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[JuliaRN]

I have been involved in health insurance administration in various ways, in my career.
Before nursing school I was the billing person for one MD.
My post hospital nursing included 12 yrs working for Regence Blue Cross Blue Shield of Oregon. I worked in various aspects of the company:
*Reviewing pre-authorizations for procedures and contacting the providers office for additional info.
*Pre certification of hosp admits and some out patient surgeries.
*Utilization Review / Claim Appeals / Data analysis for Case Management
*Working with providers to determine why a claim isn't being paid.
*Clinical Analyst for the managed care project,

The last three areas required a thorough knowledge of Medicare guidelines.

My own ups and downs with Medicare and Part D (Trying to figure out changes made mid year, with out prior notification.)

Please post questions, concerns, anything health insurance related!!!

[Carolyn, Director]

Maybe it would be possible for you to list any changes in Medicare as they take place also. I'm sure there must be some new ones for 2010...besides the increase in cost to individuals.

[JuliaRN]

here is some info about the rate increase..
http://www.cms.hhs.gov/apps/media/press ... unter=3534

[Carolyn, Director]

Thanks Julia.....maybe you can answer this question. It states that as an in-patient (hospital) beneficiaries pay a deductible of $1100 (or something like that). When Jerry had his back surgery he never paid any deductilble...if you remember back then, he went to the hospital that was just re-opening and being run by several doctors and it may be part of what they offered that we didn't have to pay any. But I am assuming that it is usual to have to pay a deductible...is that right?

[JuliaRN]

Thanks Julia.....maybe you can answer this question. It states that as an in-patient (hospital) beneficiaries pay a deductible of $1100 (or something like that). When Jerry had his back surgery he never paid any deductilble...if you remember back then, he went to the hospital that was just re-opening and being run by several doctors and it may be part of what they offered that we didn't have to pay any. But I am assuming that it is usual to have to pay a deductible...is that right?

When I was in the hosp Nov 08 I had everything covered. I need to research the current deductables.

I was royally messed up with the outpt medication (at the IV unit I go to every 2wks) They changed reimbursement in March 09 and then in July 09. I just paid nealry $500 that Medicare covered prior to those days!!

[Carolyn, Director]

Jerry was in ER a couple of weeks back, nothing serious it turned out....and so far we have not been billed anything for that. We do have Tricare for Life which is "suppose" to pick up what Medicare doesn't, however so far the statements we've received in the past show that T4L just "dittos" the same amounts that Medicare took care of...but luckily up until this point we've never paid out of pocket. I had( & can still have if I want) a great supplement thru my late husband if I need it, but it runs in the neighborhood of $250 a month so we decided if the T4L works good for Jerry it should do the same for me. The Fed Gov who it's thru, let me put it on hold and I can reinstate it if needed but saving that amount each month is a big help since we haven't had raises in some time needless to say. So I just haven't got a clear picture on Medicare for this year yet...anything you find out is greatly appreciated.

[JuliaRN]

As of 2010, Medicare requires the following out-of-pocket inpatient hospital costs:

•Deductible of 1,100 for the first day you are a hospital inpatient. This single deductible covers the next 59 days in the hospital for the same benefit period.
•Copayment of $275 per day for days 61-90 (after you have been in the hospital for 60 days)
•Copayment of $550 per day for days 91-150 (after you have been in the hospital for 90 days; these are your 60 lifetime reserve days)

Depending on your supplemental ins, that usually covers that deductible.

Found this of interest (this states 2009 rates, but the policy remains..)
Part A, your inpatient hospital insurance, has a deductible of $1,068 for 2009. But the Part A deductible is not set on a calendar year basis; the Medicare Part A deductible is for a benefit period.

Your “Medicare and You” handbook states a benefit period begins on “the day you go to a hospital or skilled nursing facility.
The benefit period ends when you haven’t received any inpatient hospital care or inpatient skilled nursing care for 60 days in a row. If you go into a hospital or skilled nursing facility after one benefit period has ended, a new benefit period begins.”

When a new benefit period begins, you are responsible for a new Part A deductible. Some people consider purchasing a Medigap plan to cover the out-of-pocket costs for the Medicare Part A and Part B deductibles.