Medical prices and Medicare.

[tomhenry]

I broke my ankle and injured my something longus ankle tendon. My foot doc sold me an ankle brace: $240. Medicare paid it.

I went online to see the real cost: <$50. I asked my wife about it. She's an ortho PA specializing in upper extremities and she works at that clinic.

She explained that the clinic has contracted with Medicare for reimbursement. Medicare sets the rates. Medicare pays, like, 5% of the charged price. The clinic has to charge an exorbitant price to recover the $40 they paid for the brace, etc.

What a mess.

She tells her patients that if they haven't paid their deductible, go buy the brace at Walmart.

 

[SMSgt]

While some see Medicare as a cash cow for the medical field, I don't have enough fingers to count the number of doctors I know who have stopped accepting Medicare due to the paperwork and hassles it involves. They decided enough was enough, and they are all still doing nicely in their businesses.

 

[LVSteve]

While some see Medicare as a cash cow for the medical field, I don't have enough fingers to count the number of doctors I know who have stopped accepting Medicare due to the paperwork and hassles it involves. They decided enough was enough, and they are all still doing nicely in their businesses.

It's become a major issue in retirement cities like Vegas and the Phoenix area. Wait times to see a doctor are creeping up to the UK/Canada level in some specialties.

 

[SMSgt]

It's become a major issue in retirement cities like Vegas and the Phoenix area. Wait times to see a doctor are creeping up to the UK/Canada level in some specialties.

It's become a problem here also, the land of senior citizens. Currently the number of medicos cannot keep up with the growth.

 

[Doug M.]

Looking at the statements of benefits I get every month, I am embarrassed to see how low the rate is for most of my stuff. OTOH, being qualified for medicare below 65 by my diagnosis has been a fiscal blessing. They almost never quibble.

 

[pantannojack]

I am staying as far away from corporate health care as I can. I recently lost my Osteopath because she will not suffer the insurance pressure to move product unnessessarily. Example the PA who insisted that I need a Tetanus shot for no reason, a Covid shot for no reason, A statin additiction for no reason. She explained that in my INDIVIDUAL case my natural diet, lifestyle of exercise, stress free outlook far outweigh the blood lab indications. Nuthing to do with busted bones, but this is where we have become.

 

[Rustyt1953]

 

[Greyman50]

Seems if on medicare the Md’s “ pile on” as many ailments as they can on people.

 

[JohnRippert]

It is not just Medicare. I have a Gold level insurance policy through healthcare.gov, and when I had my heart attack and had a stent installed the hospital initially charged $133,000 for my day in the ICU and day in the hospital. It was bargained down by the insurance company to $28,000 of which they paid 80% and I paid the remainder. All healthcare seems to need to charge exorbitantly so they have a starting point to dicker with the insurance companies.

 

[llowry61]

The pricing and the amount you pay are an accounting trick to lower profits. The difference between the "list price" and the money paid by the insurance company can be shown as a loss for tax purposes.

I never understood why patients without insurance paid such a high price if they were paying in cash. Well, if they charged the same amount to the uninsured then they would lose the write-off.

 

[rwsmith]

The entire health care system....

...is a complete racket. It's wide open for abuse as the OP pointed out. But I can only get Ozympic for diabetes when I'm lucky because of shortages caused by prescribing it to people for weight loss. Trying to get it this month was a joke, but a very unfunny one. My prescriber said I could use Trulicity. It's not as good, but it's available. Needless to say, this makes me mad as fire but there is absolutely nothing I can do except jump through hoops and hope for the best. The system, Medicare and the whole kit and kaboodle are in serious need of reform. Our policymakers, however, are incapable of working with each other, so I don't hold out hopes for a workable reform to health care.

 

[GaryS]

Cash customers pay retail.

The Centers for Medicare and Medicaid services (CMS) sets the rates for patients who have either of both. They also control what supplemental insurance pays for Medicare patients. Medicare payments are low and Medicaid is even worse.

A friend who owns a dental practice gave up accepting Medicaid patients because the pay out was so low AND he was audited by CMS just about every other year.

BTW Primary Care pays the worst.

The pricing and the amount you pay are an accounting trick to lower profits. The difference between the "list price" and the money paid by the insurance company can be shown as a loss for tax purposes.

I never understood why patients without insurance paid such a high price if they were paying in cash. Well, if they charged the same amount to the uninsured then they would lose the write-off.

 

[LVSteve]

Late wife #1 was a medical biller. If just half of her stories about insurance companies got out, the executives of those companies would mark many a major road like the end of Spartacus.

As for dealing with NV Medicaid, what a merry go round that could be. The game got too much for my wife's boss when the Medicaid crew changed how you contacted them for adjudications about four times in one month. The joke in the office was something like "OK, this is Tuesday and the Moon is waning with Mercury retrograde, so I use the fax". Ah no, it was after 2pm so that meant you had to use their website to check the rules. However, the first pop-up stated that nothing on the website was binding in law. Errm, on the state maintained website where they said the rules were located? You couldn't make it up.

 

[CAJUNLAWYER]

I broke my ankle and injured my something longus ankle tendon. My foot doc sold me an ankle brace: $240. Medicare paid it.

I went online to see the real cost: <$50. I asked my wife about it. She's an ortho PA specializing in upper extremities and she works at that clinic.

She explained that the clinic has contracted with Medicare for reimbursement. Medicare sets the rates. Medicare pays, like, 5% of the charged price. The clinic has to charge an exorbitant price to recover the $40 they paid for the brace, etc.

What a mess.

She tells her patients that if they haven't paid their deductible, go buy the brace at Walmart.

And THIS is one of the many things that are wrong with the system

 

[johngalt]

Ultimately will wind up with socialized health care and the industry will have only themselves to blame.

 

[biku324]

My mother uses colchicine for gout. Her Medicare insurance pays the bulk of the price, but her co-pay is still $1.50 per pill. I buy it here in Somalia for $15 per 100 from EU pharmaceutical manufacturers and take it back to her when on leave.

500 MG Amoxicillin is $18 per 100.

 

[GaryS]

And it will be the patients who suffer the most.

BTW, Canada has to health insurance system. There is the socialized system that non government employees get, which sucks. Then there is what is essentially Blue Cross/Blue Shield of Canada which government employees get.

That's how socialized medicine works.

Ultimately will wind up with socialized health care and the industry will have only themselves to blame.

 

[rwsmith]

I think I mentioned this elsewhere....

...but a guy I knew from another country was wondering why he couldn't get medicine for his wife's rheumatic heart. It seemed simple. You have a rheumatic heart you take 'x' medicine. But noooooooo.

 

[Sistema1927]

The system is broken, and government is NOT the answer.

 

[johngalt]

The system is broken, and government is NOT the answer.

It's not the answer, but it will be the answer we get.

It is common for the cash price for a procedure to be 10x the negotiated rate for the insurance company. They write off the difference as a loss, even though they were never going to get it. What other industry gets to cook the books like that?

A big problem with drug prices is the U.S. customer is forced to subsidize the entire rest of the world. Every other 1st world nation has socialized health care and sets the prices at which they are forced to sell even if at a loss. All of their development costs and profits are on the backs of the U.S.