Medicaid coverage amount?
January 24, 2007 12:27 PM Subscribe
How can I find out how much the standard Medicaid coverage is for a certain surgical procedure?
I was having dinner the other night with some friends, complaining about how expensive my recent outpatient surgery was, and a guy at the next table said he worked in medical insurance.
His advice was to offer the hospital the standard Medicaid coverage amount for the procedure - undoubtedly less than they initially charged - and that 9 times out of 10 they'll be happy with that amount.
But I'm having a tough time finding out how much that amount is. (I've already paid the surgeon and the anesthesiologist.)
I was having dinner the other night with some friends, complaining about how expensive my recent outpatient surgery was, and a guy at the next table said he worked in medical insurance.
His advice was to offer the hospital the standard Medicaid coverage amount for the procedure - undoubtedly less than they initially charged - and that 9 times out of 10 they'll be happy with that amount.
But I'm having a tough time finding out how much that amount is. (I've already paid the surgeon and the anesthesiologist.)
Do you have the bill from the hospital with the procedure codes? Take this and then go to your state government web site and find their Medicare documents. Hopefully you will find some documentation which lists the maximum fee allowance for individual procedure codes. It might be called a Hospital Services Manual.
posted by caddis at 1:49 PM on January 24, 2007
posted by caddis at 1:49 PM on January 24, 2007
Fee Schedules New Mexico Human Services Department
Like caddis wrote, procedure codes would be helpful. Ask for an itemized bill if you don't already have one.
On preview, caddis has it.
posted by badger_flammable at 1:57 PM on January 24, 2007
Like caddis wrote, procedure codes would be helpful. Ask for an itemized bill if you don't already have one.
On preview, caddis has it.
posted by badger_flammable at 1:57 PM on January 24, 2007
Response by poster: Thanks. (Am I confusing Medicaid with Medicare?)
posted by gottabefunky at 1:58 PM on January 24, 2007
posted by gottabefunky at 1:58 PM on January 24, 2007
Response by poster: Hmm...I do have an itemized bill, and every line has a six-digit charge code ("213608").
On the Fee Schedules, everything seems to have a four-digit code with an alpha prefix ("A4351")...?
posted by gottabefunky at 2:04 PM on January 24, 2007
On the Fee Schedules, everything seems to have a four-digit code with an alpha prefix ("A4351")...?
posted by gottabefunky at 2:04 PM on January 24, 2007
sorry, those are five digits. I am out of my element here, this is getting quite specific. Perhaps someone who codes bills can chime in.
posted by caddis at 2:32 PM on January 24, 2007
posted by caddis at 2:32 PM on January 24, 2007
Yes, it is Medicare, not Medicaid.
posted by rasputin400 at 6:58 AM on January 25, 2007
posted by rasputin400 at 6:58 AM on January 25, 2007
This thread is closed to new comments.
posted by apocry_phil at 1:28 PM on January 24, 2007