[Priebehouse]

I was in the health insurance business for 30 years. These fees became more prominent when healthcare systems started buying up doctor's individual practices since the costs of doing business increased. Malpractice insurance, rent, personnel, equipment and supplies, etc. and other expenses was making it almost impossible for doctors to be in private practice. As the clinical systems took over, they discovered they could recover their investments by charging facility fees, itemizing charges for supplies and pharmaceuticals.

Think about it. You used to go see your doctor in a small offfice with one or two nurses, an office manager and an assistant. Now you see them in a mega building with all the related equipment and supplies. Somebody pays for that. Medicine has become so complicated as technology has evolved.

[Rainger99]

Originally Posted by CoachKandSportsguy

Medicare Advantage Reimbursement Rates:

and then power hungry people started cutting taxes to get elected.

Does Medicare Advantage have a different reimbursement rate than Medicare??

On the tax issue, we cut tax rates. The issue is tax revenue - not tax rates.

We are bringing in $1.6 trillion more this fiscal year than in 2019. Revenue increased by 45.7% in those six years.

However, we are spending $2.6 trillion more in 2025 than in 2019. Spending went up 59.1% in those six years.

Is it a spending issue or a revenue issue?

- FY 2019:
- Revenue: ~$3.5 trillion (16.3% of GDP)
- Expenses: ~$4.4 trillion (20.9% of GDP)
- Deficit: ~$984 billion (4.6% of GDP)

- FY 2025 (Projected):
- Revenue: ~$5.1 trillion (17.9% of GDP)
- Expenses: ~$7.0 trillion (23.3% of GDP)
- Deficit: ~$1.9 trillion (6.2% of GDP)

“Annual income twenty pounds, annual expenditure nineteen [pounds] nineteen [shillings] and six [pence], result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.” ~ David Copperfield

[CoachKandSportsguy]

Originally Posted by Rainger99

Does Medicare Advantage have a different reimbursement rate than Medicare??

On the tax issue, we cut tax rates. The issue is tax revenue - not tax rates.
Is it a spending issue or a revenue issue?

its both and all:

* tax revenue is brought in by tax rates, ceribus paribus. . . (judgmental comment withheld)
* spending issue is due to a fixed govt program and having the volume explode due to demographics of increasing longevity with a boomer based population growth.

[USOTR]

JUST SAY NO

If we all ban together and take our business else ware, this latest means to take our money will go away.

[Rainger99]

Originally Posted by CoachKandSportsguy

ceribus paribus. . .

All things being equal?

But they are not. The economy is dynamic and when you increase or decrease taxes, it impacts growth and investment and many other factors.

If cutting tax rates increases revenue, would you be for it?
And if raising rates decreased revenue would you be for that?

If all things were equal you could increase the tax rate to 90 or even 100% and really rake in the money.

However, most economists say that a 25% tax rate would bring in more money than a 100% tax rate.

[MandoMan]

Originally Posted by Rainger99

I just saw this article on facility fees. I had never heard of them but it seems like a new scam.

Has anyone been charged facility fees??

Did your doctor'''s office charge you a '''facility fee'''? Here'''s what to know.

Are you on Medicare? Do you have a decent supplemental policy? If so, you probably don’t need to worry about this. I have Medicare and a Blue Cross/Blue Shield supplemental policy. Between them, THEY decide what gets paid, no matter what is billed, and in most cases the doctors and hospitals are NOT allowed to pass on to me whatever they don’t pay. For example, I had a serious surgery in January and was in the hospital overnight. The total bill came to $131,000. Of that, my insurances paid about $15,000 total, and I had to pay $259. If I get an MRI, I pay nothing and my insurance pays about $150 of a $5,000 bill and cancels the rest. I doubt that any extra facilities fees are paid.

[RoseyRed]

Originally Posted by Rainger99

Does Medicare Advantage have a different reimbursement rate than Medicare??

On the tax issue, we cut tax rates. The issue is tax revenue - not tax rates.

We are bringing in $1.6 trillion more this fiscal year than in 2019. Revenue increased by 45.7% in those six years.

However, we are spending $2.6 trillion more in 2025 than in 2019. Spending went up 59.1% in those six years.

Is it a spending issue or a revenue issue?

- FY 2019:
- Revenue: ~$3.5 trillion (16.3% of GDP)
- Expenses: ~$4.4 trillion (20.9% of GDP)
- Deficit: ~$984 billion (4.6% of GDP)

- FY 2025 (Projected):
- Revenue: ~$5.1 trillion (17.9% of GDP)
- Expenses: ~$7.0 trillion (23.3% of GDP)
- Deficit: ~$1.9 trillion (6.2% of GDP)

“Annual income twenty pounds, annual expenditure nineteen [pounds] nineteen [shillings] and six [pence], result happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.” ~ David Copperfield

Very good point! I realize expenses increase but do believe they could manage the revenue better. My husband worked for our hometown hospital for 15yrs and 5 of those years did NOT receive a raise. Luckily the hospital merged with a larger hospital which seemed to help a lot!

