our system at work

I am currently on Medicare and I’m grateful for that since I’m not sure how I could exist without it for now. Overall, it works well for me and I haven’t had much trouble with getting approvals or whatever.

But this is funny. Medicare has been refunding my 20% “co-insurance” (don’t call it co-pay, they don’t like that) with the shrink. I was advised by someone to not try and call Medicare to figure this out, just to cash the checks. But, as far as I can tell, they shouldn’t be refunding this. I figured if I cashed them, at some point people in boring dark blue suits would show up at my door to arrest me.

So I called. And they have a hell of a long computerized system to just get to an agent. Of course I was disconnected and had to go through it again. The agent I eventually spoke with insisted that Medicare was right. I shouldn’t be paying the co-insurance (not co-pay! really!) up front and that was probably why they were refunding it. Huh? They’re actually refunding more (slightly) than I pay and if they refund me, that cancels out my 20% so I’m paying nothing and, in fact, making a slight profit. The agent got irritable the more I tried to understand and told me I could file an appeal if I disagreed but they were right.

So, okay, I guess I cash the checks. I still don’t get it. Be prepared to write me in prison.

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9 thoughts on “our system at work”

  1. I would be apprehensive too. Dealing with a bureaucracy can be difficult at best. (one person tells you one thing but another could tell you an entirely different story)

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    1. Back in the day, we used to work to get our chronically mentally ill clients (who mostly had been displaced from the state hospitals when they were shut down) disability and medicare. You could talk to half a dozen people at social security or medicare and never get the same answer twice. My fear was both doing something wrong but also upsetting the medicare system. I don’t want them mad at me!

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  2. There is usually a price on a service and then the price that medicare or insurance will actually pay which is significantly less than the stated price. Most places then accept the payment on which they have an agreement with the insurance company or medicare. Recently I had a surgery and the actual out of pocket cost was to be $5kish. After dealing with my insurance my total cost actually came in at $2kish.
    I expect that is what is going on with this in your case.

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    1. It was something we considered. Depending on whether you compute my 20% at the approved amount or the paid amount, you get a slightly different number. But it still doesn’t add up. I’ve been paying $18.76 for my co-insurance and they’ve been refunding me $19.59. But they insist they’re right and who knows? Maybe this is coming from some wrong payments in the past or something?

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  3. That is so funny. Our government is so broken with all the rules and regs and it just wants to make you pull you hair out but I can’t even do that since I am bald. Be well Sweets and I will even come visit you if they put you in the slammer.

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