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An elderly friend recently had to go to emergency with severe pain and was told that any tests run may not be covered for her. When she received the bill, it was around $15,000!! She has good insurance and also Medicare, so we wonder if the Affordable Care Act has reduced coverage for people over a certain age?

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I misspoke- Medicare Advantage is Medicare's HMO plan...not supplemental. Fingers typing faster than I can think!
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Medicare Advantage is standard Medicare with the HMO supplemental plan, and they become your primary, being the go-between for Medicare. Medicare with a Supplement Plan means Medicare is the primary insurance with the supplemental plan covering a lot of what Medicare doesn't. If you do not have a lot of health problems, a Medicare Advantage plan works well for most - the premiums are low, and it has fairly low co-pays (but there are co-pays for just about everything you need, which can add up), whereas a Medicare w/Supplement plan is more expensive per month BUT the out of pocket costs are a lot less. My mother was paying over $5,000 out of pocket each year with the HMO plan, and when she switched to Supplemental coverage (Plan F) she didn't pay any co-pays, skilled nursing was 100% covered for 100 days, and hospitalization was covered almost 100% also. My mother had a LOT of medical issues, prescriptions, dr. appointments, so it really paid to switch her over. Whatever you do, don't make that decision based on the cost of the premiums alone...it's the out of pocket expenses that will get you.
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BREN34748, I agree with Jinx. I think you are being honest, but that what you were told was not the entire picture. The survival rate for brain bleeds is not good, from everything I have read. There are factors that make it less likely to be treatable, such as age and the amount of the bleeding and where the bleeding is. The doctors have to look at all information available to them and decide on the best course of action. I am sincerely sorry that your active friend died from hitting his head on concrete, but it is by no means certain that death could have been avoided through treatment. And certainly no insurance that sets an age cap. The ACA is not in effect yet, and won't set age caps on procedures when it is in effect.

The sad truth is, we do not have the means to prevent all deaths, especially from severe blows to the head.
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to add to my above reply, I am sure I will get billed for some other hospital or dr expenses, but still do not think it will be much.
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I just turned 65 last week and went early in the month to a dermatologist and discovered a melanoma on my arm. I am in aarp medicare advantage and find it great. this is the 1st illness I have ever had, on no meds, eat healthy, but melanoma is heridatary, did not luck out here! dermatologist was $35, hospital yesterday was $250. I had an agressive melanoma cancer so they did inject nuclear dye into it to check the sentinal lymph nodes. they operated both the removal (by a plastic surgeon) of the melanoma and another surgeon found 1 sentinal node showed the cancer and removedd that. I am blessed it only go that far. someone earlier stated that the advantage plans replace regular medicare-this is not true, it does all the paperwork, for medicare. itis still the same, medicare pays it part and my advantage supplemental(which is free) pays the rest. My mother has been on this type of plan for as long as they have existed. 2 yrs ago, (she is now 95), she discovered a large golf size lump in her breast and it was cancer. they had to remove her left breast and all she paid for everything was $1,000. she is also very healthy, and this is still cheaper than paying for one of their other supplemental plans. No One over 60 should go to a dr or hospital without another person who can help make decisions.
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From the Wall Street Journal (owned by Rupert Murdoch, a Conservative with a Capital "C") October 28, 2013: The headline of the article is, "Those Over 65 Need Not Fear the Affordable Care Act". The subhead is: ALICIA MUNNELL: The Affordable Care Act will have no impact on those 65 and over as they have Medicare. For people younger than 65, it will allow those who no longer have employer-provided coverage to buy affordable health care to tide them over until they, too, are eligible for Medicare.

Alicia Munnell is the director of the Center for Retirement Research at Boston College, where she also serves as the Peter F. Drucker Professor of Management Sciences at the Carroll School of Management.

From AARP's Factsheet about the ACA:The law strengthens Medicare by including more preventive benefits, lowering the price of prescription drugs in the Part D doughnut hole, and fighting waste and fraud.
Medicare is strengthened

Your guaranteed benefits are protected. You earned your Medicare over a lifetime of work. The health care law protects your guaranteed benefits so you can always get the care you need when you need it.