[CoachKandSportsguy]

Originally Posted by MandoMan

Are you on Medicare? Do you have a decent supplemental policy? If so, you probably don’t need to worry about this. I have Medicare and a Blue Cross/Blue Shield supplemental policy. Between them, THEY decide what gets paid, no matter what is billed, and in most cases the doctors and hospitals are NOT allowed to pass on to me whatever they don’t pay. For example, I had a serious surgery in January and was in the hospital overnight. The total bill came to $131,000. Of that, my insurances paid about $15,000 total, and I had to pay $259. If I get an MRI, I pay nothing and my insurance pays about $150 of a $5,000 bill and cancels the rest. I doubt that any extra facilities fees are paid.

and you should never not wonder about hospital bankruptcies. . due to the boomer generation just happening to live alot longer due to the effects of modern medicine. .

[Cliff Fr]

Originally Posted by Rainger99

I just saw this article on facility fees. I had never heard of them but it seems like a new scam.

Has anyone been charged facility fees??

Did your doctor'''s office charge you a '''facility fee'''? Here'''s what to know.

Medical care gets expensive when you add 20 million people to the system that never paid into it

[DARFAP]

Originally Posted by Rainger99

I just saw this article on facility fees. I had never heard of them but it seems like a new scam.

Has anyone been charged facility fees??

Did your doctor'''s office charge you a '''facility fee'''? Here'''s what to know.

Consider it a tip.

[golfing eagles]

Originally Posted by Cliff Fr

Medical care gets expensive when you add 20 million people to the system that never paid into it

closer to 50 million

[oneclickplus]

Originally Posted by CoachKandSportsguy

its a billing distinction, of pure doctor / medical and then rent, overhead, etc.
yes, it used to be all in one. . and i will check to see when and who, i suspect CMS, started demanding the two be split out, so that all medical services are identified separately from rent/ operational overhead. medical then should be billed per procedure to medicare. . facilities are dependent upon the local situation. .

the biggest problem is that there are two bills instead of one now.

No, the biggest problem is not that there are two bills. The biggest problem is the surprise billing of a charge not mentioned ahead of time. Attached is a screenshot of the recent news segment I saw. The man went in for a routine shot of some kind in his doctor's office. He had this exact same visit in the past. Suddenly there is a facility fee of over $14,000 plus several other unexplained fees for a total of over $17,000 for a routine doctor's office visit. That's just f***ing ridiculous. The man's out-of-pocket cost on this visit was over $700. He later found an independent doctor (not affiliated with a hospital group) where the same service resulted in a $35 co-pay.

This fee / practice should be criminal without clear notice well before the office visit. If I get a notice like that, I drop that doctor like a hot potato. I'll bet an independent doctor somewhere would love my business.

The Epi-Pen story is a classic example that still persists. And there are generics of this product. The actual 0.3mg of epinephrine in each pen costs about 35 cents. But, a pair of these pens loaded with the generic form of this cheap chemical is still priced anywhere from $500 - $800. WTF!! The actual pen is a cheap disposable device that costs about $3.00 to manufacture. Research and development is BS. This device is less complicated than the mechanics of just the print head of an $80 inkjet printer.

Medical costs are high because there is very little market knowledge. People need to be able to see a price list and get a quote BEFORE scheduling service or choosing a pharmacy. Obviously, this is not the case for an emergency situation. But, the vast majority of medical purchases for service and pharmaceuticals are routine. I should be able to visit multiple websites to see both patient reviews of doctors' services as well as the cost of various services by same. Ditto with pharmacies and costs for drugs - a complete price list made public. And perhaps some kind of mechanism where the consumer is rewarded for making better economic choices with that information. For example, make the co-pay (there should always be a co-pay, never a no-cost transaction) a percentage of the price giving the consumer (insured or not) the proper incentive to make good choices. Competition works but not when prices are hidden and surprise billing exists.

[mrf6969]

With a Medicare Supplement plan you will not see this extra charge. On the other hand, with an Advantage plan you very well could get stuck with it.

[Rainger99]

Originally Posted by oneclickplus

Medical costs are high because there is very little market knowledge. People need to be able to see a price list and get a quote BEFORE scheduling service or choosing a pharmacy. Obviously, this is not the case for an emergency situation. But, the vast majority of medical purchases for service and pharmaceuticals are routine. I should be able to visit multiple websites to see both patient reviews of doctors' services as well as the cost of various services by same. Ditto with pharmacies and costs for drugs - a complete price list made public. And perhaps some kind of mechanism where the consumer is rewarded for making better economic choices with that information. For example, make the co-pay (there should always be a co-pay, never a no-cost transaction) a percentage of the price giving the consumer (insured or not) the proper incentive to make good choices. Competition works but not when prices are hidden and surprise billing exists.

Your suggestions are excellent. Hopefully the medical professionals on TOTV will discuss it.

And $14,000 for a facility fee!!!!

No wonder states are trying to regulate them!


States move to put limits on health care "facility fees"

[jimdecastro]

Originally Posted by Rainger99

Under Original Medicare, facility fees are a covered service, and you are responsible for 20% of the cost of the fee. Medicare Advantage Plans must also cover facility fees, but there is no requirement as to how much of the fees the plan must cover. Because of this, your copays could be high. If your Medicare Advantage Plan denies coverage for the facility fee, you should appeal on the basis that Medicare Advantage Plans must cover the same services covered by Original Medicare.

If you have Advantage, it is probably a good idea to contact the doctor and the insurance company in advance to find out if there is a facility fee and, if so, how much is paid by the insurance company.

All facility fees must be in the Summary of Benefits.