Community Chat

[rms1954]

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@aroc3435 wrote:

@rms1954   "Things change" would not be an acceptable answer for me.  Is the woman who said this the receptionist or the one who handles the accounting end of things in the office.

You will get a statement in the mail since you had to make a co-payment which will have codes on it for the procedure.  Compare it to earlier statements for the same work to see if there is a change.

Then I would go back to the doctor's office, papers in hand, and ask what PRECISELY has changed.  Is it no longer a procedure REQUIRED by your physician?

If this is a legitimate change for a procedure you get weekly you need to adjust your budget to cover this outlay from you pocket and you need to know why.  Did the office make a mistake by NOT charging the co-pay for prior weeks?  Did Medicare change a policy with respect to this procedure?

Medical charges and statements and billing are usually confusing.  And there are mistakes made in the codes used in billing Medicare or other insurance carriers. 

It gets even MORE complicated when hospitalization is involved--in OR outpatient.

There is a great, concise, clearly written book--Never Pay the First Bill--by Marshall Allen that is a real eye opener concerning medical procedures and billing and all the medical system's quirks.   I highly recommend it.

Hope you feel better and that you get better information from someone more competent and professional in that office. 

aroc3435

Washington, DC

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The girl that told me that is the same girl that drew the blood and when finished I left the exam room and was about to leave and she called me back and said I had to pay the copay.  It seems this lab has people that do multiple tasks.  Great advice and information.  I may purchase that book.

[Group 5 minus 1]

Sadly,I think the reason she said,"things change",is becuz she did not know. 

[FranandZoe]

I have a Medicare Advantage plan - Aetna.

My husband racked up over 500 thousand in hospital bills in 2020 - if he had had traditional Medicare our share of those bills would have been 100 thousand.  And that's just for the hospital expenses.  Not counting regular dr visits.

I can't imagine people just having tradional Medicare with no supplement.  Or no Advantage plan.  But I know they do.  I was talking to a woman in the dr's office a few years ago and that's what she had.

[gidgetgh]

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@FranandZoe wrote:

I have a Medicare Advantage plan - Aetna.

My husband racked up over 500 thousand in hospital bills in 2020 - if he had had traditional Medicare our share of those bills would have been 100 thousand.  And that's just for the hospital expenses.  Not counting regular dr visits.

I can't imagine people just having tradional Medicare with no supplement.  Or no Advantage plan.  But I know they do.  I was talking to a woman in the dr's office a few years ago and that's what she had.

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@FranandZoe - yep. Traditional Medicare, A and B, with no supplement, you are responsible for the remaining 20% with no cap to that. 

[TVLand]

Even with traditional Medicare....there is an annual deductible....the amount cannot come from one visit/ service....it spread out until the amount is met....for most people it usually goes up a little each year....if you are in a lower income bracket....you can apply to have the deductible waived....

[Kachina624]

Without a supplemental plan, a person is playing Russian Roulette with her financial future as well as her health.  One surgery or illness could ruin a person financially.  What if an expensive drug was needed that cost several thousands of dollars a month?

There are supplemental plans that cost nothing, usually HMOs.  The largest provider in my area has this type of plan.  My parents used it and just had a $5 or $10. Co-pay for medical services.

The OP needs to make investigating her options a priority sooner rather than later.

[Trailrun23]

It also matters which state you live in. Wish it would be consistent, but it is not. DH has Aetna advantage plan. I have UHC advantage plan. Our copays and other out of pocket costs are very different for both of us.

[pupwhipped]

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@paixmcdao wrote:

Weren't you recently hospitalized after falling and hitting your head? How much of your stay was covered by Medicare? 

1-800-633-4227  1-800-MEDICARE

@paixmcdao, yes, with having only Medicare and no supplemental insurance, you would think the recent trip to the Emergency Room with an overnight stay might set one back at least a few bucks.  

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[Snoopp]

I think this might be of help to you.  Go to the SHIP site online, that's the State Health Insurance Assistance Program.  They are a national program.  On their webpage you will see a SHIP locator.  That should get you to a local office where you can call and speak with a SHIP counselor.  A counselor should be able to go over your plan and get you an explanation.  It's free.

[Kachina624]

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@Trailrun23 wrote:

It also matters which state you live in. Wish it would be consistent, but it is not. DH has Aetna advantage plan. I have UHC advantage plan. Our copays and other out of pocket costs are very different for both of us.

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@Trailrun23    And I have an Advantage plan where I pay absolutely nothing, no copays or deductibles.  I've had major surgery and never paid a penny.  My former employer also picks up the premium cost.  I'm very fortunate.