Medicaid

Discussion in 'Health & Wellness' started by Ken Anderson, May 8, 2017.

  1. Ken Anderson

    Ken Anderson Senior Staff
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    I am starting this thread in order to make a point that I was thinking of making in another thread, in which the discussion of Medicaid came up, but I felt that it would be distracting from the focus of that thread, which was not on Medicaid. So I thought I would do it here instead. This thread may, of course, be used for any other discussion of Medicaid.

    There is often the assumption, I think, that Medicaid pays the medical bills of those who cannot otherwise afford medical care. While this is true to a limited extent, the larger portion of the bill is often paid by the medical provider.

    One thing that I learned while I was the director, and later an owner, of an ambulance service is that, most often, Medicaid doesn't even pay the actual costs of providing the service. The smaller the medical provider, the more disparity there is, as far as the cost of accepting Medicaid is concerned. It works to the advantage of the largest suppliers of medical care, and at the disadvantage of smaller providers.

    It has been several years now, so I no longer remember the exact numbers, but Medicaid did not even reimburse us for what we paid for non-reusable medical supplies and, in most cases, they didn't pay for the use of (often very expensive) reusable medical equipment.

    For example, if we paid $1.15 for an IV catheter, Medicaid might reimburse us $.80. This disparity was true all the way down the line, and a fairly routine emergency call would require the use of one or two IV catheters, the IV solutions, and whatever was used to secure the IV in place. The cost of oxygen delivery devices (mask, cannula, etc.) were also reimbursed at far less than our actual cost.

    EKG monitors/defibrillators cost us in the neighborhood of $10,000 but Medicaid would approve any costs associated with running an EKG only if the final diagnosis of the patient turned out to be cardiac related. As the EKG is a diagnostic device, an EKG would be a part of protocol in any medical event that might possibly be attributed to a heart problem, yet if the chest pains or the shortness of breath turned out to have been caused by some other problem, we were not even reimbursed for the actual cost of the electrodes that were used in monitoring the patient's EKG.

    The disparity in costs borne out by larger versus smaller medical providers stems from Medicaid's use of average costs in determining the lesser amount that they would reimburse, and a large medical center went through a whole lot more IV catheters than any one ambulance service would use, so they were able to negotiate far better costs. Since they bought in bulk, they were able to buy catheters for $.80 apiece or less, but we couldn't get a catheter at that price.

    Prior to the Clinton Administration, we were able to buy many of our disposable supplies, such as catheters, from one of the medical centers, but the Clinton Administration determined that, in allowing ambulance companies and independent medical clinics to purchase through the hospital's purchasing department, the hospital was acting as a medical wholesaler, and they were no longer able to do that.

    We did put together a regional EMS cooperative, but still we couldn't get costs that came close to what we were able to get from a medical center.

    The result was that if we were to simply transport a Medicaid patient to the hospital, we might be able to make a small profit, but the cost versus reimbursement disparity set in whenever we actually did anything for that patient.

    If it was a medical case, anything that we used to held diagnose and treat that patient came at a cost to us, rather than a profit. In a trauma case, we lost money on every bandage or splint that we used.

    I believe that I can honestly say that we didn't do this, but I can certainly understand why an ambulance company might be tempted to do less for Medicaid patients than for those with insurance. It wouldn't be so much a matter of greed, but one of actual costs. Yes, Medicaid pays a portion of the costs of providing medical care to those who can't afford to buy insurance, but the medical provider shares in those costs as well, and these costs are made up in higher expenses all the way around.

    That is a big part of why we charged $25 for an aspirin, and set a $500 base rate.

    To make matters worse, Medicaid would deny at least half of the claims that we made, requiring us to appeal the decision. Often it would be denied again, so that we would have to apply for an administrative hearing. Even bills for patients who died days after arriving at the hospital were often denied as not being an emergency.

    Someone has to pay for the time involved in this too, and it's not the Medicaid patient. It is those who are paying their own way.

    It took an average of a year for us to collect on a Medicaid call, and I believe that is intended as profits for the state that is administering the Medicaid program. States receive their Medicaid allotment from the federal government before the fact. They are paid at the beginning of the year so whatever length of time they can delay passing that money on to the medical provider, they are able to use this money.

    When a patient had Medicaid as a supplement to Medicare, that was another matter because the bulk of the expense was paid for by Medicare, and Medicare would have made the decision as to whether to approve or deny the claim. There was still a long delay for payment, but not as long.
     
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  2. Yvonne Smith

    Yvonne Smith Senior Staff
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    Mine is paid partially by Medicare, part by my Cigna Medicare Advantage supplement, part by Medicaid, and my copay, which is usually small because of only getting $400 SS per month.
    I know of people who had Medicaid who were not on Medicare, and that person thought nothing at all of going to the emergency room because she stubbed her toe or had a headache. She one time even had an MRI for the stubbed toe, which seemed pretty ridiculous. It was purple, but not emergency-room bad, in my opinion.
    She had all kinds of anti-depressants and pain medication (stubbed toe again) and Medicaid always paid for all of this.
    So, it seems to me that there needs to be some kind of better way of providing for the elderly, and even for other poor people. After reading Ken's post, it appears that even the medical providers don't come out good with this, and it covers some non-essential things and does not cover some things that should be covered, like my heart meds.
     