You get more from your Medicare

The health care law lowers prescription drug costs. If you have Medicare Part D, and you reach the coverage gap or “doughnut hole” in 2013, you will get more than a 50 percent discount on brand-name prescription drugs and more than a 20 percent discount on generic drugs while you are in the coverage gap. The discounts will continue to grow until 2020, when the gap will be a thing of the past.
More preventive care is covered. Medicare now covers yearly wellness visits and more preventive care. This includes cancer, cholesterol and diabetes screenings, immunizations, diet counseling and more.
The health care law fights fraud, scams and waste that take money from the Medicare program. The law strengthens Medicare by adding more resources to catch those who fraudulently bill Medicare.

Updated August 2013
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I agree with Jinx, there may have been more to it than what you were actually told. Perhaps he had some type of DNR order and the family decided to let him go and maybe the wife is too distraught to remember that??? My brother in law was very young (40's) but he had an illness that was taking a toll on him, he developed pneumonia and was hospitalized and I do not know all the details but my sister deferred to his mother and sister's wishes and they told the doctor to let him go.

If anyone knows anything about what BREN was referring to and knows it to be enacted in our healthcare system now, I would really like to know about it.
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BREN34748 - I believe that that is what you were told, but I don't believe that that story is true, not in the details.

My father had cancer and an aortic aneurysm. The aneurysm needed to be fixed first, and that surgery could have killed him. My father chose no treatment, rather than risk the aneurysm.

The doctor may have decided that your neighbor was too frail for surgery. I won't believe that the reason was his age, or that that was the only reason.

I know that there are NO laws that would allow such discrimination. It's possible some arrogant doctor might have decided that, but that's the fault of one doctor, not the ACA.

It's awkward, because I won't believe it without proof, and this is an anonymous website, so you can't really give me proof. We'll have to agree to disagree.
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Blannie: Thank you for the suggestion. We actually spoke to all the nurses that assisted my Mom while she was hospitalized and asked them who they would say would be a good general practioner, much to our chagrin they told us that since they have instituted "hospitalists" which are the doctors that see you when hospitalized so your own doctor doesn't have to..... they no longer see these general practioners, because they can no longer come into the hospital to see their own patients!!! They did tell us which "Hospitalists" from which HMO were the best to use while in hospital but we need the doctor you can run see for a cold or earache and that is willing to listen to the gerontologist Mom see's.

I do love you idea about using the PPO book. I wish California did not have HMO's they are a pain in the bo hind! They mess us up even when we do not belong to them!
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And I do believe we will see more and more and more of this kind of lack of treatment for elderly. And tremendous expense out-of-pocket. Please do not sign any form for care without careful review!
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I had a very active neighbor, 82, who fell and hit his head on the concrete. He ended up with a brain bleed. He was told that since he was over 76, he could only be given comfort care, so they did nothing to stop the bleed. Two weeks later he died. So very, very sad for a very active man, who should not have died. His wife is now going down hill, physically and mentally, since his death. To think it could have been avoided, makes me sick!
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OK all, I did decide to make contact with my elderly friend's daughter at her work place. She was SO grateful for my call (concerning her mom's payment of about $15,000 in an overnight hospital stay with tests) and will be looking into it soon. Her mom obviously made the decision to pay the large bill without asking one of her children about it. Daughter I contacted gave me her own cell phone so I could call again when I notice anything I think the family should know. I feel so much better now! Thanks for all the help and encouragement. Now to keep things ok with my own parents!! Calling our insurance agent this morning.
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HolyCow I'll tell you what I did. When my parents moved up here to be near me, I took the booklet with the list of the doctors in their PPO to our hospital. I went to the general nursing floor and went to the nurses' station. I asked the nurses to point out which doctor(s) they'd recommend for their elderly parents. At first, one nurse didn't want to help (they're afraid they'll get in trouble), but another one came over and started looking and giving me feedback. Comments like, "I wouldn't take my dog to him"... stuff like that. I soon had two or three nurses going through my list. I found a great doctor for my mom and dad that way. You may find resistance (and do it when docs aren't there at the nurses' station doing their rounds) but it worked for me.

