Part B Excess Charges

[sman]

A Reply to Sman and Somarco

Wow –

This is very entertaining.
Please read carefully before responding.

Re: “You believe? So do you have any empirical evidence to back up your belief?”

Yes, I believe that to be the case. I stated such.

And there was a time when some believed the earth was flat. I asked for some empirical evidence such as what we see in the Kaiser study.

But if you are selling Medigap plans and suggest the client can go anywhere for coverage, you should know if that means they will face Part B excess charges.

Can you point to one single post on this entire forum (not just this thread) where I said or even suggested that a client can go anywhere for (coverage?) treatment and haven't stated the possibility of excess charges for non-par physicians or facilities?

I can say from the experience of doing that leg work that it appears to me that more than 4% of those hospitals are non-participating. That is my opinion.

Yes, it is your OPINION. How many hospitals do you think there are in this country? How many have you actually called?

Re: “I think you'd be hard pressed to find a hospital that doesn't accept assignment. “

Perhaps I wasn’t as clear as I should have been in my statement. The data we have all seen from the Kaiser foundation refers to doctors, not hospitals. They are different entities,

No sh*t Sherlock.

To assume that just because only 4% of doctors are non-participating, 4% of hospitals are the same is just that, an assumption.

Hmmm, did I say that? Please show me where I said that.

My statement: “While only 4% of doctors are non-participating and may have excess Part B charges, the percentage of non-participating hospitals may be more. I believe excess part B charges are more common from hospital outpatient services that from individual doctors.” Emphasis on those words that appear to have been misunderstood.

Not misunderstood at all. That's why I asked if you had any empirical evidence. A simple yes or no would have sufficed.

“Let's be honest, if this were a big deal we'd be hearing horror stories by now of those who are on Plan N.”

Not necessarily. Do the math, or look up those that have done the math for you. United American, for example, has a great presentation showing a hypothetical $93,952 medical bill. In this example the person with a Plan F pays $0, with Plan G pays $147, with Plan N pays $4,592 because their insurance did not cover Part B excess charges.

Ah yes, the old "hypothetical" medical bill. How many outpatient services result in a Medicare approved amount of $93,952? That's a serious question. I'd like to know. I have yet to see one. Does it exist? I'm sure there's some scenario where it could. I just haven't seen nor heard of an ACTUAL instance where it has happened. I'm pretty confident that my health insurance carrier (it's a point of service plan) has a higher reimbursement rate than Medicare. I had an outpatient surgery last year (two different procedures at the same time). The hospital charge was $10,203. The approved amount was $1,177. So again, if you can provide me with something which shows a Medicare approved Part B charge of $93,592, I'd love to see it.

Is that a horror story? Probably not, unless the client is living paycheck to paycheck. But if I sold them a plan and just Poo Poo’d the potential for excess charges as something that won’t happen I would consider myself negligent, and they probably would too.

There you go again implying I've done something which I haven't. Can you point to where I've "poo poo'd" the potential for excess charges as something that won't happen? All I've stated is they aren't common. I've never said they don't exist. And if you've done any research on this forum of my posts regarding which plan I prefer and sell the most you'd see it's Plan G.

If an agent lead me to believe that excess part B charges were not an issue to be concerened with, and I ended up with a surprise bill...that agent would be on my sh!t list and depended on how that agent presented the issue to me , may get sued.

See above response.

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No, I don't need to show my work.

I have already wasted half my afternoon clarifying misread assumptions.

I am not doom and gloom either.

That certainly didn't stop you form doing the same.

 

[MatthewC]

Smon -

Good grief. You are blowing this way out of proportion.

I never accused you of anything. I never intended of accusing you of anything. I have never met you and don't anything about you other than you probably spend too much time on this forum and need help with reading comprehension.

You are very defensive and reading into this way more than what is there and are creating conflict where none was intended. My use of "you" was not literal, it was a generic reference to "insurance agents". Like i said, I don't know you. But golly gee, even when I referrenced myself you took it as an accusation or implication against you personally.

...and I never said the hypothetical bill was all Part B. Please re-read what I wrote. I said "medical bill".

I also mentioned that Medicare approved rates are typically 15% to 18% of the non-medicare billed rate.

Please note: I used the term "typically", not "always". The word was chosen to denote a common range, but not a striclty defined range for all cases.

Source: A professional certified Medicare billing specialist with approx 10 years of expereince.

Like I said, Good Grief!

Calm down. No one is trying to accuse you of anything.

 

[sman]

Smon - Good grief. You are blowing this way out of proportion. I never accused you of anything. I never intended of accusing you of anything. I have never met you and don't anything about you other than you probably spend too much time on this forum and need help with reading comprehension. You are very defensive and reading into this way more than what is there and are creating conflict where none was intended. My use of "you" was not literal, it was a generic reference to "insurance agents". Like i said, I don't know you. But golly gee, even when I referrenced myself you took it as an accusation or implication against you personally. ...and I never said the hypothetical bill was all Part B. Please re-read what I wrote. I said "medical bill". I also mentioned that Medicare approved rates are typically 15% to 18% of the non-medicare billed rate. Please note: I used the term "typically", not "always". The word was chosen to denote a common range, but not a striclty defined range for all cases. Source: A professional certified Medicare billing specialist with approx 10 years of expereince. Like I said, Good Grief! Calm down. No one is trying to accuse you of anything.

Nice tactic there Matty boy. Like I said, a simple yes or no would have sufficed. And you talk about my reading comprehension? Sheesh.

By the way, referenced has two r's not three.

 

[somarco]

Some people may not be aware of this neat tool from Medicare that allows anyone to look up doctors, hospitals, clinics, etc and determine if they are par or non-par.

You are welcome.

 

[sman]

Some people may not be aware of this neat tool from Medicare that allows anyone to look up doctors, hospitals, clinics, etc and determine if they are par or non-par. You are welcome.

I recall seeing that somewhere else on this same thread. I wonder who posted it?

Interestingly enough, whenever I'm discussing Plan N with a potential client I will ask for the doctors they use and the hospital they'd likely use if needed. I then look them up to make sure they accept assignment. I also email the link to the client.

 

[GreenSky]

I recall seeing that somewhere else on this same thread. I wonder who posted it?

Maybe you posted it but I have you blocked.

Thanks Bob.

Rick

 

[sman]

Maybe you posted it but I have you blocked. Thanks Bob. Rick

The post count on this thread changed, but I can't see who posted above. I have my settings so that I only see relevant posts.

 

[somarco]

I recall seeing that somewhere else on this same thread. I wonder who posted it?

Are you claiming I cheated and copied off Rick's post? He is the only one, other than me, that knows this kind of information.

 

[sman]

Are you claiming I cheated and copied off Rick's post? He is the only one, other than me, that knows this kind of information.

The only way Rick knew about it is if Luke told him.

 

[DS4]

with Plan N, pays $4,592 because their insurance did not cover Part B excess charges

I'm kinda new to these Medicare supplements, can you tell me how often this amount in "excess charges" is likely to happen?