Wednesday, March 7, 2018

How Does the Facility Stay Open?

I received my Medicare billing update yesterday.  I've already met my annual deductible of $183, although I don't remember receiving any bills totally that amount.  I saw all my doctors in January and early February; since I got shot I've made a point of checking myself out at the start of each new year.  I saw the GP and the gynecologist and the dermatologist and the eye doctor.  I had a mammogram and argued about the necessity of doing a DEXA bone scan (I won and didn't do it.)

I also had a colonoscopy.  That was the subject of the Medicare billing statement. 

The anesthesia cost $3,657.01 (don't you love that penny at the end?)  The actual injection cost $100.  My stay in the recovery room cost $1,711.23.  There were no doctor bills associated with this claim; I wonder if he did the test for free.

According to the billing statement, I owe nothing. But, reading further I found that Medicare paid nothing either, although the Medicare-Approved Amount was the same as the Amount Facility Charged -$3,657.01. 

How can the free standing surgical center stay in business if their costs are not met?  Does it really cost that amount?  Who's picking up the amount Medicare didn't pay?

My cousin, a former CFO of very-big-and-important-hospitals-whose-names-you-would-know, told me that I would never figure it out.  "Don't go there.  It makes no sense."

I'm not an ignorant person.  I can do research and I can understand complicated explanations.  This just boggles my mind.

Is this any way to run a health care system? 


  1. You are probably like us, other insurance besides Medicare...Medicare reimbursement is almost nonexistent for drs here in Fresno, the lowest in the nation from what I've been told. They bill the other insurance agencies (we have two others) and they fill in the missing $$.

  2. I have a drug plan and an AARP Supplement. All my doctors have taken it except the dermatologist for a purely cosmetic procedure (that damn red spot on my face is GONE!). But G'ma had Empire, the NY State Teachers Union insurance and every one of her doctors smiled when they saw THAT card.

  3. There is an issue with having lots of insurance, the medical facilities add on the tests! I too have Fresno Unified medical and also Tricare since Terry is retired military, and as with your mother, the medical people love to see us coming!


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