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Re: Medicare's Coverage for Bad Debt

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Message 11 of 27

@MIseker wrote:

@GailL1 wrote:

@MIseker wrote:
Around here ( tri ounty area) if you have an outstanding bill they wont treat you. the system in my county makes people with no cash sign up for a credit card on the spot..like in the lobby of the ER.

I am my brothers keeper.

You mean if a person has Medicare they make them pay (whatever) as their part of the out of pocket?

Remember with these folks, they have Medicare and Medicare will pay the Medicare part of the charges.

I don't think they would be turning people away that have Medicare as their primary insurance?

Am I wrong?


Yes you are for my locale. MediCAID requires a co pay. and they will not treat if you owe say, around a hundred bucks. Doctors just say no. so its back to emergency room treatment, and signing up for that instant approval credit card. My son is on disability for Ankylosing Spondylitis...cant be reliable enough for gainful empolyment. he does work when he can, and is off and on mediCAID, or at the least his co pay changes, often leaving him not paying enough at copay time. DOctors dont send out a monthly bill in our healthcare system.. they wait and turn it to a collection agency and cut you off. MY DOCTOR  did it..and i had no clue i had a bill. I told the bill collector to go pound sand, called the doc and paid by phone. Its a pretty good health system..it was ranked #15 2 years back. but, their billing  is trash. for at least 40 years i have had trouble with them off and on.

 


I am not talking about MEDICAID - This is about MEDICARE - NOT dual eligibles, NOT Medicaid, NOT ESRD beneficiaries - just regular Medicare beneficiaries with original coverage - heck some of them might even be high income beneficiaries - the "who" has not paid after collection efforts is not revealed.

 

Original Medicare Beneficiaries who don't pay this:

 

OUR CURRENT SINGLE PAYER ORIGINAL MEDICARE SYSTEM:

Original Medicare -Cost at a Glance

2018 Part A hospital inpatient deductible and coinsurance

You pay: 

  • $1,340 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $335 coinsurance per day of each benefit period
  • Days 91 and beyond: $670 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs (all costs in 2018)

Part B deductible and coinsurance

 

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: Medicare's Coverage for Bad Debt

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Message 12 of 27

@GailL1 wrote:

@MIseker wrote:
Around here ( tri ounty area) if you have an outstanding bill they wont treat you. the system in my county makes people with no cash sign up for a credit card on the spot..like in the lobby of the ER.

I am my brothers keeper.

You mean if a person has Medicare they make them pay (whatever) as their part of the out of pocket?

Remember with these folks, they have Medicare and Medicare will pay the Medicare part of the charges.

I don't think they would be turning people away that have Medicare as their primary insurance?

Am I wrong?


Yes you are for my locale. MediCAID requires a co pay. and they will not treat if you owe say, around a hundred bucks. Doctors just say no. so its back to emergency room treatment, and signing up for that instant approval credit card. My son is on disability for Ankylosing Spondylitis...cant be reliable enough for gainful empolyment. he does work when he can, and is off and on mediCAID, or at the least his co pay changes, often leaving him not paying enough at copay time. DOctors dont send out a monthly bill in our healthcare system.. they wait and turn it to a collection agency and cut you off. MY DOCTOR  did it..and i had no clue i had a bill. I told the bill collector to go pound sand, called the doc and paid by phone. Its a pretty good health system..it was ranked #15 2 years back. but, their billing  is trash. for at least 40 years i have had trouble with them off and on.

 

So it begins.
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Re: Medicare's Coverage for Bad Debt

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Message 13 of 27

@GailL1 

I disagree Medicare has some strict guidelines these hospitals are required to follow before Medicare will agree to pay that 65%, and I think soon to be 25% according to your links of a person’s deductible. I mean they have to go beyond the norm of reminders, dunning letters, collection agencies and threats to try and collect these deductibles so these people have to be indigent or not have a pot to p-ss in as they say on these boards.

 

We’ve been kicking healthcare costs down the road since Hillary forewarned us in 1992 that we had better do something soon or else we’ll be in the pickle we are today. No one listened.

 

Single-payer lowers the cost of healthcare as we see from your chart. Less administrative fees, better efficiency.

 

Like Bernie says “Medicare for All: Leaving No One Behind”

https://berniesanders.com/issues/medicare-for-all/

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Re: Medicare's Coverage for Bad Debt

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Message 14 of 27

@rker321

We are talking about MEDICARE - the cost of whatever type care have already been negotiated by government - down to a pretty low level, IMO.  This has nothing to do with the cost of care because I think most people would say that Medicare has negotiated, rather dictated, some pretty good price on services - but Medicare only covers 80% of that amount AFTER the deductible.

