Healthcare Systems – Billed Charges

Here I go again!. I just received my “ Medicare Summary Notice” for Part B (Medical Insurance) claims processed, on my behalf, between June 22 and September 20, 2024. Medicare Part A is for Hospital charges.

As many of you will remember, I had a pacemaker installed at UVA health on May 30th of this year. On July 9th, I had a follow up appointment at UVA Health for a cardioversion. I had previously been diagnosed as having AFib, a condition where the heart beats abnormally. Cardioversion is a procedure where the heart is shocked in an attempt to get it into a “normal rhythm.” This was my fourth cardioversion procedure.

The Medicare Summary of Charges for this visit totaled $4,850.20. of which Medicare paid $572.83, and my Supplemental Medicare Insurance paid $146.13, for a total of $718.96. Fortunately, I have both standard Medicare and a Medicare Supplemental Policy with a private carrier. As a result, I had no personal out-of-pocket expense. I should mention that my Supplemental Policy cost amounts to $519.51 a month. The Supplemental Carrier can rate you, based upon each individual’s situation. If you have higher medical costs than what is considered normal, you will pay a higher premium. In comparison, my wife’s Supplemental Policy is only $298.00 a month.

In looking at the detail behind the $4,850.20, UVA Health charged $$1,901.00 for “External shock to heart to regulate heart beat,” and $1,746.00 for “Anesthesia.” The balance of the charges represented “blood tests.”

The $4,850.20 was based upon UVA Health System’s “billed charges.” Billed charges represent charges that a health system, or provider, establishes for various procedures. They are sometimes referred to as “chargemaster prices.”

They also have no relationship to what the actual costs of performing a procedure is. Private insurance providers, such as Aetna, Blue Cross, Humana, United Health etc., never pay billed charges. They have arrangements with the Health System’s and individual providers, on a schedule of costs that both parties have agreed on. It should be noted, that not all private insurers pay the same amount for a similar procedure

Not all providers are Medicare Providers. However, if you are a Medicare provider, you must accept Medicare’s schedule of “Approved” amounts.

It is the “Uninsured” that are penalized under this system. They are billed based upon “Billed Charges.” As a result, many are unable to afford the cost and are forced into bankruptcy by the Health Systems. There have been many discussions concerning this inequity, but nothing seems to be done. Why shouldn’t the uninsured be billed at the same rates as either Medicare, or the lowest rate private insurer.

Another charge on my Medicare Statement was for an ultrasound of my heart on August 6th. I was born with a bi-cuspid aortic valve, and was told that it would eventually wear out and need to be replaced. As a result, I had my aortic valve replaced in 2012. Periodically, an ultrasound is done to determine how it is working.

The ultrasound was performed by a medical technician and took about 30 minutes. The billing for this procedure amounted to $4,132.00. Medicare paid $161.44 and my supplemental paid $41.18 for a total of $202.62. Quite a difference!

I was curious, so I did some research on the cost of a healthcare ultrasound machine. My research indicated that one could be purchased for between $2,000. and $10,000. If this is true, assuming the upper end of the purchase, three ultrasounds, at billed cost, equal the cost of a machine.

In fairness, some of the “Medicare Approved Charges,” for certain procedures do not appear reasonable and should be increased.

This is just another example, of the many issues that exist in the healthcare system. It is a fragmented system on many fronts. It is not easily fixed, but hopefully we will see small improvements in the future.

Jess Sweely

Madison, Va.

September 29, 2024

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