a Medicare Advantage plan, ask for a copy of the list of providers and the formulary (meds covered and at what rate). If you think there is a mistake, appeal within 30 days.
Medicare A will pay 80% of hospital charges. Medicare part B covers outpatient treatments @ the same amount, I believe. Make you you have A and B, B requires a monthly premium that is usually paid directly out of your social security. I recommend getting a Medigap policy of some sort than will cover a portion of the 20% Medicare doesn't cover and even with this you will probably be financially responsible for something. Good luck!
Tom, I am moving your question back to the front of the list since it's been 3 days without an answer.... hopefully someone who is familiar with this can answer you.
When you get the "final bill"--then you can call and make arrangements for payment of what you'll owe. Hospitals will often work with you. I NEVER took a hospital bill as the final word. AND I would go over that bill with a fine tooth comb. MANY times there were double charges and charges for things never received. You will be held responsible for some of that balance--but you won't know until Medicare kicks in their portion.
Try not to worry, right now about this. I know that's easier said than done, but stressing out doesn't help. Good luck to you in your recovery.
If I understand the question correctly, the OP is asking how much Medicare will pay the hospital for his treatment. The short answer is that Medicare has a schedule of payments and they pay providers according to that schedule. You should get a "Medicare Summary Notice" which lists the charges, the amount Medicare approved, the amount Medicare paid (usually 80% for traditional Medicare) and the amount you may be billed. If you have a supplemental insurance policy, that 20% will be paid by that policy assuming that you have met any deductible. For example, a recent office visit was billed at $180.00, Medicare approved $100.58 and paid $78.85. $20.12 is billed to the patient or to his or her supplemental insurance. The provider gets $98.97 of the original $180.00 charge. I am reading this directly from a summary notice and I do not know why the amounts do not add up to the $100.58 approved by Medicare.
My Mom was recently in the hospital for five days and the cost was 75,000. Medicares maximim was much much much less. Then they took 20percent of what they considered resonnable. Then her supplimental based their payment on Medicares allowed amount and left her a balance of $600. Medicare did this with the doctors and then the doctors made adjudtments and Mom has paid no more than $20 to them. You really need to wait for Medicares summary then your supplimental for your final amount u will owe. Good Luck.
I have personally never dealt with cancer treatments but I worked for 10 years doing medical insurance billing for Ophthalmologists so I can tell you generally that Medicare never pays 100% of any charge. Each year doctors and facilities get new updated payment details from Medicare which are generally lower than the previous year. As an example: If you have a surgery and the doctor charges $2,500 for the surgery, Medicare may say their reasonable charge for that surgery is $1,000. So if the doctor is participating with Medicare he must adjust off $1,500 from the surgery. Now the $1,000 surgery charge is not paid 100% by Medicare, they only pay 80% or $800. You are responsible to pay the remaining 20% or $200. This is why you have to have a secondary insurance to pick up the remaining 20% unless you are willing to just pay it out of your pocket.
Now Medicare does not cover EVERYTHING, you will find there are treatments or surgeries or medical supplies that Medicare just does not cover, so when anyone tells you that you need to have something done, you have to ask them if it is covered by Medicare, if it is not, you are responsible for payment in full. In our office, Medicare did not cover eye refractions to get glasses, it was a non covered charge, so the patient is responsible for payment in full.
Doctors and Facilities also have to participate with Medicare, like joining their plan. This means they agree to accept the Medicare allowable and adjust off the amount Medicare tells them to. If your doctor or facility does not participate with Medicare, you will be billed the full amount and you are responsible for paying it.
In your instance, it sounds like your treatment was covered and you only have to pay the remaining 20% (copay). If you have a secondary insurance carrier like AARP or any other medical insurance, they should be billed for the copay and see if they will pay it.
Many secondary insurance plans unfortunately now do not cover the remaining 20% that Medicare does not pay. To me this is almost fraud because why would you want to pay for a secondary insurance plan if it is not going to cover the remaining balance? It is like they are taking your money for nothing....this actually does happen. So if you decide to purchase a secondary insurance, make sure they do cover the remaining 20% medicare does not cover!
I hope I have made this simplistic enough for everyone to understand without confusion. Good Luck and Best Wishes for a full recovery!
Medicare pays what the list as usual and customary-which means they pay a reduced amount. Then you may be responsible for 20% of that amount, not $50,000. Most facilities will work out a payment plan. Here is the answer directly from Medicare: "As an inpatient, you pay the Part A deductible and coinsurance (if applicable). As an outpatient, you pay a copayment, and the Part B deductible applies. For therapy at a freestanding facility, you pay 20% of the Medicare-approved amount for the therapy, and the Part B deductible applies." Hope that helps.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
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APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
I recommend getting a Medigap policy of some sort than will cover a portion of the 20% Medicare doesn't cover and even with this you will probably be financially responsible for something.
Good luck!
You will be held responsible for some of that balance--but you won't know until Medicare kicks in their portion.
Try not to worry, right now about this. I know that's easier said than done, but stressing out doesn't help. Good luck to you in your recovery.
Now Medicare does not cover EVERYTHING, you will find there are treatments or surgeries or medical supplies that Medicare just does not cover, so when anyone tells you that you need to have something done, you have to ask them if it is covered by Medicare, if it is not, you are responsible for payment in full. In our office, Medicare did not cover eye refractions to get glasses, it was a non covered charge, so the patient is responsible for payment in full.
Doctors and Facilities also have to participate with Medicare, like joining their plan. This means they agree to accept the Medicare allowable and adjust off the amount Medicare tells them to. If your doctor or facility does not participate with Medicare, you will be billed the full amount and you are responsible for paying it.
In your instance, it sounds like your treatment was covered and you only have to pay the remaining 20% (copay). If you have a secondary insurance carrier like AARP or any other medical insurance, they should be billed for the copay and see if they will pay it.
Many secondary insurance plans unfortunately now do not cover the remaining 20% that Medicare does not pay. To me this is almost fraud because why would you want to pay for a secondary insurance plan if it is not going to cover the remaining balance? It is like they are taking your money for nothing....this actually does happen. So if you decide to purchase a secondary insurance, make sure they do cover the remaining 20% medicare does not cover!
I hope I have made this simplistic enough for everyone to understand without confusion. Good Luck and Best Wishes for a full recovery!
"As an inpatient, you pay the Part A deductible and coinsurance (if applicable). As an outpatient, you pay a copayment, and the Part B deductible applies. For therapy at a freestanding facility, you pay 20% of the Medicare-approved amount for the therapy, and the Part B deductible applies." Hope that helps.