Tuesday, October 22, 2019

Va con dineros

One of the things you learn with this disease is that some days the best thing you can do is create a spreadsheet.   I've kept all my medical bills so far and so have a pretty good record of what things cost - or do I?

As I read the 30+ invoices I have received since I started talking to doctors you see some interesting numbers; each bill has five lines.

  1. Amount billed by provider
  2. Amount Allowed 
  3. Medicare Paid
  4. Amount paid by Supplement carrier (in my case Blue Shield)
  5. Patient Responsibility.
As someone who has spent a lot of time thinking about cost structures in colleges and universities, I admit to being baffled.   Here are my numbers at this point -

  1. Amount billed by providers - $76,641
  2. Amount Allowed  - $16,727 (22%)
  3. Medicare Paid - $13,366
  4. Amount paid by Supplemental Carrier - $3,362
  5. Patient responsibility - $1,650
So if the numbers are correct the payment is about 24% of the amount billed.   The most expensive part of my co-payments came on a surgery bill to implant the port - where I will be billed $1,087.   One other thing struck my eye - the rate of payment off the billed amount varied widely.  The highest percentage so far has been over 60% the lowest just .32% of billed amount.

I am not in any way griping about the money I have been asked to pay.  What intrigues me is that rarely in this process have I been presented with a real consumer choice like how much more effective is one procedure over another?  The place where it did show was in a set of blood tests that a physician ordered where I was asked to pay for all of the tests (evidently they are not in the Medicare list of covered services).

I understand discounting in higher education.  Some private colleges and universities offer 50%+ discounts to make their first year classes.   But an almost three quarters discount is hard to comprehend.

I asked my nephew who works in health care consulting and he confirmed that the first number is made up - and that between Medicare and the supplemental carriers the amount paid is based on ultimately negotiated schedules.

Tomorrow I go for the second infusion.  We will see how that goes.


  1. The Medicare/ supplement payment is confusing. One needs a full time bookkeeper to track everything. Sending love and healing energy. J

  2. Somehow, I don’t think that this argues for single payer. Opaque turns to midnight black?