I could not hardly believes my eyes !

As many of you know, I went on Medicare in June… one of the big benefits of Obamacare for Medicare folks was that it is now going to start paying 100% for some procedures… like annual physical…

I have been going to the same doc for the last 15 years or so and have went to him annually for a physical… This past Oct, I returned once again for my annual physical.

I came away from the physical, thinking that it was somewhat “abbreviated” from physicals that I had previously received.

Today, I got a email notice from Medicare supplement that I had a new claim to review on line… I had elected to go “paperless” on EOB’s (explanation of benefits)

So I pulled up the claim…  of course, the supplement had to pay ZERO .. since Medicare paid 100% of the claim.

I now understand the reason for the “abbreviated physical”…  Medicare was billed for the physical, venous stick, and 4 different blood tests… the total billed to Medicare was ~ $300..  the ALLOWED AMOUNT was $36 and change…

If this is a indication/example of what the allowables/reimbursement for services under Obamacare… who  is going to be able to afford to provide services?

Unless they have changed the rules, even if a physician elects not to take assignment (payment sent directly to physician) then the physician is prohibited from charging a Medicare pt more than 15% above the Medicare allowable… and the check for services is sent to the pt and the physician has to collect from the pt.

When I had a pharmacy and if the insurance company sent the check to the patient by mistake.. because we had specified on the claim that we were accepting assignment.. the excuses of why the pt is not going to pay the bill can get pretty strange.

I remember one pt telling us that the senior high rise that she lived in.. had a nuclear accident/radio active accident and that she had to pay to have it cleaned up.

One pt denied getting the check and in the same sentence.. said that they had already spent it.

Just remember, the Feds don’t have the word “profit” in their vocabulary…  it is reported that for the last several years… the FED have borrowed 40 cents for every dollar they spend…We were all promised that we could keep our own doctor under Obamacare, but will our doctor want to keep us as a patient under Obamacare?

And this is just the first small step toward the implementation of Obamacare..

2 Responses

  1. I looked up the allowed charge from the year before and it was $110.98.. So Medicare allowable was ~ 30% of what Anthem/Blue Cross was the previous year. IMO .. this explains a lot !

  2. What was your bill versus allowable before you went to Medicare? You can’t really make any judgment unless you can compare Medicare reimbursement to the also pitiful allowables by standard insurance. I am on Blue Cross Blue Shield od Rhode Island and am frequently amazed at the amount billed versus the amount allowed.

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