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Author Topic: Medicare Co-pays  (Read 399 times)

zxcvbob

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Medicare Co-pays
« on: February 24, 2021, 08:32:46 PM »

I took my mom to a neurology appointment today (a worthless appointment, it should have been handled over the phone but we didn't know that; they just reviewed an X-ray taken elsewhere and we didn't even see the doctor)  She has traditional Medicare parts A & B, and probably a prescription plan if drugs are not part of B.  The receptionist demanded a $100 copay up-front.  I told her to just send us a bill if there was anything left after Medicare and CMR paid.  She didn't like that; called their insurance people.  They actually called us back to reception after the nurse had called us back and was taking mom's vitals.  If I hadn't paid at that point I really think they would have called security and thrown us out.  WTF?

If I was the patient rather than Mom, I would have walked out and they could have forfeited both the Medicare money and the $100.  I asked if they took credit cards because if they didn't trust us to pay our bills, I didn't trust them to give them cash. (and if Medicare pays the whole thing and there is no copay, I can dispute the charge and claw the money back)

Is this normal and I've just never dealt with it before?  Mom said as far as she knew it was a first.  Usually my brother takes my parents to their appointments and he'd never heard of it either.

I may call the neurologist tomorrow and give him a piece of my mind.
"It's good, though..."

BobR

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Re: Medicare Co-pays
« Reply #1 on: February 24, 2021, 08:46:10 PM »

A few things.

Maybe the Doc doesn't take Medicare, some don't.

IIRC Medicare A only pays for 80% of the allowed charges, the patient is responsible for the other 20% either through a supplement or self pay.

Calling the Neurologist won't help, you need to speak to their office manager and I would do just that.

What they did was allowed.  http://www.medicarepaymentandreimbursement.com/2013/10/can-provider-collect-medicare.html

You need to find out if your mother has a supplemental plan and find out how it works and what they pay.

bob

Grandpa Shooter

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Re: Medicare Co-pays
« Reply #2 on: February 24, 2021, 08:52:37 PM »

I have both Medicare and Tricare (military retiree medical plan) Since I turned 65 I have only had a charge of $125 as a new patient fee with a urologist.  I get shots regularly and never get charged.  Since my primary private health care is always charged first to Medicare my providers always bill Medicare and I never get charged a co-pay, they accept the Medicare payment.  I would talk to the office manager, or their billing service, whichever can give the best explanation.  Don't bother with the neurologist, they know nothing of how the office is run.

zxcvbob

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Re: Medicare Co-pays
« Reply #3 on: February 24, 2021, 08:54:24 PM »

A few things.

Maybe the Doc doesn't take Medicare, some don't.

IIRC Medicare A only pays for 80% of the allowed charges, the patient is responsible for the other 20% either through a supplement or self pay.

Calling the Neurologist won't help, you need to speak to their office manager and I would do just that.

What they did was allowed.  http://www.medicarepaymentandreimbursement.com/2013/10/can-provider-collect-medicare.html

You need to find out if your mother has a supplemental plan and find out how it works and what they pay.

bob

Thanks.  She does have a supplemental plan but I don't know what it pays; I've never dealt with Medicare before (I'm still about 4 years away.)  Sounds like I should call the supplement plan first to see if there really is a copay.

Also from the link you just gave it looks like they were in violation of this part:

"Requiring Prepayment as a Condition of Admission is Prohibited
Providers must not require advance payment of the inpatient deductible or coinsurance as a condition of admission. Additionally, providers may not require that the beneficiary prepay any Part B charges as a condition of admission, except where prepayment from  non-Medicare patients is required. In such cases, only the deductible and coinsurance may be collected."
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BobR

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Re: Medicare Co-pays
« Reply #4 on: February 24, 2021, 09:15:41 PM »

Thanks.  She does have a supplemental plan but I don't know what it pays; I've never dealt with Medicare before (I'm still about 4 years away.)  Sounds like I should call the supplement plan first to see if there really is a copay.

Also from the link you just gave it looks like they were in violation of this part:

"Requiring Prepayment as a Condition of Admission is Prohibited
[/b]Providers must not require advance payment of the inpatient deductible or coinsurance as a condition of admission. Additionally, providers may not require that the beneficiary prepay any Part B charges as a condition of admission, except where prepayment from  non-Medicare patients is required. In such cases, only the deductible and coinsurance may be collected."


