Posted on 05/07/2021 6:04:36 PM PDT by sit-rep
I never thought it would happen to me!
April 16th, Kiteboarding at Desoto Beach Florida, I fell and when I stood up Bam!! Stingray Barb right in the bottom of my foot!! The bastard got me good because the water turned Crimson around me almost immediately! I made my way back into the beach, wrapped my foot the best I could, stowed my gear in the van and headed to Palm Medical Center near Treasure Island.
Long story short, I got 2 X-rays on my foot to check for pieces of the Barb, a little saline flush syringe, and the Doc glued the loose skin and filled the hole. Told me no water for 2 weeks... I came home!
Last week I got 2 calls from their billing department. the first was mild, but the second one today, was pushy, trying to get me to sign up for Medicaid to pay for the bill. The first call wouldnt tell me the amount. but told me they would send the bill in the mail. Today's call, told me the amount was $8000 and change... I said are you Bleeping kidding my?? 2 xrays, a plastic syringe douche and glue is 8K???? Her response!?? Well if you sign up for Medicaid, they will pay it no problem!!!
I lost it and told her that I think I'm getting ripped off, and i'll be damned if I'm gonna allow you to rip of the Tax payers!!
Now granted, 8K isnt jack in the medical field. but its just the friggin point... How determined the girls were to get me to sign up to pay the bill... friggin Crazt!!
so, I think its a clear case of fraud... who do I lay this on for the best results??
HOORAY sit-rep. Great to see you. REAL NEWS from a citizen journalist.
Good news. Medicaid will pay them about $400.
Total scam.
Trump was right, as he often is, that medical billing prices should be published by the provider. Let the customer choose. Right now the whole thing is so opaque, with different insurers getting different discounts and pharmacy suppliers giving rebates etc etc.
And you thought figuring out the dealer price for a new car was difficult!
If you look at the elective surgical industry - nose jobs, tooth implants, breast augmentation and the like - they are very transparent about their pricing because they have to compete in a free market and there is no insurance for those procedures. The price they quote is the price you pay and you can shop around for price and quality and other factors. The entire medical establishment should do the same.
you don’t have health insurance? I thought only homeless people didn’t have health insurance.
really?? thanks for your pearls of wisdom...
If you are eligible why not sign up for it?
btt
because I dont like government hand outs. I’ve been that way all my life. heck, I have been on the hardest of times, and to date, I never even recieved a dime in unemployment benifits...(even though I’ve paid into it for years...or my employers have...)
Just doesnt sit right with me...
This sounds like a job for SuperPrez, Joe Biden!
Don’t know what type of insurance you have, sounds like the hospital is what is known as balance billing. The hospital wants the full amount not what your insurance paid, don’t know about Florida law, but Medicare and medicaid in Cali does not allow for balance billing. Until you get an actual bill from the hospital ignore them.
Not sure why you call this Medicaid fraud. Provider fraud would be more like it, although no worse than all the others.
Yeah, I had an upper endoscopic exam last year. Everybody and their brother sent me a bill - anesthesiologist, endo doc, hospital. Came out to $20k. Even with insurance, couldn’t you quit farming out the load, keep it in-house, and work out a payment plan?
so are you going to write a check for $8k?
So a couple things. Based on your presentation, I am guessing you are not insured. Most hospitals have an uninsured discount, but also a medicaid pending status.
The hospital is attempting to recuperate costs it spent on you that is otherwise not recoverable. What most people do not understand is under Clinton, hospitals were required to have a single charge master. In other words, the charges for a service can only have one price. That price is meant to cover the entire gambit from people who do not pay all the way to the best insured
Insurance contracts tend to be pegged to Medicare reimbursement. That is to say, 85% - 125% of MC reimbursement which is set by the federal government. The way reimbursement is calculated is the DRG x CF which yields a single dollar amount. All insurance contracts have a contractual write off so that the actual reimbursement has nothing to do with the price of the charge master of the hospital.
In terms of medicaid, the hospital has the right to charge medicaid for one year following the billing if you are Medicaid eligible. The hospital will not make $8,000, but the medicaid rate, which is a very small rate. The other poster who said the hospital may recover $400 is perhaps a little optimistic, perhaps somewhat less than that.
The bottom line is that there is no fraud here. This is what must happen in order for the hospital to cover the costs that are legally required (free care) and keep the lights on and the doors open.
My best advice — get health insurance.
You have no idea what you are talking about,
You also have no idea what you are talking about, this is not provider fraud. All the charges listed are hospital charges. Provider charges are separate.
the hospital/doctors office sounds pretty sketchy.
The sad truth is despite stating you dont want a hand out, by not paying the bill or accepting insurance, you have stuck the tax payer with the costs of your care.
Think survival at any cost. You can philosophize later.
Do whatever you have to do to give that wound a chance to heal and close up on it’s own without any infection gaining ground. Good luck to you. I used to be that idealistic until I encountered some very serious medical situations over the years. Not every Government program is a bad idea.
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