Wednesday, October 02, 2013

Some of my own case histories with retiree health care, Medicare, and providers not taking Medicare

Today, at a post-op visit to a dental surgeon (I did the “clear choice” thing, but with private dentists and surgeons, at pretty much the same, or maybe slightly lower, price).  The surgeon had previous biopsied a periodontal cyst.  The biopsy analysis (done in Richmond) had been covered by Medicare Part B but the actual cost was pretty low (about $100). 
Today, I asked if the cyst obliteration during surgery might be Medicare covered.  The surgeon though maybe, but the office said that it doesn’t take Medicare at all.  That’s interesting.
Back in early 2005, after a major infection when I think the cyst formed, I did get a cat scan.  It was covered by my retiree health insurance, after deductible, but because it was covered, the Virginia Hospital Center in Arlington did it for a list price of about $350 (about a 70% discount, according a contract with United Health Care).  Also, the visit to an oral surgeon in Reston then was covered (we didn’t do much).  Maybe it was a matter of ING’s retiree policy and its being fairly generous with dental-associated problems.
Generally, Medicare doesn’t cover problems of dental origin (like cysts) but there are gray areas if there are health implications (like secondary heart disease) that seem likely.  It may well be that some Medicare Advantage (replacement) policies will cover these, but then again, Obamacare has cut back on some things Advantage plans can cover. 
I do have United Health Care through AARP as my supplemental policy, and I’ve never run into any complications with any claims yet.  Again, during this debate on Obamacare, remember, once you have insurance at all, the list price (which does affect out-of-pocket costs) for most procedures will be much lower, because it is determined by a contract between the insurance company and provider, who wants enough patients to make a profit.

Let me add another aside.  In 1998, I fell in a convenience store, and sustained an acetabular fracture.  I received a new operation at the University of Minnesota on the East Bank campus.   I never saw a bill for the new medical device (almost one of the first installed) or the surgeon’s labor, just the OR and anesthesiology.  It looks like the surgery was almost free because it was subsidized by the medical device company, to prove that the new appliance worked (it did, healing very quickly). There was an insurance squabble for a while over some things, but they were eventually resolved.    Surgery was on January 8, 1998 (it took 6 hours).  I could walk without crutches some distance on March 1.  I was completely off crutches the night of an academy awards fundraiser for the Minnesota AIDS Project at the Orpheus in downtown Minneapolis in late March.  A wonderful night that was.  Maybe “conservatives” would love this story.  In this case, the market actually worked.  

Picture: Minneapolis, 2011.  My pelvic titanium "implant" does not trip TSA machines.  

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