That is for inpatient admission. Outpatient visits are different, where they can collect up front.

bob

BobR

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Re: Medicare Co-pays
« Reply #5 on: February 24, 2021, 09:18:32 PM »

I have both Medicare and Tricare (military retiree medical plan) Since I turned 65 I have only had a charge of $125 as a new patient fee with a urologist. I get shots regularly and never get charged.  Since my primary private health care is always charged first to Medicare my providers always bill Medicare and I never get charged a co-pay, they accept the Medicare payment.  I would talk to the office manager, or their billing service, whichever can give the best explanation.  Don't bother with the neurologist, they know nothing of how the office is run.

I don't believe you should have had that charge, Medicare is your primary and TFL will pick up your copay. I would call and talk to the office manager and maybe drop the words Medicare fraud and see how fast the can come up with answer. Just my 2 centavos worth of sketchy knowledge.

bob

Grandpa Shooter

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Re: Medicare Co-pays
« Reply #6 on: February 24, 2021, 09:28:29 PM »

I don't believe you should have had that charge, Medicare is your primary and TFL will pick up your copay. I would call and talk to the office manager and maybe drop the words Medicare fraud and see how fast the can come up with answer. Just my 2 centavos worth of sketchy knowledge.

bob

I have had two $40,000+ hospital bills in the last four years and not been charged a penny for the hospital or the Doctor/Surgeons.  I don't mind paying $125 in that same time frame.  I feel sorry for the the folks who have little to no insurance and go bankrupt paying for medical care and medicines.

MillCreek

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Re: Medicare Co-pays
« Reply #7 on: February 24, 2021, 09:33:40 PM »

All of the outpatient clinics now place a high priority at collecting the copay at the time of service.  Both the Feds and the private insurance companies require the clinic to make a good faith effort to collect the copay, and there is abundant data that you get a higher rate of collection if get it at the actual visit.  So what they did is completely legal and standard practice in the industry.
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

charby

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Re: Medicare Co-pays
« Reply #8 on: February 24, 2021, 09:49:48 PM »

MercyOne?
Iowa- 88% more livable that the rest of the US

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dogmush

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Re: Medicare Co-pays
« Reply #9 on: February 25, 2021, 09:07:16 AM »

Not to be a dick, but what is the problem?

Every Healthcare provider I've ever been to wants the Copay at the time of service.

Hell, every provider of any service wants the money at the time of service.  My massage therapists expect to be paid at the visit,  Mechanics will let you pay at the end, because they are hoping to add services, but you aren't driving home and waiting for a bill.  Walmart expects to be paid before you leave.  Dog groomers, roofers, pretty much everyone, unless you are on some kind of subscription.

Why would you not expect to pay the copay at the time of the visit?

zxcvbob

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Re: Medicare Co-pays
« Reply #10 on: February 25, 2021, 09:43:29 AM »

Not to be a dick, but what is the problem?

Every Healthcare provider I've ever been to wants the Copay at the time of service.

Hell, every provider of any service wants the money at the time of service.  My massage therapists expect to be paid at the visit,  Mechanics will let you pay at the end, because they are hoping to add services, but you aren't driving home and waiting for a bill.  Walmart expects to be paid before you leave.  Dog groomers, roofers, pretty much everyone, unless you are on some kind of subscription.

Why would you not expect to pay the copay at the time of the visit?

That's a good question.  The answer: I've never encountered it before. All of my doctors bill the insurance company first and then I get a bill afterwards.  And I don't know that Mom really has a copay.  She's had some pretty big medical expenses already this year and should easily have met any deductible. 

Forget about the supplemental insurance for just a minute, we'll come back to it; Medicare pays 80%.  This was a 10 minute office visit with a PA, not an MD.  Does that cost $500?  (giving a copay of $100)  Especially at the Medicare rate.  Let's say it does; in fact the office visit is $650 (pulling a number from my 4th point of contact) and that is the Medicare rate.  So M pays $520 and sends a $130 bill to the supplemental insurance, and then they pay something.  I doubt that $100 is left after that, but I don't know.

Basically I got blindsided and thought we were being treated poorly.  And it didn't pass the smell test.  I'm just glad I had a credit card with me.
« Last Edit: February 25, 2021, 09:58:00 AM by zxcvbob »
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dogmush

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Re: Medicare Co-pays
« Reply #11 on: February 25, 2021, 11:11:31 AM »

I completely understand not wanting to be blindsided, and being concerned they are charging you incorrectlly.  Med insurance payments are hard to keep track of at the best of times, and getting the Feds involved doesn't help.

I read :
Quote
  I asked if they took credit cards because if they didn't trust us to pay our bills, I didn't trust them to give them cash.

as being more upset that they wanted the money at time of service rather than being willing to bill you later.  Perhaps I inferred too much into your statement.

FWIW, every healthcare practitioner (except ER's) I've been to in the last 15 years wants the Co-Pay at time of visit, and will still bill you later if insurance doesn't pay enough.

