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Robert
Premium Member
join:2001-08-25
Miami, FL

Robert to What the

Premium Member

to What the

Re: Emerency Room Payment

Never happened to me, both at the ER and the Urgent Care.

When I had to go the ER recently, I was seen by the ER doctor, had an ultrasound done, blood work, and pain medication given. Towards the end, a representative came in to collect my insurance information and asked if I could pay the $100 co-pay now, or they can bill me if I am not able to make the payment.

At the Urgent Care, they collect your insurance while you wait, but you don't pay the co-payment until you are done.

I go to a private hospital (baptisthealth.net)
PX Eliezer1
Premium Member
join:2013-03-10
Zubrowka USA

PX Eliezer1 to Mele20

Premium Member

to Mele20
said by Mele20:

We have a critical shortage of physicians, particularly primary care, on this island. The ONLY colo-rectal surgeon in the ENTIRE STATE (he's on Oahu) will not take Medicare patients.

I'm [not] disagreeing with your main points, but the official Medicare provider directory for Hawaii lists four colo-rectal surgeons who participate in Medicare. I've looked them up, all four are present in Hawaii, all four do colon and rectal surgery, all four are boarded in general surgery, and at least 3 of the 4 are boarded in colon and rectal surgery.

SAWAI, REBECCA S
3288 MOANLUA RD
HONOLULU, HI 96819
(808) 432-0000

KUEHNE, JONATHAN P
3288 MOANLUA RD
HONOLULU, HI 96819
(808) 432-0000

LISEHORA, GEORGE B
1380 LUSITANA ST
HONOLULU, HI 96813
(808) 524-1856

WONG, RONALD
1380 LUSITANA ST
HONOLULU, HI 96813
(808) 524-1856

Hope that may help someone.
Mele20
Premium Member
join:2001-06-05
Hilo, HI

Mele20

Premium Member

The first two are Kaiser. That is not Medicare. That is Kaiser only patients who have the Kaiser Medicare Advantage plan. So, a patient with Medicare only could not be seen by a Kaiser physician.

The second two take HMSA (Blue Cross/Blue Shield for Hawaii) but NOT Medicare patients who do NOT pay for EXTRA plans beyond Medicare. The extra plans (65CPlus was one of the best if not best in the entire nation) were killed by Obama and the new Advantage plans that HMSA was forced to introduce are a LOT MORE expensive for a LOT less benefits (particularly if you live on a neighbor island).

I mentioned HMSA because many physicians here do not take any Advantage plans from other offerers like United Healthcare but that is not the point. The point is that the information you found is wrong which is typical of Medicare website. Also, Wong is too old to be doing surgery. My understanding is that only Lisehora does the surgery and he will not take Medicare patients that do not have Advantage plans in addition to Medicare plan. A LOT of folks in Hawaii who are elderly (especially on the Big Island - look at the Census results for the poverty level) can't afford more than plain Medicare and alot of them get the premium paid free because they have Medicaid ...that low income. We have the highest percentage (Big Island) of seniors who live below the poverty level of the entire nation.

My statement was correct.
PX Eliezer1
Premium Member
join:2013-03-10
Zubrowka USA

PX Eliezer1

Premium Member

said by Mele20:

My statement was correct.

We're at odds here.

On one hand, you are in Hawaii.

OTOH, I am a physician myself and have contracts not only with conventional Medicare ("Medicare participating") but also with some Medicare Advantage plans. I am well familiar with the difference.

I do agree that the Medicare.gov website as well as the one operated by your regional Medicare carrier (Noridian) may have errors, but the Noridian site should have fewer.

When you look up on the Noridian directory, it should tell about conventional Medicare (original Medicare). If a doctor is listed there, he/she is supposed to take Medicare patients whether or not there is supplemental insurance. If not, the patient can and should file a complaint:
»norweb.noridian.com/medp ··· main.asp

That conventional Medicare list is totally separate from the list for United Healthcare Medicare Advantage, or any other Medicare Advantage plan's list.

-----

A person on conventional Medicare CAN be a patient at Kaiser-Permanente for medical care (Medicare Part B) and hospital care (Medicare Part A). Yes, Kaiser-Permanente have their own Medicare Advantage plans, and yes, they push those plans very aggressively.

But a patient with regular Medicare (Parts A and B together also known as Original Medicare) can be seen there. They try to hide that on their website, and it's even possible that some young clerks may be ignorant of that as they are ignorant of other things. But Kaiser certainly participates in regular (conventional) (Original) Medicare.

-----

As far as Dr. Wong, I think that he's about 57. I don't consider that "too old" for a surgeon unless there are other special factors. He's younger than me. You'll be 57 before you know it, trust me.

