medicare fees


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Old 01-06-17, 11:29 AM
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medicare fees

anyone know where is a list that shows what a doctor gets paid for certain kinds of visits visits..??like eye exams..
the average provider compensation for 2016..
 
  #2  
Old 01-06-17, 12:26 PM
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I always got my fee schedule directly from Medicare, they mailed me a new one every year.
 
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Old 01-06-17, 01:58 PM
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... and if you are on medicare you'll get a monthly statement showing how much the doctor charged, how much was discounted, what medicare paid the doctor and what your co pay is.
 
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Old 01-18-17, 12:01 PM
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i am not on it yet..... what did your doctor get paid for cataract` surgery per eye????
and list your state..
 
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Old 01-18-17, 12:10 PM
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Are you conducting some sort of survey or something? They're not allowed on here, nor is this a DIY question.
 
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Old 01-18-17, 12:47 PM
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Not sure I understand the concern on how much the doctor gets paid, the main thing is figuring out how much the procedure will cost you ..... and the insurance provider or medicare should be able to provide that figure.
 
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Old 01-18-17, 01:01 PM
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I'm not going to respond specifically because I think this topic is a little far afield of DIY. Having said that and in the spirit of DIY, you can do an internet search and find links easily, perhaps using physician rather than doctor.
 
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Old 01-18-17, 02:01 PM
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In an indirect way, Medicare could be considered a DIY item. We have the choice of enrolling in an Advantage Plan. I just started Medicare & that's what I did based on the advice of a stingy self made millionaire. The money that taken from my social security check goes to the plan. The coverage is better than straight Medicare. Pro tip: Whenever you want a good deal on something, ask a stingy person.
 
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Old 01-18-17, 03:01 PM
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I absolutely agree that Medicare and options / choices could be relevant here but not as much so but when it comes to what doctors receive. It's like asking how much Home Depot makes on a hammer.
 
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Old 01-19-17, 03:15 AM
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That counts too. Do you remember the $600 hammer during the Reagan years?
 
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Old 01-19-17, 03:40 AM
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Stan admits he is not on Medicare, yet. I am not sure why he is concerned what the doctor or hospital gets paid. It's not like he is looking out for their welfare. The monthly or per-incident statements will tell all you need to know.

2013 had surgery in Denver, then turned around and had a shoulder replacement at the end of the same month. Both bills were in excess of $75,000 each. With my supplement, I paid $142.00. I really couldn't care less what each entity got paid. They have their contract with the insurance companies, and probably make their money on volume rather than individual instances.
 
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Old 01-19-17, 04:15 AM
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It's not like he is looking out for their welfare.
Is Medicare looking out for our welfare?
 
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Old 01-19-17, 05:45 AM
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Is Medicare looking out for our welfare?
Of course not. Medicare is insurance; it provides coverage. Medicare doesn't look out for your health any more than your auto insurance looks out for your car.

Medicare (like other insurance) provides protection. Without Medicare, those most likely to require expensive treatments would be forced to buy coverage in the marketplace at a time when they're most vulnerable. And good luck if that ever happens.
 

Last edited by Tony P.; 01-19-17 at 06:14 AM.
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Old 01-19-17, 07:24 AM
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Yes, I understand how insurance works in a capitalist society.
 
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Old 01-19-17, 01:50 PM
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Not such a bad set up.....being a capitalist. I can think of worse economic situations.
 
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Old 01-19-17, 01:52 PM
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And one can always move to someplace like North Korea, if they're opposed to it.
 
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Old 01-19-17, 03:12 PM
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You don't have to move - just talk to friends that live in countries that have socialized medicine. Everyone is covered but the wait times and treatment often sucks.

At least in the US you know that you are probably getting the best available.
 
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Old 01-20-17, 02:59 AM
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Thanks for the invitation to NK but I think that I would try Italy first. There is no internet in NK.
 
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Old 01-20-17, 03:08 AM
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So you like PART of the capitalist society, just not all of it.
 
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Old 01-20-17, 04:21 AM
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That's incredible insight. I can come up with many differences between North Korea and Italy but wouldn't have mentioned internet. How about the best food in the world versus starving to death? Ciao.
 
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Old 01-20-17, 07:19 AM
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This is an interesting discussion . . . . especially when we try to combine Capitalism and "free market" forces with Medicare.

I believe that everyone is influenced by Medicare, whether they're covered by Medicare or not, whether they have private coverage or not.

Medicare publishes a chart of procedures that are covered and for which they'll pay the Usual and Customary Fee. Physicians, Clinics, Hospitals and others, reference this chart as a form of bible in their billing procedures, and use it as a guideline to what is reasonable to charge for various procedures. There used to be alternative guidelines published; but those have ceased to even exist.

