Might be getting a huge Mayo bill--anyone know

Well, I was at Mayo earlier this month.

Had blood tests, MRI, and C11 scan.

Final figures are not in yet, but it is looking like the charges will be $12K, give or take some scratch.

Now, we got it pre-authorized via my MediCare Advantage Plan. I looked on their site and the "adjusted cost" is about 75%- 80% less and they pay a portion of that. It looks great, specifying my final cost as relatively small.

But, will Mayo agree to the adjusted cost? If so, fine. If not (and I seem to recall some mention somewhere that they might not), then my bill will be quite high.

So, I was wondering if other HW folks have been to Mayo using MediCare Advantage, and what was your experience.

Mel

Mel,

Your insurance company has a contract with Mayo so they will pay the adjusted (reduced) cost.

My PSMA at UCSF - full price 12 grand - insurance paid 4 grand and I paid 300 dollars.

You do not have a problem!

Bobby Mac

If my insurance company says no, C11 choline is unproven for prostate cancer (which it does), and I ever do go for such a workup, would I be on the hook for the entire $12k? Yikes. That's not gonna happen.

JNF:

I know from my BCBSM site, what they say I owe. My concern is that Mayo will not agree.

Specifically, there is one bill for:

$11675 (MRI and C11 Scan).

It says Amount Approved: $2057.80

It says Amount Paid: $1852.02

It then says:
Amount I Owe: $205.78

Now, that would be fantastic. But will Mayo accept their payment as payment in full??

Mel

While providers accept the Medicare adjusted fees, they are also happy to accept the inflated list price billing charged to wealthy foreigners who come to the U.S. for treatment.....

The point with all medical costs is the following:

NOBODY PAYS THE RACK RATE!

There are many reasons why medical providors and facilities like to have these seemingly ridiculously high "billed amounts" . When negotiating with insurance companies it's certainly easier to start from a high number and work your way down. But, it is pretty funny that these numbers are so high. And to anyone who thinks that number is out there so the "saudi" sheik can pay top dollar for such medical care, even THEY don't pay the rack rate, they negotiate in advance. Maybe 50%..

Even people with no insurance or POOR insurance, after the fact, EVERYTHING is negotiable and often facilities already have resources in place to adjust pricing down or simply remove all costs that one's insurance doesn't pay.

The three amounts to take into consideration are: Billed amount, the APPROVED AMOUNT, and the co-pay or co-insurance amounts. (that's the one that relates to YOU either with insurance, medicare or whatnot. You'll only pay YOUR portion - the co-insurance amount of the APPROVED AMOUNT.

I've seem approved amounts closer to 80% of the BILLED amount but most I have seen are closer to 20% of the billed amount. Some are like 5% and some are 0%.. yes, 0% of the billed amount is approved.

The billed amount varies HUGELY by provider. I think some just think, why the heck have such a huge number, when I know the insurance is only going to pay x. I've had an MRI billed at 12,000$ and approved at 2,000 and another billed at 2500 and approved at 1800$.. In the end, I pay my portion (usually about 30%) of the APPROVED amounts.

The crazy things are the following: For a not-4-profit, often times the difference between the BILLED Amount and the APPROVED amount is a WRITE OFF. I think from an accounting standpoint that is a crock. Creating millions in artificial losses, for really not having done anything.

Another crazy thing is BILLED amount and even APPROVED amount vs. actual COST of care or service delivery. Recently the university of Utah medical center and the Johns Hopkins medical center have done multi-year cost analysis of care delivery, including materials, real estate usage, power consumption, time and motion studies etc. to come to a closer understanding of what their ACTUAL cost of care/service delivery is and the finding were shocking. Both findings were very similar.

The gist of them were the following: The cost of many services and even consumables was in the pennies on the dollar and often times actual PENNIES. The BILLED amount for services such as MRI and RADIOLOGY was between 10x and 25x of the ACTUAL costs. The costs for lab worked ranged from 1.5x-1000x the actual cost. It does on and on.

Now, historically, organizations could make the argument that costs were rising faster than the ability to bill and they had to stay ahead of it, and also they could make the argument that so many people were NOT insured and therefore they had to generate profit on the INSURED to cover the UN-INSURED.. that argument is waning today for sure.

So, I think we're reaching a high water mark in our experience of costs. We'll see.

For my experience with having had MRI/BIOPSy's at Stanford the billed costs for CONTRAST MRI and BIOPSYS was about 40K, allowed was about 18K, and I paid about 4K out of pocket each time.

For the actual RoboProstatectomy, billed was about 90K total, 15K for the surgeon and 75K for everything else. In the end, the surgeon had about 9K approved and the hospital/surgical suite/labs/pathology had about 24K approved.. I ended up with about 6K total - but only had to pay about 3K since my annual OOPM was nearly met.

It's expensive but as the old saying goes, "your money or your life!"" I chose life.

With the Mayo, you get one bill - their doctors and other staff are salaried, so they don't bill separately.

However, Mayo does not accept Medicare "assignment" - I think that means they reserve the right to bill above the amount Medicare pays - about 15% more, I think it is. However, we have never had a surprise big bill with our Medicare Supplement plan and we've been to Mayo Minnesota and Mayo Scottsdale. Between Medicare and UHC, our part of the bill has been reasonable. But next year, our insurance is changing to a Medicare Advantage Plan. I talked to both our new plan admin and Mayo, and Mayo Scottsdale will NOT accept it. Mayo in Minnesota has no problem with our Medicare Advantage Plan. You are lucky if you got pre-approval with your Medicare Advantage plan.

Bottom line is Medicare Likes to scare people. I always get sent a huge bill that says I have to pay huge amounts and then when I call them up....they say don't worry about it....I don't have to pay it.

when I became disabled...I went from Tricare(Military) to Medicare first then Tricare 2nd. I always get sent a statement which is not a bill but it will tell me what I may have to pay. So far I haven't payed a dime because Tricare picks up all the rest.

I believe you wont be paying much at all if any.