HUMPTY DUMPTY – USA Health Care

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A frequent refrain sung in today’s USA health care services reminds me of Humpty Dumpty – “It’s broken and can’t be put together again.”

The Medicare system mandated for our elderly is a cogent example.  Enrollment is required, deducted from Social Security benefits and administered by the Federal Government.

When I first encountered Medicare, I was delighted. The cost was less than private pay insurance and Federal Law guaranteed services. My hospitalization for a heart attack was covered. I also learned the Original form was more economical and I saved the difference in cost of add-on premiums.

And then the fissures started to appear. They were not restricted to Medicare but permeated the whole structure of health care.

My first glimmer of flaws occurred in reviewing a claim where Medicare was charged and paid for services I did not receive.

I dutifully filled out and filled the fraud section of the Medicare claim. When I tried to follow up on the results, a Medicare agent told me I could not have access to the information despite the claimant’s billing me for co-payments. Perhaps it was not cost effective to retrieve the money. I wondered how many $200 payments were not retrieved a year and what % accounted for the cost of Medicare.

Last month I had an annual exam. Yesterday, I received my electronic claim history. It contained the annual exam and an additional charge for the same day. The additional charge paid by Medicare cost more than the annual exam and was charged as a ‘facility fee.’

I contacted Medicare to find out what this was for. After several hours, I finally reached a representative who read a statement authorizing ‘facility fees’ from an unknown source. Since, I had not been charged a facility fee before, and my exam was in a clinic, not the hospital, I questioned the charge.

Ascending the ladder of Medicare supervisors did not resolve my questions. Why was I & Medicare charged a ‘facility fee’ for a routine clinic visit?   No one could explain this charge.

I called a Practitioner friend to determine if she had any insights. She said she had a non-Medicare patient complain about the same issue when billed for an office exam.   The fee for the exam was usual however the facility fee was additional and more than the exam.

Can you hear the CRACKING sound?

Who authorized these facility fees and the spending of my tax money? Why does the facility fee equal more than the professional service exam?

Please advise if you have information on the shattering of our health care system.

 

 

 

 

 

 

 

2 responses »

  1. Medicare is notorious for paying for BILLIONS of dollars of fraud annually. If a certain president was truly interested in saving money on health insurance, cleaning up this fraud would be the place to do it.

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  2. The facilities fees have been bundled into fee and the newest electronic billing -dare I say systems’ have to disclose it now. Sorda like how rent includes the property tax and garbage fees within the monthly… The health industry is just following the bankers and tax assessor so they can stay in currency flow. My take on it anyway🤑 I’m back fromOregon. Pretty exhausted from travel last night but getting my game on today. I’m glad I built in a buffer day before returning to the health care industry . Xosistaml Sent from my iPad

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