INR Test Charges and Payments

[ALCapshaw2]

My local AntiCoagulation Clinic with 1500+ patients is affiliated with our Local Hospital.

Their charge for an INR test is $51.

My Employer Based Insurance paid $49 of that charge.

I recently discovered that Medicare pays LESS than $6
for the same INR Test while the Hospital "writes off" $45.

No wonder Doctors / Hospitals don't like to take too many Medicare Patients!

OTOH, it is my understanding that by LAW (enacted by OUR? Representatives), Medicare is NOT ALLOWED to negotiate (high volume) discounts on Prescription Medicine with the Drug Manufacturers, giving them a Legal Stranglehold on Prices!

There was a Very Interesting Interview on Bill Moyers (PBS) last night with the former Chief Communications Officer of Cigna (Insurance) company who revealed how insurance companies scrutinize patient records to find legally binding ways to disqualify policy holders when faced with potentially Large Payments.

It will be interesting to see how Medical Care "Reform" works out...

 

[Lisa in Katy]

Al, my plan pays $2.02 to LabCorp - less than Medicare. In the past, Medicare rates were low. However, it is not unusual for it to be higher than commercial payors now. That's because government overreacted to the complaints that doctors were opting out and raised their reimbursement too much. Another thing that scares me about a government plan. They don't know what they're doing.

I think that this guy from CIGNA is getting subsidized by the federal government. Believe some of what he says, but certainly not all. Large payments are made each and every day without blinking an eye. There are very few things that aren't covered by most insurance plans. If someone has a very limited plan, denials could occur, but you pay for what you get. Compare health insurance to car insurance. Does car insurance pay for oil changes, engine repairs, new wiper blades, tires, etc.? No, but health insurance pays for the equivalent of these things. In car language, about the only things health insurance doesn't cover are paint jobs and rims - things that aren't necessary.

 

[dick0236]

Al...Currently I am in a Medicare Advantage plan and they pay my PCP the following per INR test(finger stick):

Testing- Dr. charge $23.00, Insurance pays $5.74, I pay -0-

Physician reading - Dr. charge $10.00, Insurance pays $6.50, I pay -0-

Total- Dr. charge $33.00, Insurance pays $12.24, I pay -0-

A couple years ago, I went to my Cardios ProTime Clinic. The clinic charge was much higher than my PCP. However, Insurance did pay a greater amount and I had to pay +/- $20 'cause a specialist "read" the result (they also use fingersticks).

I am now trying the QAS program and, as I have been told, the test will cost about $40. Insurance will pick up 80%($32) and I will pay ($8).

As an "old" health insurance professional, I am scratching my head as to what is going on in healthcare.

 

[Nancy]

Joe's doctor always told him that he lost money on the testing, and was urging Joe to get a machine so he could do it at home. Joe was quite unstable towards the end, and had to be tested very frequently.

He didn't want to get a machine.

But we never paid for any of the tests. His insurance covered it.

 

[Rich]

I know Iv'e mentioned this before.
The reason I never looked into home testing is quite simple.
I go to my hospital lab for the old arm poke.
It doesn't matter whether I go monthly or weekly, I pay nothing. Medicare pays the whole bill and it's been that way since I went on Medicare a half dozen years ago.
Prior to going on Medicare when I was still working I had a $9.00 co/pay for each blood test, now nothing.
And my hospital has a special out patient lab just for people like us, with little or no waiting.
My nieghbor who is 80 still goes to his PCP for a finger poke, and he pays over $40 for each test.
Rich

 

[dick0236]

No wonder Doctors / Hospitals don't like to take too many Medicare Patients!



It will be interesting to see how Medical Care "Reform" works out...

Al, in Kentucky, there are virtually no hospitals and only a "smattering" of docs that won't take Meciare. Many grumble, but most are compensated fairly and they DO TRUST that Medicare pays in a timely manner....unlike some insurers.....
.....and you are right, "it will be interesting to see how Medical Care Reform works out".......I have my own ideas, and my idea does include a "government option". As a senior on Medicare, I have never had any complaints with the Original Medicare system until I went into a Medicare Advantage plan which is a Privately Run MEDICARE health plan. Mine is thru Anthem BC/BS "Senior Advantage".....Grrrrrr.

