Can someone help me with a Medicare question?

[LeftofObama]

If this is in the wrong forum let me know and I'll move it. I wasn't sure where to post it, so I thought maybe someone here could help.


I had chest X Rays done last Wednesday and a follow up doctor's appointment on Friday. On Friday the doctor ordered more X Rays (cervical spine) and some blood work and ordered a stress test for this Wednesday. Today, the doctor's office called and said since I am already going to be there for the stress test on Wednesday that I need to have an MRI done on my cervical spine as well.

My question is this... This is the only time I have ever used Medicare, let alone had this many X Rays and other tests done all at once. Is this going to be one of those cases where I am going to end up getting a bill for multiple thousands of dollars after all is said and done? If it is I might just call and cancel those extra tests because I don't want a several thousand dollar doctor bill. My doctor's office is in a university hospital. That's the only reason I chose him.

[ScreamingMeemie]

1. It could be. Do you have Part B coverage?

The blood work and stress test should be mostly covered. The MRI could get expensive. I would explain this to your doctor.

[LeftofObama]

2. I have Medicare Parts A, B, and D.

I have never had to use it before except for the part D for my prescriptions. I am nervous as hell about getting a surprise multi-thousand dollar bill.

[ScreamingMeemie]

5. My suggestion after talking to my dad (he's a Medicare user) is to call

and ask. He has done this before, and they are very helpful.

[jehop61]

3. Give a call

To the Dr's business office and they can usually assess what's covered under your policy. Good luck and good health.

[Shandris]

4. Bloodwork and x-rays...

...tend to cost me about 100-150 each. My only MRI was roughly 450. I'm not sure how much of that is variable based on the nominal charges, though.

...and University hospitals tend to be -outrageously- expensive. Or rather, the one I went to was. $15,000 just to use an operating room for a half hour and a recovery room for 2 (It was a non-Medicare procedure, don't freak out! ). But that's still a pricy charge, even with Medicare knocking off 80% or so (assuming you have Plan B of course).

[DURHAM D]

6. If I understand correctly you have regular Medicare Parts A & B (plus D)

Do you have a Supplemental insurance policy for A & B? If not, Medicare will pay 80% and you will be obligated for only 20%.

Keep in mind that Medicare determines what doctors/hospitals can be paid for each procedure so it doesn't matter what they bill, it matters what Medicare allows and you are only responsible for 20% of the reduced amount allowed by Medicare.

[Sgent]

7. Do you have a supplement or medicaid?

If so this will be paid via those mechanisms usually at 100%. If you don't, I would look to have the lab and radiology done at a freestanding laboratory or "imaging center", as these will be much cheaper than a hospital.

With the tests your describing (other than the stress test), I would expect your copay to be less than $300, maybe as much as $450 if you haven't met your deductible this year. There is no co-pay for blood work, and the co-pay on imaging is 20% of the Medicare allowable (not the charges). However, the allowable amounts are different for those at a free-standing clinic and a hospital.

Although its probably better overall to have the work done at the hospital, there's no reason that the (bloodwork especially) needs to be done there -- Labcorp, quest, etc. provide perfectly good results. There may be an argument for having the MRI at the hospital if they are using new techniques or new machinery that isn't in the general community -- ask your doctor's office.

[DURHAM D]

8. I am confused by your post.

Are you assuming that the OP is in a Medicare Advantage situation?

[Sgent]

10. No

what makes you think that?

An advantage situation would be a different story entirely.

Without a supplement medicare pays:

Charges
- Medicare Discount
------------------------
Medicare Allowable

Medicare Part B will then pay for imaging (Allowable - Deductible) * 80%. For lab work they will pay 100% of the allowable (but only 80% of the blood draw cost, for patient responsibility of $5 or so). In both cases the patient is responsible for the remainder. The deductible is about $150 this year.

The allowable is different based on the service location, so the allowable for a hospital is different (and higher) than the allowable for an outpatient imaging center.

For those who have supplements, most supplements will pay 100% of everything; however, there are some high deductible supplements which wouldn't kick in until a certain threshold is met.

Depending on where you have an MRI done, the allowable could be $600-$1500 (or possibly more).

[DURHAM D]

11. Thank you for your response.

I am just trying to learn a little more. I have a Supplemental (Plan F) so there are things I just don't worry about. But I have three family members who are always asking me questions about Medicare. Two of them have Advantage plans and the other does not have a supplemental so your sentence above service location and allowable charges is very enlightening. Bottom line for them is that they just need to ask questions in advance. Thanks again.

[LeftofObama]

9. Thank you all for the replies!

If I am calculating it correctly I figure the total will be just under $1000 which I can afford. I was just scared to death that I was going to be socked for a whole lot more than that. Thanks again.