Medicare has a deductible. I think it’s $135. I f you have a supplemental policy like AARP it covers the deductible and copay, but it’s possible that if you have a secondary and not a supplemental, it might not cover the deductible. It gets confusing.
So the Medicare deductible…would apply to the anesthetic for a colonoscopy but NOT for the roocedure itself?
That makes a ton of sense…not!
The deductible applies to whoever got their bill in first. So maybe the anesthesiologist’s billing department is more Johnny-on-the-spot that the colorectal doc/clinic.
My billing person gets the bill out electronically on the DOS. So often the patient’s deductible gets applied to my bill even though they have seen a doc a few days before me in January (or whenever).
Similar to the anesthesiologist issue, I had a problem with insurance not paying the radiologist’s bill. The tests were done at an in-network facility where I had no control over nor any idea who would be reading the x-rays. It took months of phone calls to get insurance to pay the radiologist’s bill.
Something isn’t right. I believe a colonoscopy is fully covered under Medicare…in other words…the deductible doesn’t apply. Because if it did…I would have gotten dinged for the rest of my deductible on the roocedure billing…and I didn’t.
I just think it’s very odd that the procedure is fully covered…but the anesthetic isn’t…supposedly because it was not pre approved. That’s what my EOB says. Then it says it is part of my deductible.
I have an excellent supplemental plan. They aren’t paying the $68 either.
Does the anesthesiologist accept Medicare?
And these days, some radiologists are off shore. The films are digital, and are read on the computer in India or somewhere.
Yes, the anesthesiologist accepts Medicare.
Wanna be further confused about the Medicare coverage for colonoscopy anesthesia? Read from pg 33 on http://www.asge.org/uploadedFiles/Members/Practice_Management/2015%20Medicare_Physician_Payment_Presentation_Slides_FINAL_11-10-2014.pdf. Sounds like they maybe cover it for an initial (first) screening but not for a follow up?? Or that used to be true and it changed? All very confusing. as is their table on p 34. Clear as mud.
This might help:
http://www.anesthesiallc.com/publications/anesthesia-industry-ealerts/724-medicare-eliminates-patient-cost-sharing-for-anesthesia-for-screening-colonscopies.
Never underestimate the stupidity of Medicare policies.
Not medicare related…
I went for my annual mammogram. CA mandates a patient be told if they have dense breast tissue. Dense breast tissue can hide certain problems. A followup SCREENING ultrasound mammogram is suggested.
After being told by the provider that it was covered by insurance under the ‘screening’ category I received a bill for the full amount.
I fought this for 6 months - and I have a great track record of winning these fights. Not this time. The end result… there is no CPT code which allows for a screening ultra sound mammogram. They are ALL diagnostic. The diagnosis is ‘dense breast tissue’. Dense breast tissue is a completely normal condition, it is a by product for some of us because we …um…have breasts. That’s the story I was given…and they are sticking too it.
This story is to be continued on an annual basis I guess until it become a big enough issue that this particular infinite loop gets untangled.
Until then I will only go for the ultra sound every two years.
Dietz,
Do you have the name of the person who verified your benefits at the insurance company? Do you happen to have a confirmation number? That can really help. As can a letter to the insurance commissioners office.
I started reading this thread and had to stop. These stories are beyond frustrating. Two words: single payer.
A few people have stated that they do not have problems with their claims. Others have shared horror stories. I’d love to hear which insurance companies tend to NOT play these insane games and which are bad offenders. If people wish to share, it’d be great to include some detail (i.e. HMO vs PPO or which state if it’s not a national company). I live in California and have found Cigna easy and pleasant to work with. We’re pretty new to Anthem Blue Cross (HMO) and, so far, so good.
Incidentally, I negotiate managed care contracts between insurance groups and providers (hospitals and physician groups) and this thread makes for a fascinating (albeit depressing) read. FYI, regardless of what a hospital bills, the vast majority of hospital inpatient claims (commercial, Medicaid/Medi-Cal, Medicare) are paid on a per diem basis (a fixed amount per day).
Someone else mentioned this upthread but last time I went for a physical, my PCP told me that, if she found anything that required a diagnosis (don’t remember her exact wording but anything other than “well” issues, my visit would be billed twice–once for my “well” visit and once for whatever was “wrong” with me. I go to a large clinic and the clinic (system) had discovered that they were entitled to a second payment from the insurance companies if they billed this way. No copay from me for my physical (“well” portion of the visit); my regular physician visit copay for the other.
Insurance payments tend to be low. Providing medical care is costly. I understand providers need to do what they can (legally) to recoup costs and make a reasonable living. The administrative costs of implementing their contracts are very high. I agree that our system is broken.
I gave HI BC/BS PPO and have had it my whole life. Overall, I’ve been pretty satisfied, tho have had to speak with them more than I’d like, especially ehen they kept trying to send H’s bills to Medicare B for primary processing, tho he wasn’t yet enrolled and they were his only coverage.
For us, the great thing is that nearly all the docs in the state accept it and are familiar with it, since they cover 75-80% of our population. Another good hong is that the provide coverage for out of state providers as well. Premiums are decent and coverage under the federal plan has been very comprehensive.
As with pretty much any system, once something goes wrong it is hellacious to get it really and truly fixed. The problem is that we tend to have more encounters with medical billing than with any other kind of billing system we deal with, so more opportunities for things to go south. Either things go through correctly the first time or you’ve got a mess on your hands that becomes a tar baby. Personally, I’ve had a lot more trouble with the Pharmacy Benefits Managers like Medco/Express Scripts than I’ve had with insurance companies per se.
Medicare was not so easy, either. It is not single payor – they hire intermediaries to handle claims from different states, and the intermediaries are allowed to make Local Coverage Decisions that vary region to region. Their doctor payments to primary care doctors are shamefully, shamefully low.
CBS national news tonight saying 4 out of 5 medical bills have errors on them. Half of employers offer free access to medical advocates to their employees because it is so common.