For private Patients, they may charged the Medicare Rate +5%, or +10% . . . . or + 40% . . . . but I doubt that you'll ever see them charging "less" than the rate permissible under Medicare. As Medicare goes up, so goes the rest of the Medical Industry , , , , there are no market forces operating to pull those prices in the opposing direction i.e. DOWN !

So while it might be true that you shouldn't have to be concerned about what Medicare pays . . . . or how much your health care provider receives, especially if you're not even on Medicare, it does have an indirect influence on how much you'll pay . . . . and it explains in part why health care costs in the USA increase at a rate far beyond that of other segments of the economy, or far beyond general inflation rates. It's a hidden form of centralized control and planning.

Capitalism and market forces no longer play a role! Maybe someone can prove me wrong ?

Anyway, that's my 2
 
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Old 01-20-17, 10:29 AM
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How about the best food in the world versus starving to death?
Fortunately, there are no sanctions against Italy. Maybe, it is because the food is so good.

U.N. sanctions on North Korea hurts aid efforts - Humanosphere

Capitalism and market forces no longer play a role! Maybe someone can prove me wrong ?
Everything is connected. Without writing an essay, it comes down to one thing. Either we increase the size of the American Pie or everyone & everything gets a smaller slice. That includes Medicare & the people on it.
 
  #23  
Old 01-20-17, 12:27 PM
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Best food in the world? Top 5 maybe but you have to give props to France, Spain, China, Japan and the good old USA.

I was fortunate to live in Southern Italy (Napoli) for a couple of years a long time ago. More recently I worked with an Italian company out of Bologna for several more. Up until few years ago we visited Italy often. Just like everywhere else, some great food, some good food and some not so good food. The thing about Italian food is that it is very regional, although not as restricted as it was 30 years ago.
 
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Old 01-20-17, 12:44 PM
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OK, I won't go into the whole food thing, since the thread was about Medicare.

I'll just say, I've probably eaten more, different types of food in different parts of the world than anyone here. Almost every place has it's own great dishes (except the UK in my experience, unfortunately) you just have to explore them. I've eaten things that most people would recoil from and loved almost all of it. That's why I learned to cook. Here in Smalltown AZ, there aren't a lot of choices, so if you want it, you have to make it...if you can find the correct ingredients or substitutions.
 
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Old 01-20-17, 03:09 PM
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I don't have a problem with Medicare. What they don't cover is picked up by my Tricare. I do have a problem with being forced by the government to switch from my long time insurance that I really liked to medicare when I started drawing SS.

Vic - I've sampled the food in 19 countries, plus PR and the USVI. Uncle Sam is great for expanding your travel experiences. I have passed on some local delicacies though. Casu Marzu (maggot cheese) in Sardenia comes to mind. I also ate a balut once but not by choice.
 
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Old 01-20-17, 03:42 PM
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I do have a problem with being forced by the government to switch from my long time insurance that I really liked to medicare when I started drawing SS.
I have heard of a few instances where Medicare can be the secondary instead of the primary coverage.
 
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Old 01-20-17, 04:33 PM
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CW, I'm virtually certain you have it wrong. It's your health insurance provider that stops coverage when you become eligible for Medicare. Insurance companies can provide coverage if they wanted to. If they did, premiums would rise tremendously because healthcare costs for seniors are so high.

Beyond that, Medicare premiums are far lower than private insurance can charge because Medicare premiums are subsidized by employment taxes.
 
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Old 01-20-17, 06:26 PM
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Donoli... I don't think that's possible. I've never heard of it at least.

CW, I may have to pick your brain privately about Tricare and Medicare. No matter how many times I read the rules, it just doesn't make sense. "You have to buy part B before C as long as you are younger than your next door neighbor. If you are driving a 10 y/o car, your premium may vary up to $400 per month, except in leap years. If you've ever had surgery, your prescriptions are no longer free and will come a pill at a time." At least that's what it sounds like.

I was on shallow draft LSTs for the first two tours, so I went places almost no one else could. Like 100+ miles up the Amazon to Matadi Zaire (when there still was such a place). Coming downstream the CO was being stupid and went to flank. Only 32 knot LST ever. Went around the Horn and the Cape, down one side and up the other. There were advantages to a 'gator, even if it meant living with Jarheads everywhere (Is TG around? lol)
 
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Old 01-20-17, 07:41 PM
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donoli2016
I do have a problem with being forced by the government to switch from my long time insurance that I really liked to medicare when I started drawing SS.
I have heard of a few instances where Medicare can be the secondary instead of the primary coverage.
There is one long-time member here (I don't remember who) that insists he has a friend/acquaintance that has Medicare as his secondary insurance. I think he is mistaking an Advantage plan as making Medicare secondary, they do not.

Advantage plans are a partnership between Medicare and private insurance companies. You still have to pay the Medicare premiums and you get ALL the benefits of Medicare. You also get additional benefits from the private insurance. The private insurer MAY make the payments to the provider and then get reimbursed by Medicare but this is simply a paperwork exercise, Medicare is STILL the primary insurer.
 
