30 Second Insurance Tips©

Tip #301- How Do They Stay In Business?

Fred enjoys good health. In 2016, he saw his doctor just twice; once for a bad cold, the second time for a routine physical.
He visited our Mequon ‘store’ the other day to show me his Medicare Part B “Summary Notice,” also called an Explanation of Benefits (EOB).
Both office visits were described as “established patient, 15 minutes or less” (code 99213). The provider charged amount was $235. The Medicare approved amount was $60.08 for the diagnostic visit; $70.68 for the physical. We wondered why the paid amount would be different if the codes are the same, although for the physical, Fred noted he was with his doctor for 45 minutes!
The EOB also showed Medicare actually paid nothing for the two visits. That’s because the Part B deductible for 2016 was $166 (increased to $183 for 2017). The ‘Medigap’ plan we sold Fred covered the $130.76 of approved charges
Here’s the real reason Fred stopped in. He wanted to ask “how can my doctor stay in business with those payments?”
I believe that qualifies as a rhetorical question.
P.S. I literally just got back from a trip to the vet. Next week we’ll look at those charges. What a hoot!