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Passing interest on Medicare Payments

Posted by john h on 7/13/04 at 15:56 (155346)

I recently had a 3 level Discogram on the back and a lower back MRI. I thought it might be of interest to note what the Hospital charged and what Medicare paid. This will not supprise the Doctors on this board:

Discogram charges: $6019.22 What Medicare actually will pay: $1324.23

MRI: $3548.54 What Medicare actually will pay: $780.68

I guess some insurance companies will pay the full amount and if you have to pay yourself you will be billed the full amount.

Re: Passing interest on Medicare Payments

Pauline on 7/13/04 at 21:10 (155363)

Can you describe what a Discogram is and what exactly will it will or will not show for back conditions. Has this test been around for a while or is it new. Is dye use? Never heard anything about this and just wondered if it's a common test.

Have you had them before?

Re: Passing interest on Medicare Payments

john h on 7/14/04 at 09:26 (155379)

Pauline: A discogram has been around for some years and is a diagnostic tool usually performed by a Pain Specialist on the order of a Spine Specialist. It is sometimes done under general anaesthetic and sometimes local but in any event the patient has to be awake when dye is inserted into the disc so he can advise the Doctor what he is feeling when the dye is inserted into the disc. A needle is inserted into a disc using flouroscopy. This is a delicate procedure especially when one has degenerative disc. They are also shooting pictures as the dye is inserted and immediately after the procedure a cat scan is completed to observe where the dye may have leaked from. Usually they will do at least three levels such as L1/S5 L1/S2 L2/S3. As a disc is pressurized with the dye they may discover leakage where there should be none or a bulging dics may increase pressure on a nerve causing pain which you relay to the Doctor. They are looking for the patient to tell them that when the dye is inserted they are experiencing something different than their normal pain. It is performed in an operating room setting with 3 or more people there. I have had two of these over the years. One using local and one using general. The most recent one I just had when they inserted dye into the L5/S1 I experienced some real pain that I had never had or at least it was double what I had ever had. The other two disc seemed about the same to me. The Doctor will now look at what my reaction was. What the pictures of the dye showed as far as leakage and the catscan and MRI and hopefully come up with a diagnosis. I am scheuled to revist him in Dallas on 4 August and I do not have a clue as to what he might say. I think this test may have more or less replaced the test where dye is inserted into the spinal column and X-rays are taken. That procedure really sucked as you had to lay on your back perfectly still for about 12 hours to hopefully prevent bigtime headaches. I had low back surgery about 25 years ago and for the most part did well as I played golf,basketball,ran all the time, lifted weights, etc. My back went south after I developed PF and I think probably because I lost a lot of my body tone and flexability (just a guess)..

Re: Passing interest on Medicare Payments

Kathy G on 7/15/04 at 10:05 (155511)

One only has to see what Medicare pays to understand why doctors charge the amount they do for services rendered. They have to absorb anything over what Medicare, or, for that matter, privance insurance pays. Not only that, they have to wait for months for payment. Thus, rates are inflated just so they can stay afloat.

It wasn't that long ago that one assumed that all doctors were wealthy. Now, with the rising cost of education, malpractice insurance and the way they are paid, doctors are doing all right financially but they'd become richer in another field. That's why fewer young people are going into medicine. I suppose the positive side to it is that the ones who go into medicine aren't in it to become rich but the negative side is that some very smart people who could be good doctors aren't pursuing the career.

And pity the poor person who doesn't have any insurance and pays individually. He/She is bankrolling the rest of us by having to pay the full, inflated amount for services rendered. There's something wrong with this picture but it would take someone far wiser than I to come up with a new system.

John, I had a myleogram (Sp?)years ago and I was petrified. It turned out not to be bad at all. For me, the worst part was not the lying flat, as I had a very good book to read but that fact that my surgeon insisted that all his patients be given Tylenol#3 following the procedure, whether they got the headache or not. It made me sick so he decided I should take something else, maybe Percocet? I kept telling the nurses I was fine and didn't need any painkillers but he was one of those doctors who they all feared and no one would call him. In retrospect, I suppose his prophylactic treatment was wise, but I was really mad at him because I didn't think I needed any medication.

What you had done sounds very painful and I sure hope they can find some treatment that will help your back pain.

Re: Passing interest on Medicare Payments

john h on 7/15/04 at 11:04 (155524)

Kathy: it sounds worse than it really was.