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  3. Ken Anderson

    Ken Anderson Senior Staff
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    We were also required to accept Medicaid as full payment, so we couldn't bill the patient for any costs not paid by Medicaid. Most Medicaid-only patients wouldn't have paid anyhow, so we viewed it as at least being able to get partial reimbursement of our costs. As I said in my earlier post, Medicaid as a supplement to Medicare wasn't a problem. When someone had both Medicare and Medicaid, we referred to that as an American Express Card, since the combination of the two would usually result in ample reimbursement.
     
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  4. Chrissy Cross

    Chrissy Cross Supreme Member
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    Healthcare is complicated...no easy answers no matter what side you are on.

    I think a big problem is the crazy prices for drugs, tests and a hospital room. Why dis my husband's room cost $2,500 a day and it was semi private?

    It's not even the drs or the surgery that costs too much if you look at your bill...it's everything else. Fix that and insurance rates can go down in my opinion. My husband's last hospital bill was $600,000!

    Why does Wellbutrin cost $1,000 a month? It's been around forever.

    Also, in California Medicaid is called Medi Cal.
     
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  5. Babs Hunt

    Babs Hunt Supreme Member
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    https://www.medicaid.gov/medicaid/

    Medicaid is set up for those who cannot afford health care and yet it is probably everyone taxes that are covering this making it harder for us to afford good health care too.

    In my personal opinion the Health Care systems and Health Insurance as well as Drug Companies all have so much corruption and fraud in them lining the pockets of the Owners, etc. while cheating and overcharging all of us who need health care and medicine.
     
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  6. Yvonne Smith

    Yvonne Smith Senior Staff
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    Someone posted the answer to your question some time ago (and I thought it was you) when you were talking about the price of Wellbutrin before.
    Apparently , what has happened is that insurance covers so many prescriptions and people only pay the co-pay, which does not change that much. When the pharmaceutical company raises the prices, it is the insurance company who pays the additional price and most people do not notice that the actual cost has gone up unless they have to pay for the meds themself.
    Then, the insurance companies have to raise their rates because they have to pay so much more for the medication. this is why some of the meds are so much cheaper online or from Canada or somewhere else.
     
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  7. Ken Anderson

    Ken Anderson Senior Staff
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    Another contributing factor is that other governments make demands of the pharmaceutical companies, requiring them to offer medications at lower costs. Despite the fact that U.S. taxpayers probably pay more than those in most other countries for the research that goes into developing some of these medications, we pay the highest costs possible.

    I am not necessarily saying that this is a desired position but we didn't have Medicare, Medicaid, or other forms of government subsidized insurance, and if people were not required to enroll in an insurance plan, the costs of medical care would drop significantly, and insurance companies would have to offer good value for the money in order to stay in business.

    This might also mean that there would be fewer new drugs, and fewer advances in medical science, but probably not, since much of the actual science that goes into these things is done by tax-supported schools and research facilities anyhow.
     
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  8. Yvonne Smith

    Yvonne Smith Senior Staff
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    I found out a little bit more from Evelyn about the cost of the nursing home and how the Medicare/Medicaid is working there. She said that the actual cost to live there is $200 per day, so $6000 per month. After everything is paid that Medicare and Medicaid pays, she still owes over $800 per month out of her own pocket, which is almost her whole SS check !
    Since Medicaid is now saying that she has been "rehabilitated" from the injuries from her fall in February, they do not intend to pay for her to stay at the nursing home.
    She is supposed to find out tomorrow more about what they are charging her and how soon she has to be out since she can't pay the $200 per day.
    It would not seem like they can just kick an elderly person out of a nursing home when they have no place to go to, and I think that this is something that needs to be addressed in how we care for people, especially elderly and disabled people.
    Even if the nursing home is not receiving the full amount from Medicaid, it seems to me like they are charging enough that they probably are still getting enough money to operate with.
    Feeding people fried bologna sandwiches is not any kind of quality care, and being so understaffed that people do not even get their meds on time, this should not be allowed, even in a state-run nursing home, and maybe especially in one that is supposed to be being operated by the state.
     
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  9. Hedi Mitchell

    Hedi Mitchell Supreme Member
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    What Medicare Advantage plan do any of you use? I signed up with Care n Care two years ago.. all is well...but only because I am not sick or on meds. The deductible went from $ 3400 to $7500 this year. Just trying to decide which way to go this year when renewals begin. Or would any suggest getting supplement policy ?
    All I really need is periodontal and hearing type insurance ...which of course is almost not extant.
     
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  10. Chrissy Cross

    Chrissy Cross Supreme Member
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    I have Medicare Part A and B and Care1 as my supplemental...it's a PPO and that means I have to stick to Fresno and the hospital and drs they cover. I went with them because my dr took it and the hospital is St. Agnes which is the best hospital in Fresno.

    I don't think I have a deductible...if I do it's small. This plan costs me 0 and I've had it for a year and have gotten no bills for any of the wellness tests I had done or anything else. It covers my office visit 100% and I pay anywhere from $5 to 0 for prescriptions that are generic and on their approved list.

    So far I've not had any problems with them at all but then I don't cost them much since I've never even been in a hospital....hope it stays that way.

    $125 is deducted from my widows benefits for Part B of Medicare.

    So far I'm happy.

    Of course if I'm not in Fresno and something happens they'll cover that.
     
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