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Here Fox Business you -- and we answer our viewer mark sent us this question about his medical bills here we go.
He's on short term disability following recent surgery and he goes on to say I am off work right now.
And I have a question about doctor bills and what the insurance agrees to pay as the accepted -- -- now.
Mark gave us some of his examples and here are those examples hospital services charges of 23669.
But the allowed amount was 2940.
54 dollars anesthesia.
3000 -- -- -- the aloud about 812 dollars all of us have seen this kind of thing on our bills against surgery the charge 101000 bucks plus.
Aloud about 2852.
Dollars so -- the large discrepancy.
Between charges and allowed amounts Wal-Mart.
We thought it's a great question to ask and here -- to try and answer this for us.
Is medical contributor fox medical contributor doctor Marc Siegel and is there a simple explanation for this.
-- -- out of there -- one of the questions that the bureau but it also emailed in is about what is he responsible for and want to get to that.
What we should understand first is that Medicare for the most part -- part -- Only pays 80% of the bill.
They pay what is called a maximum allowable charge.
They -- those charges in those charges are always a lot lower than what we really want to build what we -- private insurance it's a fraction.
Of what we actually -- private insurers that's why you see in his email.
The huge discrepancy in amounts.
What you're seeing on the right side is the maximum allowable charge ridiculous is okay only -- 500 dollars for the hospital stay even though you -- 23000.
They only pay a certain amount they're only paying 80%.
What is left is the 20%.
That either the patient has to pay out of pocket.
Or they have a secondary insurance to take care of it.
Or and we've given a lot of attention to this third part lately.
They have Medicare Advantage which would cover the whole 100%.
And then they wouldn't have to pay out of pocket but that's -- terrible jeopardy right now we'll.
Let me ask you if I'm understanding -- the 101000 figure let's use this type of nearly 101000 for surgery of -- which the Mac the maximum allowable.
Courage he's 2000 the ten thousands of bogus number.
The two thousands the real number correct in my right at that point.
Yes you're you're right but I want to add that what private insurers pay -- always about 15% higher than that Medicare is always lower than the private payers.
Okay so in any case said OK it's two -- the real number proof for our viewer -- his question you know Medicare gonna pay out the 200980%.
And then he's on the hook for the 20% or he might have coverage that fills the 20% gap out to the 2000 correct.
That's important and that's right -- -- but the viewership needs to know that you are not gonna get hit.
For that other 22000.
Nobody can -- you for that Medicare won't kill you for what this is anything remaining.
Between what they say you should pay and what some doctor -- hospital is trying to build begin what you're not gonna that you're here with there.
Why don't the hospitals just charge.
The real figure.
Well they should -- there's less to do with an old computer system which is has been some old figure from twenty years ago that they never get paid they want to have a standard -- -- they give everybody the private insurers.
And Medicare they don't want to have to bill Medicare differently so that's where that figure comes from but that figure is from like twenty years ago it's outlandish and nobody's -- -- -- By the way a really good point is that the private insurers tend to follow Medicare Advantage and shrink down.
So the -- below one point was actually getting to 40000 dollars.
That was a long time ago they get -- with a private insurers a little less -- Medicare and the patient.
Get stuck with a 20% if they don't have a secondary insurance it's a very difficult situation for patients right now.
And the hospitals should come up today in terms of what they're -- shows.
All right doctor -- I'd like to continue the conversation.
Although my eyes are already spinning because as you said that 20% coverage is in jeopardy but we're gonna have to continue it for another day we appreciate you being on breaks.
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