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Fri., Jul. 31
Serving the communities of Jefferson, St. Lawrence and Lewis counties, New York
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Disparity in medical bills


Recently we’ve become aware of a disparity in the billing of Medicare patients. Like many people our age, we are covered by a Medicare Advantage plan (administered by United Health). Co-pays are $15 for a primary doctor visit, $35 for a specialist and $65 for an emergency room visit.

Nearby are two health clinics. Hubby goes to one affiliated with Carthage Area Hospital and sees a male doctor. I go to one run by Samaritan Medical Center and see a woman doctor.

At my clinic, co-pay is expected at the time of my visit. At hubby’s, the clinic does not do their own billing, but refers billing to the hospital. When the bills come from them, there is not just a $15 charge for the doctor, but an additional charge of $20 from the hospital.

Seems that Medicare (rules that Medicare Advantage plans must follow) requires hospitals to submit their bills in two parts, one for the physician, the other for the facility.

In essence, then, we’re paying for a specialist when we visit our primary doctor. I’ve talked with a clerk in Samaritan’s billing department ,who confirmed this is the procedure they follow to submit bills.

My brother-in-law in St. Lawrence County has the same United Health plan we do and sees a private practice doctor. He pays only the $15 co-pay. Because his doctor either owns his own office or rents his space, there is no additional bill. Hardly seems fair.

Speaking of disparity, earlier this fall I was visiting a girlfriend when a representative from their Medicare Advantage plan, Today’s Option, visited.

That plan hires beginning doctors, before they establish their practice, to visit clients periodically to assess their medical needs, explain their options, etc.

He warned them to be sure their doctors were “in network.” He said many doctors are electing to stay “out of network” in order to charge more.

Dorothy Reynolds

Evans Mills

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