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jim456c

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A little off topic but these forums probably have many seniors to comment on this...
I had an accident 4 months ago and Medicare paid for it minus a small amount by Medicaid....It was a trauma injury accident and required emergency 2 hour surgery and 2 day hospital stay and follow up. I recently got a summary of this claim in the mail and the numbers were ridiculous and it isn't hard to see why the American healthcare system will eventually collapse. The small city hospital had about 30 different charges and the grand total was 53,000$. I am liable for 600$ according to my notice. There were 4 columns and they were Service approved/Amount facility charged/Medicare approved amount/Amount Medicare paid/.
The only amount that shows Medicare paid is 2599$ which is one of the surgery repair items. Its easy to see the absurd overcharging but is that ALL
that Medicare is going to settle with the hospital? Is that normal? I mean the hospitals charge 20 times reasonable in order to get a settlement like that? We all know that no insurance company pays all that a doctor bills for..they get what they are given..period..if anyone here knows how Medicare works or has worked in medical billing.....does this sound like all that Medicare is going to pay?? Please comment fully..
 

seeking.IAM

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.Gov pays "usual and customary charges" for a service, not a provider's rate. Providers will argue that "usual and customary charges" are neither usual or customary. I am unsure about Medicare rules, but if you are a Medicaid provider, you agree to accept Medicaid's rate and are prohibited from passing additional charges on to the patient. That is why there are providers that won't accept Medicaid.
 
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linux.poet

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AMBASSADOR HAT

This thread has been moved from Physical & Life Sciences to Golden Eagles (age 50 or over as of 2019). That section is a good place to find seniors who are able to comment on this thread/situation.

(Also, this thread isn't really about physical or life sciences, it's about healthcare and politics.)
 
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joymercy

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The hospital often accepts what Medicare pays and then bills Medicaid for any balances after that.

After Medicaid pays something, the left over balance is your co-payment.

$600 is now your co-payment and you are responsible for this balance.

Call the billing department and ask if there is any charitable help available to help you reduce the final co-payment.
 
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