LudwigsFountain said:
DiabloWags said:
Last year, I got scratched by a Raccoon I was feeding.
The total medical bill was $112,000
The ER visit alone was $8,500.
The pharmacology bill was $75,000 given the Rabies Immune Globulin that comes from another human being who has already developed antibodies. The several vaccine shots over 3 weeks were $8500 a pop.
CMS covered most of it.
I paid $1200 out of pocket due to my deductible.
Ive since taken out a supplemental on top of my Medicaire for amother $195 a month.
Retired hospital CFO here. I take it you're on Medicare. I won't go into the craziness that is hospital billing, but Medicare paid the hospital and physicians involved a fraction of the charges you see on the bill that was rendered. The Medicare Part B deductible is 20% of what Medicare pays, not what the hospital bills. Part B covers pharmacology and ER visits (provided you're not admitted as an inpatient) , so in your case Medicare paid $6,000 for everything. I know that sounds nuts, but I looked up the CPT codes for the injections you received and the Medicare reimbursement was $300 - $400 per. Tack on another $100 or so fo office visit for each injection and maybe $2,000 for the ER visit
Commercial insurance would pay somewhat more, but still nowhere near $112,000. Medicaid (Medi-Cal) even less
If you have no insurance and your income is low (I forget the threshold) hospitals in California must discount the bills to Medicare or Medi-Cal rates.
On another front, I'm very glad you got a supplemental plan. Most people don't realize that for every year you wait to purchase one after you initially get on Medicare, the price increases and that increase carrlies through for life. Worst case you can be refused coverage if you wait and develop a chronic condition.
Thanks for your insight and color.
Yes, I'm aware that CMS only paid a fraction of what showed up on the bill.
If I'm not mistaken, I want to say that it was around $3,200.00
Earlier this year, I had an ultrasound of my kidney and bladder.
The code was 76770 and the amount that the facility charged was $1,626.50
Medicare approved that amount and paid $114.93
I may be billed $29.33
In this specific case with the Raccoon, the Rabies Immune Globulin is probably the biggest cost.
Since you don't want to wait around for the vaccines to take hold, you need to get antibodies into your system as soon as possible; hence the injection of RIG in each wound site which comes from a human being that has already developed rabies antibodies. - - - I literally had 7 injection sites on the back of my hand, and one on each shoulder. One shoulder for a big shot of RIG and the other for the vaccine. Had to follow up over the next month or so for subsequent vaccination shots.
The doctor asked, "Would you like an anesthetic before I start injecting?"
I asked, "Is that even a question?"
We both busted out laughing.
I said, "Screw it, let's just get this over with".
I actually got a cool explanation of the RIG from the billing division of United Healthcare (Optum) which handled the billing of my medical services. It was a refreshingly candid explanation and not the typical form letter.
You're right.
You almost have to have a PhD in order to understand Medical Billing these days and the codes.
But one thing is pretty simple to learn, you do NOT WANT TO BE OUT OF NETWORK for a particular medical service because the billing goes through the roof!
I got my CMS supplemental outside of the open enrollment period (about a year after I turned 65).
So when applying outside of open enrollment, you are subjected to a Health Questionaire that (naturally) asks for any pre-existing conditions.
For the younger crowd here that isn't aware, you pay $203 per month for Part B.
Part B is the medical insurance. Part A is the hospital insurance, which is $0 for most people.
The annual deductible is $283 for Part B. But you usually pay 20% of the cost for each covered service after you've paid your deductible. If you don't want to get nickeled and dimed, I suggest you get the Supplemental Coverage.
My Supplemental from State Farm costs me $195 per month.
So in Retirement, I am paying $4,776 a year for my health insurance.
What does Medicare cost? | Medicare It's a CULT.
