The Elder Law Forum

The Elder Law Forum
"Hand of Justice" reaches into patients' pockets

Medicare isn't what it used to be; or, for that matter, what it was intended to be.

"No longer will illness crush and destroy the savings that they (the elderly) have so carefully put away over a lifetime so that they might enjoy dignity in their later years," promised Lyndon Baines Johnson on the eve of Medicare's enactment. "And," he added, "no longer will this nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country."

That was then: April 16, 1964. But this is now: four decades later and in the midst of a political transformation from Johnson's "Great Society" to George Bush's "Ownership Society." Now we find the government's "hand of justice" reaching ever deeper into the pockets of Medicare beneficiaries.

Today, when seniors enter a hospital with a Medicare card in one hand, they need to have a checkbook, or a supplemental insurance policy, in the other. They will encounter "balance billing," the amount demanded by the hospital or physician after Medicare pays.

It's called "cost sharing." After a lifetime of paying the FICA tax that finances Part A Medicare, and paying $78.20-a-month for Part B coverage, beneficiaries now pay more out-of-pocket in deductibles, copayments and non-covered services than they did before Medicare was enacted.

A 73-year-old Arizona caller to the senior legal helpline described his experience with this reality and questioned its legality. A two-day surgical stay and an ambulatory follow-up left him with a $12,400 hospital debt.

It included a laser procedure with a chargemaster price of $2,100. "Medicare paid $780 for that 15-minute procedure," he advised. "And now the hospital wants me to pay another $475. What's going on?" he asked. "I don't believe I should be expected to pay that much!"

I asked him to send me a copy of the bill. However, I advised him that the billing probably includes his $110 annual deductible, plus a 20 percent copayment. And, if he was treated by a non-participating physician, he could be balance billed at 115 percent above the Medicare approved rate, for up to 35 percent of the approved rate.

"That's all very complicated," he said. "I know it is," I replied. "And it's expensive." Hang on seniors; it's going to get worse.

(Pro bono legal information and advice is available to persons 55 and older through the USD Senior Legal Helpline, 1-800-747-1895;mmyers@ usd.edu)

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