MillCreek

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Re: Medicare Co-pays
« Reply #12 on: February 25, 2021, 11:34:18 AM »

Here is an important PSA for all:

Due to security concerns (theft, robbery, internal shrinkage, transporting) more and more healthcare facilities are not taking cash for co-pays or bill payment any more. Cards only accepted.
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MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

BobR

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Re: Medicare Co-pays
« Reply #13 on: February 25, 2021, 11:56:56 AM »


FWIW, every healthcare practitioner (except ER's) I've been to in the last 15 years wants the Co-Pay at time of visit, and will still bill you later if insurance doesn't pay enough.

Exactly, every outpatient provider I have been to has had a sign predominately posted that says something like "Co-Pay due at time of visit" .

ERs don't because of the Emergency Medical Treatment and Labor Act that was enacted in the late 80s. Any facilities that the act applies to can get in deep poop PDQ if they violate the act, commonly referred to as EMTALA.

bob

zxcvbob

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Re: Medicare Co-pays
« Reply #14 on: February 25, 2021, 12:37:11 PM »

Exactly, every outpatient provider I have been to has had a sign predominately posted that says something like "Co-Pay due at time of visit" .

ERs don't because of the Emergency Medical Treatment and Labor Act that was enacted in the late 80s. Any facilities that the act applies to can get in deep poop PDQ if they violate the act, commonly referred to as EMTALA.

bob

Okay, I'm just an idiot :)  I'm actually fine with that.  Mybe I have just been lucky to only have to deal with healthcare providers where I have an account.

How does the clinic know what my copay is supposed to be?  Especially with a small retirement plan company for the supplemental part?  Doesn't really matter that much, but anybody know?  I didn't see her call the number on the back of the ID card.
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MillCreek

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Re: Medicare Co-pays
« Reply #15 on: February 25, 2021, 12:41:32 PM »

^^^The most likely explanation is previous experience with that plan, or the back office queries them electronically. 
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MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

Grandpa Shooter

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Re: Medicare Co-pays
« Reply #16 on: February 25, 2021, 02:16:29 PM »

^^^The most likely explanation is previous experience with that plan, or the back office queries them electronically.

Where we went for my wife's cancer treatments, they know because of the few health plans available and the frequency with which they see patients, at our civilian doctors they know because they deal with patients like us all day long.  It's like the old time grocery store clerks, they just know because that's how it is.

Kingcreek

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Re: Medicare Co-pays
« Reply #17 on: February 25, 2021, 03:41:45 PM »

The provider can go to an online portal to check benefits, remaining deductible and copays.
We do. And we do our best to inform the patient prior to visit and collect at time of service.
It can be really really difficult to collect from some folks after they leave.
What we have here is failure to communicate.

Cliffh

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Re: Medicare Co-pays
« Reply #18 on: February 25, 2021, 09:02:17 PM »

We've been going to the same hospital/organization for the last 12 years or so.  In the last year they've stepped up their aggressiveness re: collections.  Used to be we'd check in, visit the Dr. or PA, go home & wait for the bill.  Now, during the check in, they're telling us what our balance is (we're on a payment plan), what our estimated co-pay is and ask how much we're able to pay then & there.  And on the web portal (which has recently been changed) there's a large area of the 1st page taken up with a statement of our account.

Truthfully, I don't trust any medical billing dept.  I've gotten "refunds"* from a hospital over two years after the date of the visit they're refunding.

*They're "refunding" the money that they originally over-charged.  The math isn't that hard - bill the ins. co., (for more than the negotiated amount), receive payment from ins. co., subtract the payment and adjustments from the original charge and bill me for the rest.  Hell, I could do that without taking my shoes off.  Matter of fact, the ins. co. does the math for them on the EOB.  The EOB the hospital & I receive has the entire break-down, including what my portion of charge is.

When the provider looks up the info online, are they basing my co-pay on what they're going to charge the ins. co. (always more than the negotiated amount)?  Or are they basing it on the actual negotiated amount?

Kingcreek

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Re: Medicare Co-pays
« Reply #19 on: February 26, 2021, 06:30:31 AM »

Insurance companies sometimes deny services or charges that can then be contested or reviewed and later adjusted. This can take months or longer.
Insurance companies also sometimes give incorrect or inconsistent information. And sometimes services by other providers are submitted between the query and the actual claim submission that effect deductibles.
Insurance companies often hire retards or subcontract their customer service out of house.
Insurance companies are evil.
Medicare is government run insurance. The government also hires retards and farms out the administrative process to LCDs (that yes, hire retards)
Hope this helps.
What we have here is failure to communicate.