To The Daily Sun,
There is a distinction in the classification of hospitals that is allowed by Medicare. That distinction is called Critical Access Hospitals. This is a term that identifies a hospital that provides health care for rural Americans. Medicare allows the states to designate their own Critical Access Hospitals.
New Hampshire has 13 such classified hospitals. They are: Alice Peck Day Memorial Hospital in Lebanon, Androscoggin Valley Hospital in Berlin, Cottage Hospital in Woodsville, Franklin Regional Hospital in Franklin, Huggins Hospital in Wolfeboro, Littleton Regional Hospital in Littleton, Monadnock Community Hospital in Peterborough, New London Hospital in New London, Speare Memorial Hospital in Plymouth, The Memorial Hospital in North Conway, Upper Connecticut Valley Hospital in Colebrook, Valley Regional Hospital in Claremont, and Weeks Medical Center in Lancaster.
A Critical Access Hospital is allowed to bill more of the cost to the Medicare beneficiary. Much more.
What usually happens is a hospital sends a bill to Medicare and Medicare (like most insurance companies) says we're going to pay this amount and it is a much smaller number (called the Medicare Approved Amount). Medicare then pays the hospital 80 percent of the much smaller number, and the Medicare beneficiary pays the remaining 20 percent of that much smaller number.
For a Critical Access Hospital it's different. The Critical Access Hospital sends the bill to Medicare and Medicare pays their usual 80 percent of the much smaller number (the Medicare Approved Amount), but then it makes the Medicare Beneficiary pay 20 percent of the big number.
Here is a real example of a Critical Access Hospital emergency room bill: Amount facility charged, $10,443; amount Medicare approved, $2,725; amount Medicare paid the facility, $2,180 (80 percent of the Medicare approved amount); amount Critical Access Hospital billed to beneficiary, $1,840 (20 percent of the amount facility charged).
If the facility were not a Critical Access hospital, the amount billed to the Medicare Beneficiary would have been 20 percent of the Medicare approved amount, or $545. That is $1,295 more charged to the person on Medicare who went to a Critical Access Hospital vs. one that did not, such as a person who went to Franklin Regional Hospital's emergency room as opposed to the Lakes Region General Hospital emergency room.
And this is true for any service you receive in a Critical Access Hospital, in-patient or out-patient.
Yet this practice is against the law for private insurance. The federal government is allowing charges to Medicare beneficiaries that states say are unfair. The offices of both New Hampshire and U.S. Senators say they are aware of this problem. Kelly Ayotte was quoted by NHPR as saying "patients of Critical Access Hospitals deserve to know up front how much they'll pay for services. " What, if anything, will be done remains to be seen.
I believe that Critical Access Hospitals should make sure to disclose this information up front. They won't. It is up to us to educate ourselves and spread the word. So now you know, tell everyone.
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