Medicare

[kellyt]

I'd like to know if I should expect EOB's from Medicare?  I've been active on Medicare since Nov. 2008 and I want to be sure that the transplant hospital and clinic are billing Medicare as my secondary properly.

What exactly does Medicare cover as my secondary post-transplant?    Thanks.





EDITED:  New Topic created in appropriate section, Bajanne, Moderator

[dialysisbiller]

I'd like to know if I should expect EOB's from Medicare?  I've been active on Medicare since Nov. 2008 and I want to be sure that the transplant hospital and clinic are billing Medicare as my secondary properly.

What exactly does Medicare cover as my secondary post-transplant?    Thanks.

Well, it works like this (and i hope this does not confuse you).... Medicare does not normally pay as a secondary to a primary commercial insurance, there are a few exemptions, exhausting lifetime or yearly benefits or pre-existing condition clauses(only when primary commercial insurance denies you for that).... then if your primary coverage only allows less than what medicare would allow (which RARELY happens)... then Medicare can be billed as a secondary, until the COB is over.... course, if you were eligble/entitled to Medicare due to ESRD, you have a COB up to 33 months (but there's many different variables that can shorten or lengthen a COB period, it's an individual thing to calculate) if you've had a transplant, you will have up to three years, once that three years passes after a successful transplant, then you are no longer considered eligible for medicare, which by chance IF your kidneys again fail and you are back on dialysis due to ESRD, the COB starts all over again. (confused yet?)

Hopefully it made a little sense to you.

[Rerun]

I had Blue Cross Blue Shield (FEHB) as my primary insurance for my first 30 months of dialysis.  I would get a EOB with the submitted charges for 1 month up to  $44,000.  But my insurance only paid $5,000.  If the dialysis center (DaVita) knows my insurance only allows $5,000 a month why do they bill $44,000 or a Million....they know they will get $5,000.  Is it so they can claim they don't earn a profit as to evade taxes?

[BigSky]

I'd like to know if I should expect EOB's from Medicare?  I've been active on Medicare since Nov. 2008 and I want to be sure that the transplant hospital and clinic are billing Medicare as my secondary properly.

What exactly does Medicare cover as my secondary post-transplant?    Thanks.

You should get EOB's if medicare is being billed.  You can also go to the Medicare site and register and look at the EOB's online.

[Zach]

You should get EOB's if medicare is being billed.  You can also go to the Medicare site and register and look at the EOB's online.

Excellent point BigSky.

 

[kellyt]

Because the insurance companies hold all the cards, Rerun.  This is the way it was explained to me when I first started workig for a doctor's office.

Let's say a doctor charges $10,000 for a wart removal (not too far fetched, actually).
And the insurance pays $3,000 for that same procedure.

So the doctor's office decides to only charge the $3,000, like you suggested, because they know that's all the insurance is going to pay.
Then the insurance company sees that now they are charging $3,000.  They (the insurance company) now says "That procedure can be done for $3,000?  Well, then we're only going to pay $1,000.  And so it goes...

The insurance companies are the SOB's (in my opinion), not the doctor's.

My   

Now keep in mind this is how it was explained to me by a DOCTOR.  I'm sure someone in INSURANCE will have a whole different reason/story/explanation/excuse/etc.  Regardless, it's a messed up system.  Period.

[dialysisbiller]

Amen! someone else sees it!

It's the insurance companies that run things. Everyone is so quick to jump on billing procedures and practices but we have to dance the dance with them in order to get paid even at the minimum level.... and don't get me started on Medicare assigned plans such as Humana or United Health Care.

I'm torn between having a national health plan and keeping it the way it is. I'm sorry but I believe the quality of care will drop if it is nationalized and the way it is now is such a strain financially on normal everyday people like you and me.