2018 Medicare Deductibles: 

 

We aren't talking about indigent people, not those who are dual eligible - we are talking about Medicare beneficiaries under the original program that do NOT elect to have a supplemental plan but then DO NOT pay their part of the cost.

  • Their Part A deductible and other cost sharing
  • Their Part B deductible
  • Their 20% of the Medicare-approved price - Medicare pays 80% of this Medicare-approved price.

Remember original Medicare does NOT have a cap on out of pocket cost - so these amounts can add up to a great deal of money under certain situations.

 

You have a Medicare Advantage plan - so what happen to you if you do not pay your part of the cost?  I am pretty sure that you have co-pays, deductibles and an out of pocket limit.  If you do not pay these cost - what happens.

 

Under Medicare, people that do not have a supplemental policy are suppose to pay these cost out of pocket.  Millions of Medicare beneficiaries pay a good bit each month for those supplemental policies - but why pay that when you can just dodge your part of the cost and let the taxpayers pick it up.

 

As I said to ReTiRed51, other health care systems which we look at as better than ours have cost sharing and out of pocket cost - so this is a problem that we would have to deal with one way or another no matter what system we might ever decide to set up. (see my post below to ReTiRed51 and the graphic on out of pocket cost in other countries).

 

OUR CURRENT SINGLE PAYER ORIGINAL MEDICARE SYSTEM:

Original Medicare -Cost at a Glance

2018 Part A hospital inpatient deductible and coinsurance

You pay: 

  • $1,340 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $335 coinsurance per day of each benefit period
  • Days 91 and beyond: $670 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs (all costs in 2018)

Part B deductible and coinsurance

 

 

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: Medicare's Coverage for Bad Debt

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Message 15 of 27

@ReTiReD51 wrote:

Trying to decide who should bear the cost of healthcare for the indigent?  A? B? C? or D? Let’s throw another log on the fire of healthcare costs and who should pay, if we use a single-payer healthcare system.

 

The US spends far more per capita ($9000) on healthcare than any other industrialized nation (Germany $5000) on earth. We rank 35th out of 35 other industrialized nations who all but us have a single payer system. We don’t need a private insurer system it can be done far less inexpensively with a Medicare style healthcare system.

 

These are facts you can’t dispute. It doesn’t put any more money into the pockets of the indigent but it’s a way to lower our healthcare costs in this country. So who ever pays that bill for the indigent A, B, C, or D and we all know through cost shifting it’s always the public that pays, at least the costs will be lower.


We aren't talking about the indigent here - we are talking about Medicare beneficiaries that don't pay their part of their Medicare coverage.  The Part A deductible, the Part B deductible, the 20% of the Medicare approved amount that is their responsibility.

 

Many other countries have out of pocket cost that patient's have to pay within their system. 

That does not change based on type of system if there are some out of pocket cost -

So we also have to think about how to get people to pay their share of the whatever cost.

Would you say, pay up front before any service is rendered - don't think that would work -

Since the primary insurance of whatever type is gonna pay, in this case Medicare, the provider is pretty certain that those funds will be received for services rendered.

 

So what should we do about people (not indigent) that don't pay their share of the cost of Medicare - the private industry of providers and insurance work this out - the provider can take any steps they feel necessary to protect themselves - a credit card on file, collections, law suit, garnishment - but for our public system of Medicare - taxpayers are getting to foot the bill.

 

How would this be different under some other system - universal coverage or single payer?

Squires OECD Exhibit 02

 

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: Medicare's Coverage for Bad Debt

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Message 16 of 27

@GailL1 wrote:

@rker321 wrote:

Gail  what about those who simply waltz into the ER and are not Medicare/Medicaid  patients and simply don't pay for the services?  what can be done for those people?


How about we stay ON Topic -

How about if we expand the topic.  we are speaking about costs. and costs are also inflated by the system that we have.

Medicare/Medicaid patients are not the only ones that make this system completely useless and inefficient.
Costs all over the place is what makes this health Care system ridiculous. and the inability to understand that or the fear of not making the money that they do for the services that they provide, is probably another factor that needs to be looked into.
What would happen to all of those insurance companies that offer MA plans, probably would disappear if there was a Single Payer system or a National Health Care system. 
Insurances still would exist, but not in the manner that they do today.
Drs, and hospital costs are our of sight. and yes, in this country, one of the richest countries in this world, you get the health care that you can afford. and not any better.
Sorry Gail, but you need to see that what we have simply doesn't work.  and there are many examples throughout the world that can teach us a thing or two.