 

[Ross]

Al, in Kentucky, there are virtually no hospitals and only a "smattering" of docs that won't take Meciare. Many grumble, but most are compensated fairly and they DO TRUST that Medicare pays in a timely manner....unlike some insurers.....
.....and you are right, "it will be interesting to see how Medical Care Reform works out".......I have my own ideas, and my idea does include a "government option". As a senior on Medicare, I have never had any complaints with the Original Medicare system until I went into a Medicare Advantage plan which is a Privately Run MEDICARE health plan. Mine is thru Anthem BC/BS "Senior Advantage".....Grrrrrr.

Not to through this thread off track, but Dick, how many choices of advantage plans do you have in your area? Is there a better plan accessible to you? I know you've probably already figured that out, but just gotta ask.

 

[dick0236]

Not to through this thread off track, but Dick, how many choices of advantage plans do you have in your area? Is there a better plan accessible to you? I know you've probably already figured that out, but just gotta ask.

I just checked my 2009 Medicare booklet. In 2009 there were nine(9) insurance cos. offering at least one advantage plan in Kentucky....several offering more than one Advantage Plan. Once you choose one, you are pretty much locked into that plan for the calendar year. There are some situations that would allow you to change insurers, but dissatisfaction with service is not one of them (I tried)....I will be changing 1/1/2010. Advantage plans charge very low or NO premium (they get an amount per month from Medicare to manage my care). They operate as "Private" Medicare Plans. Obviously, the low or no premium makes these plans very attractive....but the service of the insurers leaves a lot to be desired......and I should have known better and should have been more careful and should have "looked this gift horse in the mouth" before jumping into this......Like they say, "there is no such thing as a free lunch".

I am also sorry for sidetracking this post. However, the wide variance as to how INR test are charged by providers and paid by insurers points to one of the problems, among many, that we have in our healthcare
system.

 

[olefin]

I'm on Medicare and have Blue Cross Supplemental insurance.

My cardiologist charges $30 for the INR lab test.
He doesn't charge anything for reading.
Medicare allows $17.51
Blue Cross pays $ 3.50
I pay 0.

But recently I started full home testing. I pay 0 and test once a week if I choose.

I've never had a problem finding doctors that accept Medicare and Blue Cross. Besides my Cardiologist, have a Urologists, Ophthalmologist and a Dermatologist and recently we started going to a GP for our darling Internist moved out of state.

Sure hate to see the people in Washington mess with Medicare!

 

[catwoman]

Dayton:

Love your photo!!!!!!!!!!!!! Reminds me of a couple of my husband's childhood photos......

 

[ALCapshaw2]

I'm on Medicare and have Blue Cross Supplemental insurance.

My cardiologist charges $30 for the INR lab test.
He doesn't charge anything for reading.
Medicare allows $17.51
Blue Cross pays $ 3.50
I pay 0.

But recently I started full home testing. I pay 0 and test once a week if I choose.

I've never had a problem finding doctors that accept Medicare and Blue Cross. Besides my Cardiologist, have a Urologists, Ophthalmologist and a Dermatologist and recently we started going to a GP for our darling Internist moved out of state.

Sure hate to see the people in Washington mess with Medicare!

Where did you find that number for the amount that Medicare allows? How can one verify it?
(I'm wondering why 2 others reported $5.74 as the Medicare Payment)

 

[BigOwl]

My clinic charges $21 per poke. My high-dollar BCBS pays $3.50. I pay nothing. Don't tell me that sticking me, putting the blood on the strip, and putting it in the machine costs more than that $3.50, even counting the tech's time (since the whole process takes less than a minute). The computer calculation and the printout of the receipt probably cost less than 25 cents of the total. For this privilege I pay over $300 per month, and my company pays another $300.

The folks in Washington are not trying to mess with my insurance or with Medicare. They're trying to make it possible for the folks who don't get any of this to be able to. Don't believe the scare stories or the propaganda. I would really like for people to be able to afford to get their INRs tested who can't now do so! And then, maybe they can also afford the warfarin to keep them from needing more expensive care later on, which is what raises the costs of our insurance in the first place. Well, that and the gazillion bucks I just cost my insurance company for my fancy new valve.

On a side note, the total for my care on the bill for my AVR and bypass repair (including hospital, drugs, etc., and all the pre-op tests including the cath) was $135,000. My insurance company paid $35,000 (less than what my 4-barrel bypass fourteen years ago cost). I paid $166, which was what was left from my $500 deductable. The actual costs of these procedures can't possibly be what is billed--and I'm pretty sure that's the core involved in the current push for reform.

 

[Bridgette]

Maybe what would also help is if the USA introduced a "no fault" scheme for health care like many other countries have (in NZ it is ACC - Accident Compensation Corporation), in order to avoid the massive costs around litigation. I'm no expert but it seems from what I read that in your country there is big money to be made by lawyers and insurance companies (premiums) around medical malpractice issues, forcing doctors and health professionals to hike up their charges to cover this??

