John Howell 8/11/2017
Published 10:37 am Friday, August 11, 2017
Why don’t we
Still missing in the ongoing debate about whether to end or modify Obamacare is earnest inquiry into the soaring costs of all things medical.
I am fortunate to have coverage from Medicare, an inexpensive Medicare supplement and prescription drug coverage, also inexpensive. However, the “explanation of benefits” that I receive periodically following medical visits and purchases of medical supplies provides insight into the dilemma of high medical costs.
I sleep with a CPAP breathing device because I have sleep apnea. The CPAP keeps me from such snoring that my daughter once said wakened her while she slept on a floor above our bedroom. Recently I ordered ancillary CPAP supplies like shown in the accompanying photo. The “headgear” consists of the two straps of elastic and plastic that hook over each ear and attach to the snorkel that is held against the nose.
My bill explanation of benefits states that the medical provider billed Medicare $94.17 for those two earstraps. However, Medicare only allows the provider to charge $17.66 for that piece of equipment, and the provider, to remain eligible to receive Medicare’s payments agrees to accept that amount, the $17.66.
Then Medicare paid the provider $14.07 for the headgear — about 80 percent of the agreed cost — and my Medicare supplement policy kicked in $3.59 or the remaining 20 percent. The provider got paid the full amount that it had agreed, and I paid nothing.
Among my questions to the Medicare supplement insurer was who pays full price, the $94.17?
The nice lady on the phone said that if someone from our newspaper staff who is insured through our company policy received the same piece of equipment, the provider would send a bill for $94.17 to the insurance company. If the provider is in the insurance company’s network, then it would also accept the same payment for the headgear as Medicare had approved, the $17.66, and the patient would pay the balance, the $3.59.
But if the provider was not in the insurance company’s network the patient would be billed the entire $94.17 for those two pieces of plastic and elastic. Huh?
And that’s where all the bickering about repeal, replace, reinvigorate falls short. Nobody is raising enough hell about why providers can get away with charging $94.17 for two pieces of plastic and elastic and the like.
Again, between Medicare, the supplement policy and prescription drug coverage, I’ve paid very little for the medical stuff since passing age 65. But I’ve got three children with children who are in the crosshairs of soaring medical costs. They’ve all got some type of medical coverage, but the amounts of the deductibles have soared in recent years, and even if the policy pays for 80 percent of whatever is charged, with prices of everything medical proportionally at least as high as the $94.17 for the two pieces of plastic and elastic, the 20 percent co-pay can quickly put a young family at the brink of bankruptcy.
And again, nobody is raising enough hell.