 

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Re: Medicare's Coverage for Bad Debt

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Message 17 of 27

Trying to decide who should bear the cost of healthcare for the indigent?  A? B? C? or D? Let’s throw another log on the fire of healthcare costs and who should pay, if we use a single-payer healthcare system.

 

The US spends far more per capita ($9000) on healthcare than any other industrialized nation (Germany $5000) on earth. We rank 35th out of 35 other industrialized nations who all but us have a single payer system. We don’t need a private insurer system it can be done far less inexpensively with a Medicare style healthcare system.

 

These are facts you can’t dispute. It doesn’t put any more money into the pockets of the indigent but it’s a way to lower our healthcare costs in this country. So who ever pays that bill for the indigent A, B, C, or D and we all know through cost shifting it’s always the public that pays, at least the costs will be lower.

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Re: Medicare's Coverage for Bad Debt

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Message 18 of 27

@WebWiseWoman

Don't know all the circumstances but yea, it is expensive - maybe you were paying for some of the deadbeats bill - cost shifting does exist.  But an HMO???? 

 

But on the other hand, what should be the right pay for a pediatric heart surgeon, the facilities and the staff to perform an in-utero surgery?

 

Should we pay for an expensive cancer drug for a late-stage cancer patient if it only extends life (not quality of life) for a period of (6) months or less.

 

Should a 95 year old woman in a nursing home get a mammogram?

KHN 12/20/2017 Doing More Harm Than Good? Epidemic of Screening Burdens Nation’s Older Patients

 

Since it seems that where health is concerned some people have a hard time getting and understanding all the health care facts and then determining what they want to do - then somebody is gonna have to make some hard decisions about care and cost.  OK if the government does that for you?

 

 

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: Medicare's Coverage for Bad Debt

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Message 19 of 27

@umbarch64 wrote:

 The so-called 'compassionate conservative' has used the 'dead-beat' ploy for a long time now without really trying to come up with an effective way to separate that 'dead-beat' from the truly unfortunate...particularly in the health care system.  That tactic inevitablly causes that truly unfortunate soul real and consequential pain.

 

It is way past time to solve this problem by making adequate and effective health care available to all citizens of this country.  I've lost patience with the self-serving nay-sayers using complexity to grind a political axe and enable fraud in the process.  We, as citizens of this nation, and partcipants in the society that is the very reason for its existence, pay for all of it in the end...even to keep the guys in the slammer alive while they pay for the fraud that put them there. 

 

So...let's do it in the most effective, economic way possible.  Saying we don't know how to do that or that it can't be done or throwing up the "yeah, well what about......" is pure BULL in service to a political agenda crafted to get out of paying a fair share of its cost.  Drop the charade..it really is getting stale.    

 

 


This is how it has been done since the beginning of Medicare - they have tweeked this, then they have tweeked that just to save a buck.  We have whole government agencies working non-stop trying to discover new ways to cut cost.  MEDPAC comes to mind.

 

You are right we do not have a sound health care system but it is not just private insurers or providers causing all the problems.  It is government itself.  This Medicare Bad Debt thing came about in the 70's when hospitals complained that their Medicare beneficiaries weren't paying their share of the cost.  So instead of doing something like going after the Medicare debtors, Medicare began paying this Bad Debt after collections by the hospital proved futile. At that time, Medicare paid 100% of the amount of the Bad Debt - thru the years it has been reduced - now it is down to 65%.

At times they fooled around with doing different % for different sectors - then it all got down to 65% of the Bad Debt.

 

President Obama in his 2013 budget proposal wanted it to go to 25% - but that went no where then.

 

Personally, if you want the most effective, economical way possible for health care - somebody is gonna go away mad.  Patients - Hospitals - Providers - cause we aren't gonna please everybody. 

It is the cost that it has gotten to and the money to pay for it - public or private systems - doesn't matter.  Seems we need to make some rules on both side of the fence - those that are providing the (whatever) medical and those receiving it.  It has to be: 

the best care that we can afford - that's different from the best care we can give -

the best care for the health related circumstances - that may mean we re-evaluate some care that is now given because it may not be the best value.

 

Now who is gonna tell all the doctors, hospitals, skilled nursing facilities, labs, dialysis clinics, etc. that they have to all abide by the rate of pay we are gonna be setting for them.

Who is gonna tell the patients.

Yea, right !

We want what we want when we want it - who cares who pays.

 

 

 

 

 

 

 

* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: Medicare's Coverage for Bad Debt

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Message 20 of 27

Thanks, umbarch64! Great breakdown and post!

 

#VegasStrong

 

Phil Harris, actor and showman, to John Fogerty of CCR: “If I’d known I’d live this long, I’d have taken better care of myself.”
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