 

[Ross]

I just checked my 2009 Medicare booklet. In 2009 there were nine(9) insurance cos. offering at least one advantage plan in Kentucky....several offering more than one Advantage Plan. Once you choose one, you are pretty much locked into that plan for the calendar year. There are some situations that would allow you to change insurers, but dissatisfaction with service is not one of them (I tried)....I will be changing 1/1/2010. Advantage plans charge very low or NO premium (they get an amount per month from Medicare to manage my care). They operate as "Private" Medicare Plans. Obviously, the low or no premium makes these plans very attractive....but the service of the insurers leaves a lot to be desired......and I should have known better and should have been more careful and should have "looked this gift horse in the mouth" before jumping into this......Like they say, "there is no such thing as a free lunch".

I am also sorry for sidetracking this post. However, the wide variance as to how INR test are charged by providers and paid by insurers points to one of the problems, among many, that we have in our healthcare
system.

I'm on an advantage plan HMO also. I was just wondering if there wasn't something better for you to choose from. In my area, there are quite a few, but depends on what hospital you want to use. That severely limits the choice.

 

[Lisa in Katy]

Maybe what would also help is if the USA introduced a "no fault" scheme for health care like many other countries have (in NZ it is ACC - Accident Compensation Corporation), in order to avoid the massive costs around litigation. I'm no expert but it seems from what I read that in your country there is big money to be made by lawyers and insurance companies (premiums) around medical malpractice issues, forcing doctors and health professionals to hike up their charges to cover this??

As Karlynn said, we need healthcare COST reform. There are lots of reasons for the high costs in America, much of it just pure greed. That includes physicians, hospitals, insurance companies, lawyers, and "injured" parties. Texas capped pain and suffering at $250,000 and it made a huge different in medical malpractice. It's still not enough though.

Anyone who tells you that healthcare is not available, however, is not really telling the truth. No, those without money can't go to every provider that I have access to with my insurance. However, there are many clinics that charge on a sliding scale and all hospitals are required to treat a patient for any illness until they are stable. There are also government owned hospitals that provide care for those with little or no income. The problem is that those with no money and no insurance want to be able to go to whoever they want, whenever they want, not have to wait and not have to pay. Those of you in countries with government plans know that it doesn't work that way in your plans.

 

[olefin]

Dayton:

Love your photo!!!!!!!!!!!!! Reminds me of a couple of my husband's childhood photos......

Thanks Catwoman!
I think I was about 4 or 5 when that photo was taken.
It's been awhile.

 

[olefin]

Where did you find that number for the amount that Medicare allows? How can one verify it?
(I'm wondering why 2 others reported $5.74 as the Medicare Payment)

The numbers I quoted came direct from my Medipak (Blue Cross) statement. I get a detail statement on all charges.

I have no idea how you can verify it. Why would you wish to verify it?

I have no ideal why the others reported a different Medicare payment other than....you can not compare Medicare/Blue Cross with a Medicare HMO.

 

[Lisa in Katy]

Medicare is Medicare is Medicare, except when it's not! Plans often use Medicare allowables, but not always. There are also out of network providers that will be reimbursed differently.

 

[olefin]

The folks in Washington are not trying to mess with my insurance or with Medicare. Don't believe the scare stories or the propaganda.

Myself and my Democrat Congressman knows those are not scare stories. There is MANY things in the proposed health care bill that must be changed. He's leading the Blue Dog Democrats along with the Republicans against the proposed bill.

 

[hensylee]

d

Al, in Kentucky, there are virtually no hospitals and only a "smattering" of docs that won't take Meciare. Many grumble, but most are compensated fairly and they DO TRUST that Medicare pays in a timely manner....unlike some insurers.....
.....and you are right, "it will be interesting to see how Medical Care Reform works out".......I have my own ideas, and my idea does include a "government option". As a senior on Medicare, I have never had any complaints with the Original Medicare system until I went into a Medicare Advantage plan which is a Privately Run MEDICARE health plan. Mine is thru Anthem BC/BS "Senior Advantage".....Grrrrrr.

when the Medicare Advantage plans were coming along, my supplemental insurance company advised me to not sign any of their forms until I spoke with the supplemental first because Medicare Advantage was misleading. I threw all the Medicare Advantage mail away. I'm in a small area where traveling would be involved for dr/hosp care with Advantage plans but all our local in-town drs accept Medicare.