It has beeen ten months since my rTSA surgery. It took several months for the bills to trickle in which did not surprise me. Being a medicare patient who had met her deductible, my interest was purely academic. I had read a lot about how much joint replacement surgery cost and I was curioius how much my procedure would be adding to the national debt.
Even though I have had a lot of experience with insurance EOBs (Explanation of Benefits) both personally and when I worked for a living, I was totally confused by the statements that arrived in the mail. I was embarrassed by how little Medicare approved for many of the procedures and there were several "items" that I never could find listed, like the cost of the artificial joint. I decided the latter must be included in some global charge and not priced individually. I wondered how my readmission would be handled, would Medicare pay for the iatrogenic incident? I couldn't tell what happened.
So, ten months and six days after my surgery a new This is not a Bill Statement arrived in the mail. All those surgical fees that I couldn't locate on previous statements magically appeared. Good thing I was sitting down when I opened it. I assume the item listed as Supply/Implants translates to "new metal shoulder hardware." Priced at a mere $34,168.67, the charge was denied for reasons DEandF (information was missing, I should not be billed for this (thank heavens!), and Medicare does not pay for this service). The other bigggie was Prosthetic repair of a shoulder joint at $26,167.01. This, too, was denied for reasons EF and H (I should not be billed for this service -hooray-, Medicare does not pay for this service and this service cannot be paid when performed in this facility!).
Other lesser procedures run the bill up to a total of $72,575.69. What "cloud" have these charges been floating around on? Will these claims be refiled, corrections made, information filled in, amounts proportionately reduced, and ultimately some Medicare and some Medigap payments will be made? How can "this service cannot be paid when performed in this facility" be resolved? Is there more to come?
And finally, if a person was not insured they would be expectted to pay these charges in full!
Even though I have had a lot of experience with insurance EOBs (Explanation of Benefits) both personally and when I worked for a living, I was totally confused by the statements that arrived in the mail. I was embarrassed by how little Medicare approved for many of the procedures and there were several "items" that I never could find listed, like the cost of the artificial joint. I decided the latter must be included in some global charge and not priced individually. I wondered how my readmission would be handled, would Medicare pay for the iatrogenic incident? I couldn't tell what happened.
So, ten months and six days after my surgery a new This is not a Bill Statement arrived in the mail. All those surgical fees that I couldn't locate on previous statements magically appeared. Good thing I was sitting down when I opened it. I assume the item listed as Supply/Implants translates to "new metal shoulder hardware." Priced at a mere $34,168.67, the charge was denied for reasons DEandF (information was missing, I should not be billed for this (thank heavens!), and Medicare does not pay for this service). The other bigggie was Prosthetic repair of a shoulder joint at $26,167.01. This, too, was denied for reasons EF and H (I should not be billed for this service -hooray-, Medicare does not pay for this service and this service cannot be paid when performed in this facility!).
Other lesser procedures run the bill up to a total of $72,575.69. What "cloud" have these charges been floating around on? Will these claims be refiled, corrections made, information filled in, amounts proportionately reduced, and ultimately some Medicare and some Medigap payments will be made? How can "this service cannot be paid when performed in this facility" be resolved? Is there more to come?
And finally, if a person was not insured they would be expectted to pay these charges in full!
OMG! This is an eye opener!
ReplyDeleteAnd that it took this long for them to "figure" the
charges out. What in the heck took so long???
I can't decide whether to call the hospital and ask those questions or stick my head in the sand and wait for it all to go away.
ReplyDelete