When my mom was to have a heart procedure, the cardiologist in the practice was arrogant and ignorant of the medications he gave my mom to prep for the procedure. So I asked around and took her to another doc in that practice, who we love. You can also look online at some of the ratings websites, but I think those aren't as helpful as nurses. They know what's really going on. If you need a cardiologist, then go to the hospital's heart floor, etc. Finding the right doc can make all of the difference in the world for your mom. Good luck!!
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I still don't get the whole "observation vs inpatient" thing as my mother was seeing a gerontologist for severe pain in the area of the gall bladder. We knew she had stones and had for years but it reared it's ugly head at 84 and she was in horrible pain. He sent us for ultra sound and blood work and called me and said "get your mother to the emergency room immediately, she has a severe gall bladder infection and is in need of surgery NOW. Have them call me and I will provide all the information they need." My sister and I took her and she was seen by an HMO Hospitalist doctor, even though Mom is not HMO. She was in emergency for over 6 hours and they ran all kinds of tests then decided to admit her. This hospitalist then told us they were putting her in their brand new south tower for "observation." This room was beautiful and so was the entire wing, however there was not a lot of testing or anything being done, we were waiting for the surgery to be performed. This is when the Hospitalist came and said they were releasing Mom and she would just have to live with the pain! Due to use of Warfarin and arrhythmia she was not a good risk for them to do surgery on. I was in shock and I was angry! Within 5 minutes a surgeon was standing at Mom's bedside telling us he could do the surgery the following day with no problems! It was really 5 minutes! I said great, lets do it and we did and he was right she was fine. Her arrhythmia did act up but her heart doctor was there and put her on some new meds that are working great for her. The cardiac unit that Mom was transferred to AFTER observation and surgery was horrible compared to the "Observation" room she had been in.

This was the first time this ever happened to us or that Mom was held solely for "observation" so it threw me. I do not understand why she would have ever been put into "observation" when a doctor told them she needed surgery immediately anyway!

Some of these brand new doctors that are in these HMO's scare me as I wonder just how good they really are since they do such stupid things. I feel like they cannot be trusted. Mom's private doctor retired and sold his practice to an HMO is how we became involved with these doctors anyway, now we have to find a new private practice doctor for her to see.

When the hospital sent me a questionnaire about Mom's stay, I did complain and told them what all had gone on and this doctor that was just going to release Mom and let her live with gall stone pain.

We have received some statements in the mail but everything has been covered. I was waiting for a bill to come in and getting ready to raise heck over it.... so far it has been good. Could use suggestions for finding a good private doctor for her for the future.
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I think I am calm enough now to talk about my visit with my agent. A couple of months ago I received a notice from my medicare ins. that my plan would no longer be available in 2014. My agent and I spent 4 hrs. looking for another plan. Finally found one, but all the co-pays went up, ambulance went up, in hospital co-pay per day went up, out of pocket max. pay per yr. went from $3,700 to $6,700 and the drug co-pays went up. There is absolutely no one to thank for this rip-off but our socialist pres. He is destroying our country!!!
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Bren, Congress have made it known years ago of wanting to phase out social security. And then a few years later, they also want to phase out Medicare. Either that or the media got it wrong. But I don't think so. They're trying to push those in Medicare to try an alternate option. When I first heard about Obamacare, I told my father that this is bad news. Since the feds are trying to rid of Medicare, they will say that they need more funding towards Obamacare. So they will need to take that fund from somewhere. I figured that they will take it out of the Medicare and maybe also Medicaid budgets. That was my theory. I stopped following the news on it. My father has been wanting to quit his secondary insurance. I've persuaded him - every year - NOT to do this. I've told him over and over that the feds will be cutting back on the annual budget to Medicare and he really needs that secondary insurance. sigh....
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I just met with my ins. agent today and I am so furious you really, really, don't want to hear my thoughts on this medicare issue. I can't even talk about what I have learned about OBummerCare, which has definitely affected medicare, now and next year!!!
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Thank you, I will try that approach. She is a very fearful person, so I am praying about how and when I could talk with her. It needs to be soon though!
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Maybe point out that you've just found out that some people pay before they need to and you have friends (i.e. me) who found out their parents overpaid and got a lot of money back ($2,000 in my parent's case). Ask if it would be ok to talk to one of her kids about it, to see if they might know more about how it works. If you get one of her kids involved and they need more help in understanding it, have them come here to get more help.

