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Original Fee-For-Service Medicare: How To Maximize Use

Hospitals: Out-patient

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If you receive treatments or services in a hospital, but you are not staying in the hospital, you are considered to be an "out-patient." Examples of hospital outpatient services include getting a radiology treatment, chemotherapy, x-ray, getting stitches for a cut, having an angiogram, or a visit to the emergency room.

You can end up owing a lot more money if a procedure is performed on an out-patient basis versus an in-patient.

Under Medicare, hospitals may bill outpatients for 20% of what they "charge" for the outpatient service whereas Medicare is only obligated to pay 80% of what the service "costs" the hospital.   Because of this you may end up having to pay far more out of your own pocket than you would if you were confined in the very same hospital as an inpatient for the same procedure.

Before you use any outpatient service, contact the hospital admissions office.

  • Let them know you have Medicare coverage.
  • Confirm exactly what procedure(s) will be done.
  • Ask how much it will cost you personally. Although the answer will probably only be an estimate rather than a binding dollar amount, at least you'll have an idea of the cost to you.
  • If the amount sounds too high:
    • Ask your doctor if you can be admitted to the hospital for the procedure. Explain why. While Medicare may not always approve hospital confinement for the same process, your doctor may go to bat for you to get the procedure approved as an inpatient.
    • You can negotiate with the hospital. Particularly if you let the hospital know you are in a financial bind, and offer to pay the amount due right away, you may have a shot at reducing the bill. To help your argument, you can find out what Medicare pays for the procedure in your area by calling Medicare at 800.MEDICARE (800.633.42270

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