[jayerose]

I have a supplement (United Health Care (UHC)

Stayed in the hospital in Ocala for two days

From their website:

Provider Billed Plan $7,898.50

Total Cost (Allowed Amount) $37.00

Plan Paid $107.28

Your Share $0.00

So am I to believe that while the hospital billed UHC almost $8000, all they got paid was $107?

[Bjeanj]

Yes.

[jayerose]

How can hospitals stay in business?

[JMintzer]

Is this really news to anyone?

[BrianL99]

Originally Posted by jayerose

I have a supplement (United Health Care (UHC)

Stayed in the hospital in Ocala for two days

From their website:

Provider Billed Plan $7,898.50

Total Cost (Allowed Amount) $37.00

Plan Paid $107.28

Your Share $0.00

So am I to believe that while the hospital billed UHC almost $8000, all they got paid was $107?

No, that's not correct.

I have no clue what you're actually looking at, but the odds are 100,000:1 your characterization is accurate.

Medicare paid their portion and your Insurance may have paid some portion, but you can be assured, if you spent 2 days in the hospital, the hospital was paid at least $5000, probably more.

The hospital never would have kept you there, if they weren't going to be paid for the majority of the bill.

[JMintzer]

Originally Posted by BrianL99

No, that's not correct.

I have no clue what you're actually looking at, but the odds are 100,000:1 your characterization is accurate.

Medicare paid their portion and your Insurance may have paid some portion, but you can be assured, if you spent 2 days in the hospital, the hospital was paid at least $5000, probably more.

The hospital never would have kept you there, if they weren't going to be paid for the majority of the bill.

They may be only looking at the Medicare Part B charges (that is the physician's fees...)

[walterray1]

Originally Posted by jayerose

I have a supplement (United Health Care (UHC)

Stayed in the hospital in Ocala for two days

From their website:

Provider Billed Plan $7,898.50

Total Cost (Allowed Amount) $37.00

Plan Paid $107.28

Your Share $0.00

So am I to believe that while the hospital billed UHC almost $8000, all they got paid was $107?

they pay, I do not get a bill. I am ok. Move on.

[Dave5]

Originally Posted by walterray1

they pay, I do not get a bill. I am ok. Move on.

Amount billed can be whatever the providers (either hospital or doctor) bills to the insurance (a single hospital stay can generate bills from multiple providers). If the provider is contracted with your insurance, they are bound by contract to accept their allowed amount. Your insurance may pay this allowed amount in full, or you may be responsible for some or all of it, depending on if you have a deductible or a copay.

Supplemental plans cover part of all of the balance left.

Even though you have a supplemental plan, you can still have a deductible or copay due from the supplemental plan. Sounds like your supplemental plan covered your balance in full (for this provider).

Please note: there may be multiple bills coming from doctors or specialists who treated you.

If you still have more questions, feel free to ask. I will gladly review your Explanation of Benefits (EOB) and explain it to you if you are still confused about something.

[djplong]

Originally Posted by jayerose

How can hospitals stay in business?

It's pretty simple. Ridiculous overcharging. Rates set that have aren't tethered to reality. This is something I learned when I was working in healthcare (back office IT development).

The best example that I can give is a personal one to demonstrate. Ignoring the other issues I had to go through to get an MRI, suffice to say that, after enough pain and wasted effort with useless therapies that an insurance bureaucrat thought were appropriate, I got an MRI that immediately showed what was going on.

Initial price on the statement: Over $6000
"Adjustment" for insurance company: Reduced to over $4000
Remaining co-pay for me: $685
Keep in mind, I couldn't "shop around" for the best price as nobody would tell me what an MRI costs (I live in Southern NH).

Just for the heck of it, I looked to see if there were walk-in clinics in Montreal, Canada (just under a 4 hour drive away). And there were. MRIs are not always covered by their Medicare system so it's easy to find several clinics - AND THE PRICE THEY CHARGE (I think it's a law that they have to divulge that).

Retail price for a walk-in MRI, after the exchange rate: $475

My insurance company paid several thousand dollars, plus what I paid, for the same machine and diagnostic ability as I could get for under $500 in Canada.

THAT is how hospitals stay in business. Charging 10x what something actually costs and keeping their books obscure.

[retiredguy123]

Originally Posted by jayerose

How can hospitals stay in business?

I doubt that you are looking at the Medicare Part A invoice submitted by the hospital.

[Burgy]

That does seem out of bounds. You had no copay etc? It would be helpful to know if you are in HMO,PPO or purely supplemental. My bill last year was over $100K for a same day surgery hip replacement and the EOB statement showed payment of $11K total to hospital, surgeon,anesthesia. My copay was $250. Post op.nursing and PT home visits were fully paid. This is UHC HMO.

[Wondering]

Originally Posted by jayerose

I have a supplement (United Health Care (UHC)

Stayed in the hospital in Ocala for two days

From their website:

Provider Billed Plan $7,898.50

Total Cost (Allowed Amount) $37.00

Plan Paid $107.28

Your Share $0.00

So am I to believe that while the hospital billed UHC almost $8000, all they got paid was $107?

Yep! That's the fee structure the hospital agree to when they accepted your insurance/Medicare. Don't complain - you paid nothing other than what comes out of your Social Security for your Medicare.

[FredTheHead]

All of the answers were slightly correct. First off, you said you were looking at your supplemental medical insurance statement. You also have to get your Medicare A and your Medicare B coverage statements. Each statement is separate and available on their own processing timeline. If you set-up a Medicare online account you will get an email telling you when your statement is ready for viewing. Your Medicare coverage is responsible for paying first. That means your supplemental insurance only covers what they know Medicare will not consider covering. Medicare statements that are sent to you in the mail are usually delayed for long periods after the billing period. Contact your county seniors organization. They can be trusted to help you set-up online accounts since you will be sharing all of your sensitive personal information with anyone who helps you with Medicare or insurance sites. Due to so much identity fraud do not share your personal information with anyone unless you trust them with your life, money and your future happiness. Be careful and choose financial helpers wisely. Ken.

[roadrnnr]

Originally Posted by Dave5

Amount billed can be whatever the providers (either hospital or doctor) bills to the insurance (a single hospital stay can generate bills from multiple providers). If the provider is contracted with your insurance, they are bound by contract to accept their allowed amount. Your insurance may pay this allowed amount in full, or you may be responsible for some or all of it, depending on if you have a deductible or a copay.

Supplemental plans cover part of all of the balance left.

Even though you have a supplemental plan, you can still have a deductible or copay due from the supplemental plan. Sounds like your supplemental plan covered your balance in full (for this provider).

Please note: there may be multiple bills coming from doctors or specialists who treated you.

If you still have more questions, feel free to ask. I will gladly review your Explanation of Benefits (EOB) and explain it to you if you are still confused about something.

Can you tell me does Medicare cover physical therapist?

[nn0wheremann]

Originally Posted by Bjeanj

Yes.

Hospital billing is an accounting insanity. If your plumber or auto mechanic tried those shenanigans you would take them to court and prosecute them for fraud.