An elderly friend recently had to go to emergency with severe pain and was told that any tests run may not be covered for her. When she received the bill, it was around $15,000!! She has good insurance and also Medicare, so we wonder if the Affordable Care Act has reduced coverage for people over a certain age?
All too frequently, the problem is with the coding done by the hospital, so she should should start with her insurance company and ask how to go about seeing if the hospital coding is correct.
I might add that people on Medicare often get statements from the insurance company that reflect the cost before their supplemental plan is considered. It can be horrifying. So, please have her call. She may not owe as much as she thinks.
About the fact that they didn't know if something is covered - that's scary for people. It's not the Affordable Care Act - this has been the case for years. If something isn't covered by Medicare, then it's not covered by the supplemental insurance either. And the costs - as you saw - can be incredible.I hope this isn't the case with your friend.
Warm regards,
Carol
My father had cancer and an aortic aneurysm. The aneurysm needed to be fixed first, and that surgery could have killed him. My father chose no treatment, rather than risk the aneurysm.
The doctor may have decided that your neighbor was too frail for surgery. I won't believe that the reason was his age, or that that was the only reason.
I know that there are NO laws that would allow such discrimination. It's possible some arrogant doctor might have decided that, but that's the fault of one doctor, not the ACA.
It's awkward, because I won't believe it without proof, and this is an anonymous website, so you can't really give me proof. We'll have to agree to disagree.
It's complicated. I don't want Medicare to make ME pay more for my care, but I want them to cut out all the fraud and abuse from "the bad guys." I want Medicare to be available to me and my daughter, and they need to reduce the costs to ensure that. Rock and a hard place.
There are some tests and physical therapy that use to be covered by Medicare but it is no longer covered or has been reduced. When something like this happens the patient is suppose to be informed and they even have you sign a form stating that you realize Medicare may not cover whatever it is. If you sign it and they do it, you are saying that you agree to pay for said services. The thing is you keep saying she has "really good insurance and Medicare." That statement worries me as normally Medicare is the primary insurance, if you are no longer working. When I hear patients say things like this I get sick to my stomach as it normally means they belong to an HMO and have signed their Medicare benefits over to the HMO. When this happens, you no longer actually have Medicare, you now have an HMO, like Kaiser, Humana, Scan, etc. YOU MUST SEEK ALL CARE THROUGH THEM AND THEIR DOCTORS AND HOSPITALS, MUST, MUST, MUST!!!!!!! If you fail to do this you will be responsible for paying all charges because you did not seek care through a participating provider!!!!!!!!
Lastly NEVER PAY A BILL LIKE THIS!!!!!! UNTIL YOU HAVE CHECKED OUT WHY IT WAS NOT PAID AND IS IT BEING SUBMITTED TO A SECONDARY INSURANCE CARRIER!!!!! IF YOU PAY ANY AMOUNT OF MONEY TO A DOCTOR OR HOSPITAL, MANY OF THEM DO NOT REIMBURSE YOU AUTOMATICALLY....UNLESS YOU ASK THEM TO!!!!!!
This ticks me off to no end, but I have worked for them and let me tell you they will hold on to the money because they can. There is no law that states that they have to pay you back within any amount of time. I think this is wrong, wrong, wrong and they should be penalized for doing it, but when they see they have $100,000 sitting in their bank account that should be refunded, they don't want to and they will hold on to your money!!!!!!!! My former employer is currently sitting on a large sum of money that he refuses to refund of his own accord and has instructed his bookkeeping office to hold on to the funds unless the patient requests a refund. Most of these patients are elderly and do not even realize they have a refund coming. It is sickening!!! DO NOT PAY ANY PHYSICIAN OR HOSPITAL UNTIL YOU HAVE EXHAUSTED ALL AVENUES OF PAYMENT TO THEM. DO NOT GO OUTSIDE YOUR HMO EITHER!!!
When my mom was to have a heart procedure, the cardiologist in the practice was arrogant and ignorant of the medications he gave my mom to prep for the procedure. So I asked around and took her to another doc in that practice, who we love. You can also look online at some of the ratings websites, but I think those aren't as helpful as nurses. They know what's really going on. If you need a cardiologist, then go to the hospital's heart floor, etc. Finding the right doc can make all of the difference in the world for your mom. Good luck!!
Alicia Munnell is the director of the Center for Retirement Research at Boston College, where she also serves as the Peter F. Drucker Professor of Management Sciences at the Carroll School of Management.
From AARP's Factsheet about the ACA:The law strengthens Medicare by including more preventive benefits, lowering the price of prescription drugs in the Part D doughnut hole, and fighting waste and fraud.
Medicare is strengthened
Your guaranteed benefits are protected. You earned your Medicare over a lifetime of work. The health care law protects your guaranteed benefits so you can always get the care you need when you need it.
You get more from your Medicare
The health care law lowers prescription drug costs. If you have Medicare Part D, and you reach the coverage gap or “doughnut hole” in 2013, you will get more than a 50 percent discount on brand-name prescription drugs and more than a 20 percent discount on generic drugs while you are in the coverage gap. The discounts will continue to grow until 2020, when the gap will be a thing of the past.
More preventive care is covered. Medicare now covers yearly wellness visits and more preventive care. This includes cancer, cholesterol and diabetes screenings, immunizations, diet counseling and more.
The health care law fights fraud, scams and waste that take money from the Medicare program. The law strengthens Medicare by adding more resources to catch those who fraudulently bill Medicare.
Updated August 2013
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