You're obviously a very caring person and if she's worried about paying $15k, I think she'd be thrilled at the idea she might get some of that back. Let us know if you do pursue it with her.
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The $15,000 charge was for a woman I work for in her home. I don't want to upset her, but am not sure how to help her. At 85, she is pretty with it, but I think she paid this way too fast. I am unsure if I should say that to her, or just ask her if I can talk to one of her children about it. This would really be sticking my nose in her business, but I do think she should have waited to write that check. If her kids are aware, I would think they would have stopped that and maybe handled it for her. It is a little bit touchy situation for me that I am unsure how to handle correctly.
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Ellenjay, definitely not the ACA ... as igloo points out, that isn't even in effect yet, and as others have stated, it has nothing to do with medicare. Even those non-medicare subscribers whose coverage is changing under ACA won't have the changes be effective until next year. Of course that doesn't make it less of an issue for you, but at least let's not place blame where it doesn't belong.

I've been shocked at some of my own medical statements, until I notice they have not been submitted to insurance yet ... or they have submitted it but not received payment yet. Whew! When all was said and done, I didn't owe anything, or perhaps a $10 copay.

I don't know what the $15,000 charge means for your mother. I sincerely hope it turns out she owes much less than that. Please let us know. We learn from each other.
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Jinx4740 has given invaluable information in that web link. Ask if you are staying for observation or being admitted. Do not sign anything unless it states that you are being admitted or on inpatient status or you could be stuck with the full bill unless you have part B or other health insurance cverage. It is not so much the hospital's dong, but the medicare rules that are so contradictory and unclear even to hospitals. There are too many differental governement agencies making Medicare decisions that create chaos for those on medicare.
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HolyCow - I think the whole observation scenario is geared to being able to run lots of tests. Once they are admitted then isn't it the case that Medicare has a specific list of what is allowed under the admit code? And it has to go through the hospital and under Medicare's already negotiated reimbursement rate.

But if they are just on observation, then it's like being in the doc's office and so lots of lab tests, x-rays, scans, etc as there is no set limit to what can be billed. I bet a lot of the test done get run through outside vendors too. Probably some Stark Law violations in all that too. I would so like to see CMS go in heavy on Stark compliance with doc's and their lab agreements.
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EllenJay - The ACA hasn't even started yet, still in application stage, so what happened with your friend has nothing to do with ACA.

As others have said, she needs to take the time to carefully review the statement to see what it is and what is expected. Almost all facilities take Medicare and Medicare reimbursement rates are set and paid the same for the specific coded procedure. Now the issue will be with the non-Medicare paid for part of her costs. If it was an out-of-region or none-participating provider, the costs could be significant. This is the same thing if you go to see a doctor or go to a clinic or hospital who is not in your health insurance groups "network". (BTW This is one of the reasons why the ACA is so very important in that for regular health insurance the out of region f***ing you get will be gone.)

The statements can be mailed with 48 hours from discharge or when a procedure was done and usually the first mailing does not include any payments from Medicare or the insurance company. So the amount will be some kinda huge. Then maybe 30 days later you get another statement that shows the anticipated insurance payment and then 60 days later another statement with credits, etc. Once Medicare has paid their negotiated rate and you get billed the balance due. If they are in-network it will be reduced and if not in network it won't be. Then there are charges that neither Medicare or insurance will pay ever.

It is not just the elderly that have these costs. You know I think that about 50% of all bankruptcy's are due to medical bills. One health problem & hospitalization can easily run 6 figures, and there are really no more Hill Burton funded hospitals out there like there used to be to provide for free care. Gosh, even C sections can run 20K. I just had a CAT scan due to 4th nerve issue and the study was 5K. Our insurance paid 80% and the rest had to be paid or debt contract signed before the procedure was done - if we did cash or debit card they took 20% off. Not everybody has 800K in their purse right now and that was just for 1 test. Now the digital imaging center closest to us, was NOT in network and if I went there then our insurance would only pay 50% of the cost. So I had to make sure they were in network even though the procedure was the same. It was up to me to find that out. ACA should limit that happening in the future.
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It has to do with Medicare trying to save money, of course. Medicare pays less for a patient who is not "admitted." They have contractors whose job it is to make sure all admissions are truly needed. Google "observation vs admit to hospital" for a Boston Globe article from 8/24/2013.

