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Reflections

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by Eddie Bass

Four years ago, I had a cataract removed and a new lens implanted in my right eye.

Recently, I had the same procedure performed on my left eye.

The surgery was done by the same ophthalmologist, and it was done at the same hospital.

A comparison of costs then and now should provide some clues as to what has happened with medical costs in the last few years.

You may be surprised as I was that the total cost was slightly less this time than it was four years ago.

However, that's solely due to Medicare putting the screws to the doctors involved and paying them less than they did before for their services.

For example, the ophthalmologist charged $2,100 for his services last time, but Medicare allowed only $1,152.59 for his services and paid 80 percent of that amount, or $922.07.

This time, the surgeon said his fee was $2,240, but Medicare allowed only $956.99 and paid $765.59, or 80 percent of the allowable amount.

The same was true for the anesthesiologist. Last time, the fee was $149.29, which Medicare allowed, paying 80 percent of it.

But this time, the fee was $187.82. Medicare cut that back and allowed only $100.62.

Things were a bit different with the hospital.

Last time, the total hospital charge was $1,473.44, of which Medicare paid 80 percent. This time the hospital's total charge was $1,681.97.

That included $126.34 for laboratory work and an EKG, which weren't necessary before.

It should be noted that the surgery was done on an outpatient basis. I was in the hospital maybe a total of three hours or so, but was not admitted as a patient.

Even with the higher hospital charge, the total cost of the surgery this time was $2,739.58, as compared to $2,775.30 four years ago.

I'm fortunate that I have supplemental insurance, which picks up where Medicare leaves off.

This supplemental insurance is provided by my former employer at no cost to me.

Four years ago, when I wrote a column about the cost of my cataract surgery, the hospital defended its charge if a defense was necessary by pointing out that it provided $3.6 million in charity care during the previous fiscal year.

The hospital also noted at that

time that "everyone's bill is 31.6 percent higher than it would have to be if the hospital were fully reimbursed by Medicare and Medicaid

and did not have uncompensated care."

I'm sure the same is true of the doctors.

With Medicare cutting back on their fees at every opportunity, doctors appear to be in a real bind. However, the fact that they agree to accept Medicare assignment makes you wonder.

This time the ophthalmologist said his services were worth $2,240, but Medicare said $956.99 was a fair charge.

That means the doctor had to write off $1,283.01.

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