Watch out! Medicare might not cover your hospital bills– but there’s something you CAN do



Medicare has just released a massive amount of data on the prices hospitals charge for various services and while Medicare reimbursements have been flat, the prices charged by hospitals has risen 10% a year for the last three years, far above the rate of inflation.

The list prices are not just growing, but are substantially higher than what Medicare pays. In the case of joint replacement, the most common reason for hospitalization in the data, the average hospital charged around $54,000 in 2013. Medicare, on average, paid around $12,000.

Increasing the list price is a simple way for hospitals to increase revenues, said Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health. “They want to get more money, and the only way they can do this is to raise their prices,” he said. Even if hospitals don’t get the full amount they are charging customers, he said, raising the list price “gets them some cents on the dollar.”

While hospital list prices don’t affect those with Medicare or private insurance, they do set a high bar for the uninsured or those who go out of network.

Most people with health insurance, including those receiving Medicare, won’t ever a see a bill for the hospital’s list price because the insurer negotiates a lower rate. But these rising charges are a growing concern for some consumers, especially those who are uninsured or seek care in a hospital that is not in their insurer’s network.

The data dump also includes statistics for individual physician billings to Medicare.  Several of the doctors on the top of the Medicare reimbursement list were familiar names

The second-highest earner in 2013 was Dr. Asad Qamar, a Florida cardiologist who received $16 million in 2013, according to an analysis by The New York Times. In January The Times reported that he is being sued by the federal government as part of two whistle-blower lawsuits that claim he performed unnecessary surgeries.

The third-highest biller was Dr. Salomon Melgen, a Florida ophthalmologist who has been indicted on Medicare fraud charges and on claims that he traded gifts and trips for political favors from Senator Robert Menendez, a New Jersey Democrat who was himself indicted on corruption charges this year. Dr. Melgen received $14.4 million from Medicare in 2013.

So what can you do to ensure you are prepared for any health emergency? KNOW WHAT YOU’RE PAYING FOR.

According to the Medical Billing Advocates of America, nearly eight in 10 medical bills contain some sort of error. While your bill might end up being accurate, it’s important that you know what mistakes to check for.

This graphic, from U.S. News, can help you decode the confusing layout of your hospital bill.



If ANYTHING looks out of place, be sure to mention it to your healthcare provider!