It's complicated. I don't want Medicare to make ME pay more for my care, but I want them to cut out all the fraud and abuse from "the bad guys." I want Medicare to be available to me and my daughter, and they need to reduce the costs to ensure that. Rock and a hard place.
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Make that "many are NOT taking new patients due to reimbursements."
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My statements about Medicare not paying for certain tests or as much physical therapy as they use to has nothing to do with the ACA that I know of, every year Medicare cuts the amount they pay to physicians and now they have begun to cut services not just the amount they pay.

There is a problem in some places with doctors accepting patients with Medicare so you have to ask every doctor you see if they will accept Medicare, many are taking new patients due to reimbursements.
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Jinx4740 Do you know why the hospitals are admitting patients for observation rather than just straight in patient? I am curious, this just happened to my mother who was admitted for gall bladder stones and the need for surgery, instead they admitted her for observation for 3 days, the doctor then comes and says they are releasing her and she will have to live with the pain. This HMO doctor says that because Mom has been taking Warfarin and her history of heart arrhythmia, they do not want to take a chance on surgery!!!! She left the room to release my Mom and in 5 minutes a surgeon is standing at Mom's bedside telling her he can do the surgery tomorrow with no problem and he was right. I just don't get the "observation" thing as Mom's Gastroenterologist is who sent her to the hospital for surgery.

There are some tests and physical therapy that use to be covered by Medicare but it is no longer covered or has been reduced. When something like this happens the patient is suppose to be informed and they even have you sign a form stating that you realize Medicare may not cover whatever it is. If you sign it and they do it, you are saying that you agree to pay for said services. The thing is you keep saying she has "really good insurance and Medicare." That statement worries me as normally Medicare is the primary insurance, if you are no longer working. When I hear patients say things like this I get sick to my stomach as it normally means they belong to an HMO and have signed their Medicare benefits over to the HMO. When this happens, you no longer actually have Medicare, you now have an HMO, like Kaiser, Humana, Scan, etc. YOU MUST SEEK ALL CARE THROUGH THEM AND THEIR DOCTORS AND HOSPITALS, MUST, MUST, MUST!!!!!!! If you fail to do this you will be responsible for paying all charges because you did not seek care through a participating provider!!!!!!!!

Lastly NEVER PAY A BILL LIKE THIS!!!!!! UNTIL YOU HAVE CHECKED OUT WHY IT WAS NOT PAID AND IS IT BEING SUBMITTED TO A SECONDARY INSURANCE CARRIER!!!!! IF YOU PAY ANY AMOUNT OF MONEY TO A DOCTOR OR HOSPITAL, MANY OF THEM DO NOT REIMBURSE YOU AUTOMATICALLY....UNLESS YOU ASK THEM TO!!!!!!

This ticks me off to no end, but I have worked for them and let me tell you they will hold on to the money because they can. There is no law that states that they have to pay you back within any amount of time. I think this is wrong, wrong, wrong and they should be penalized for doing it, but when they see they have $100,000 sitting in their bank account that should be refunded, they don't want to and they will hold on to your money!!!!!!!! My former employer is currently sitting on a large sum of money that he refuses to refund of his own accord and has instructed his bookkeeping office to hold on to the funds unless the patient requests a refund. Most of these patients are elderly and do not even realize they have a refund coming. It is sickening!!! DO NOT PAY ANY PHYSICIAN OR HOSPITAL UNTIL YOU HAVE EXHAUSTED ALL AVENUES OF PAYMENT TO THEM. DO NOT GO OUTSIDE YOUR HMO EITHER!!!
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Ellenjay, it may not be a bill at all. My daughter thought she got a bill for $6,000 and it was just a statement of coverage. Read it for her if you can.
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Yes, I am aware of the observation vs. in-patient issue for insurance reasons. And that they are "observing" elderly to get away with not admitting them. Such a messed up world! Will try to follow up here when we know more.
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