Jack_in_VA
Premium Member
join:2007-11-26
North, VA

1 edit

Jack_in_VA to Mele20

Premium Member

to Mele20
I just have to be double careful the provider is a Medicare Provider.
PX Eliezer1
Premium Member
join:2013-03-10
Zubrowka USA

PX Eliezer1

Premium Member

said by Jack_in_VA:

If a provider accepts Medicare the patient does not need any other coverage as the provider agrees to take Medicare payment as "Payment in full" They can't require a supplement policy.

Nope. Nope. Nope.

Medicare participating doctors agree to always accept assignment from Medicare, which means they go by the Medicare Part B fee schedule.

But of the Medicare Part B fee schedule, Medicare pays 80 percent, and the patient (or other insurance) pays 20 percent.

Part B coverage is 80/20. A coinsurance amount of 20% of the cost, for treatment, drugs and preventative services is required from the patient. Medicare pays the remaining 80%. In addition to the coinsurance, beneficiaries are also responsible to meet an annual deductible of $155.00. Coverage does not begin until the deductible is met.

»www.new2medicare.com/Med ··· rtB.html

There is a HUGE market in Medicare supplement plans (generically called "Medigap" policies) for the specific purpose of covering the other 20 percent. Based on [your] theory those "Medigap" plans would not exist.
»www.aarp.org/health/medi ··· nce.html

Exceptions are:

1) Certain preventive care covered at 100 percent.

2) Some dual-eligible patients (including some disabled) who qualify for both Medicare and Medicaid. Perhaps this is you.

3) Medicare Advantage plans which take the place of traditional (original) Medicare, such as United Healthcare Medicare Complete or Aetna Medicare Advantage.

For hospital care (Medicare Part A) there are also cost-sharing requirements.

Jack_in_VA
Premium Member
join:2007-11-26
North, VA

4 edits

Jack_in_VA

Premium Member

Nope, Nope, Nope and Nope.

You are dead wrong dude.
harald
join:2010-10-22
Columbus, OH

harald

Member

Not to criticize your experience, but as the doctor said, Medicare pays 80%, the patient or their supplemental insurance pays the balance.

I have no idea how you got such a deal different from all other Medicare users. Your statement looks like none that I have seen in the last eleven years.

Jack_in_VA
Premium Member
join:2007-11-26
North, VA

2 edits

Jack_in_VA

Premium Member

My medicare is nothing different. I think the key is choosing doctors and hospitals that accept what Medicare pays as payment in full. I'm not sure your statement that I'm getting a deal that "all" other Medicare participants are not getting is accurate. That may be your experience but may or may not be the case for others.
Expand your moderator at work
66860111 (banned)
join:2014-04-28

66860111 (banned) to harald

Member

to harald

Re: Emerency Room Payment

said by harald:

Not to criticize your experience, but as the doctor said, Medicare pays 80%, the patient or their supplemental insurance pays the balance.

I have no idea how you got such a deal different from all other Medicare users. Your statement looks like none that I have seen in the last eleven years.

It looks like a chronic problem they are having with some healthcare professionals.

»www.thehealthlawfirm.com ··· les.html

what the
join:2014-06-28
usa

what the to What the

Member

to What the
Just came off my medical insurance website and clicked around as I seen the Emergency Room/overnite stay came to $8,800 for the stay, The insurance website says that all I had to pay was the $200 co-pay and they pay the rest.
I love Cigna.

And thanks for the replies and posts you all posted a lot of them where very interesting.
billydunwood
join:2008-04-23
united state

billydunwood

Member

said by what the:

Just came off my medical insurance website and clicked around as I seen the Emergency Room/overnite stay came to $8,800 for the stay, The insurance website says that all I had to pay was the $200 co-pay and they pay the rest.
I love Cigna.

And thanks for the replies and posts you all posted a lot of them where very interesting.

Its not necessarily Cigna, it is the type of policy you have. I have Blue Shield but I have a 25% coinsurance while some other Blue Shield members have policies with 0% coinsurance
66860111 (banned)
join:2014-04-28

66860111 (banned)

Member

said by billydunwood:

said by what the:

Just came off my medical insurance website and clicked around as I seen the Emergency Room/overnite stay came to $8,800 for the stay, The insurance website says that all I had to pay was the $200 co-pay and they pay the rest.
I love Cigna.

And thanks for the replies and posts you all posted a lot of them where very interesting.

Its not necessarily Cigna, it is the type of policy you have. I have Blue Shield but I have a 25% coinsurance while some other Blue Shield members have policies with 0% coinsurance

Yup! I can get BCBS from my work but I have to pay 20% after the deductible of $500 while my wife's BCBS has no deductible and is a flat $50 for a hospital visit. Her insurance is actually like $60 a month CHEAPER then mine too.