Tuesday, February 16, 2010

Medicare allows less than 25% of the list price for typical outpatient surgery (this is why the uninsured go bankrupt!)


Well, my outpatient one hour bilateral inguinal hernia repair bill came today. The Virginia Hospital Center’s basic charge is a staggering $14143.10. But Medicare allows only 3368.03, or 23.8% of the list price. Part B supplemental paid $693.12, leaving me with the annual copay total of $155. An uninsured person would have been billed the complete $14000 amount. The Medicare-allowed amount is about ten times a typical car repair that takes that amount of time.

The Copay did go up in 2010, as one can tell from this source (link), the Ritter Insurance Marketing Blog, which gives the rundown on Medicare limits and Part B premiums, now somewhat keyed to income.

Update: Feb. 19

I got a CMS statement with an additional charge of $1365 list for the surgeon, for which Medicare allowed about $639 and paid 80%. But that means the total list was around $15500 for an outpatient hernia repair.

Office visits in Arlington for family practice seem to list at $200, and Medicare allows about $140.

See how the uninsured get shafted!

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