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Old 01-21-17, 02:34 AM
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If I understand correctly, you don't have to take medicare when you turn 65 but you pay a penalty if you don't. They only exception is if you have some other insurance that is as good or better than medicare. This usually only comes into play when the younger spouse is still working with insurance thru her/his employer. Doubt you could get any individual private insurance that is as cost effective as medicare.
 
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Old 01-21-17, 03:44 AM
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Old 01-21-17, 04:07 AM
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Thank you for that link. I wonder how many people, both as a real number and as a percentage of all with some form of Medicare actually qualify under the provisions stated. It seems to me to be primarily for retired people who are covered under a group plan of a still-working spouse.

When I was about to turn 65 (I retired at 55) I checked my employer's benefits website and found a video that stated employees about to retire should check into company-sponsored retiree healthcare plans as part of the Medicare enrollment process. I had been receiving benefits as an early retiree (excellent benefits, equal to when I was working except vision, hearing and dental) for only $20 a month and if there was any way I could continue those benefits, even at ten times the monthly cost I wanted to know about it. The video advised calling the benefits office for more details.

Well, I called retirement benefits and was told they knew nothing about any such program and I would have to call insurance benefits. I called insurance and got the same run-around. When I mentioned the video no one knew anything about it. I finally got representatives from BOTH retirement and insurance together in a conference call to ask point blank why the video if it didn't apply. I asked if it ONLY applied to salaried personnel, executives, or who and the only answer I received is that I didn't have any options after age 65 but Medicare. I haven't checked the website in quite a while so I don't know if the video still exists and even if it does I don't know if I could access it as the entire website was changed at least a year ago limiting what I, as a retired employee, could see.

On the bright side, I have only ONE complaint with my Medicare and Advantage plan and that is the incessant computer phone calls (several every month) from the Advantage insurance company when I have stated innumerable times I prefer E-mail for all communications.
 
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Old 01-21-17, 05:07 AM
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Tony,

I continued my private insurance after I retired at age 55. When I turned 65 the local SS office told me that if I did not enroll in Medicare within a certain time frame, I would be penalized if I chose to enroll at a later date. That penalty would continue as long as I was enrolled. My original private insurance never indicated that they would drop me.

Although it cost a bit more, my private insurance provided more coverage than Medicare. I wanted to keep it but the penalty thing with medicare forced me to give it up.
 
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Old 01-21-17, 05:34 AM
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I think that "delayed enrollment penalty" could be avoided by obtaining a standard letter from the private carrier indicating that you were covered during the period following your 65th Birthday.
 
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Old 01-21-17, 06:01 AM
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That is my understanding also although there are minimum requirements for the private/employer plan.
 
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Old 01-21-17, 06:13 AM
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There might also be a local interpretation being made by the Medicare Representative.

I made a point of signing diligently up for Medicare in the prescribed time frame; but later discovered that I was eligible for medical care through the VA because I had served in a Combat Zone back in the 1960s; so I attempted to withdraw from Medicare.

To do so, required that I obtain a similar letter from the VA (a US Government Agency) in order to satisfy the requirements of Medicare (another US Government Agency) and Medicare demanded that I continue paying Part B for at least one more Quarter (which I did) . . . . with the prospect of being refunded some or all of that redundant Premium. Fat Chance . . . . so forget about it !

It's important to study this matter in advance and get your ducks all lined up so that you do it right the first time . . . . this is one area where there's is no opportunity for a re-do.
 

Last edited by Vermont; 01-21-17 at 06:58 AM.
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Old 01-21-17, 07:21 AM
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I called insurance and got the same run-around.
Not to bring the IRS into it but an IRS investigator told me that Congress makes laws & then tells the agency to implement it. Many times, the laws are so complicated that no one knows how to do it.

There might also be a local interpretation being made by the Medicare Representative
That shouldn't be since it's a Federal program. It shouldn't matter if one is in NYC or the Rocky Mountains.
 
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Old 01-21-17, 09:03 AM
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Originally Posted by donoli2016
". . . That shouldn't be since it's a Federal program. It shouldn't matter if one is in NYC or the Rocky Mountains . . ."
That sounds right . . . . and in a perfect world, it would be; but this isn't a perfect world.

As long as there's a role for human, or managerial discretion, there will be differences.

When everything has been automated, or systematized so it can be performed by robots, those differences will be eliminated, and human frailties, and their propensity to err, are removed, things will be better.
 
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Old 01-21-17, 09:27 AM
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When everything has been automated, or systematized so it can be performed by robots, those differences will be eliminated, and human frailties, and their propensity to err, are removed, things will be better.
I hope that you are right but the saying "garbage in garbage out" may still apply.
 
 

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