Payment Process
The Medicare Advantage Plan will only pay for certain parts or types of hospital stays. It will also only pay up to a certain dollar amount. People can opt for HMO programs or for Preferred Provider Plans or "PPOs." If you have a PPO, you will have to pay less out of pocket at the "point of sale," so to speak. The plan will charge you a hefty monthly premium, as well. Group practices, that is doctors and hospitals, give preferential treatment to patients with the most money who pay for their PPOs, so when you need your Medicare Advantage to pay for a hospital stay, be sure to have a PPO program. If you do not, you may not have a doctor or practice that is within the practice network, and the hospital will "nickel and dime" every service that you receive.
Buyer Beware
People have to be careful when they decide on certain insurance or healthcare programs. No matter how distasteful it may sound, these companies work at a profit. How they pay hospitals is just like any other business, too. After you use hospital services, your insurance company will basically get an itemized bill. The standard procedure, for many insurance companies, is to deny initial claims. Many companies make a huge annual profit by decreasing service, while increasing yearly premiums, too. If the claim is not denied at first, the insurance company will most likely pay a flat fee to the hospital. This generally works on an invoice system. This fee is usually agreed on before a patient ever visits a hospital in the first place. Sometimes, the hospital will generate a bill for the insurance company before a patient within the network ever goes to the hospital. Both entities use statistics to presume when or where a person of a certain age, race or income status will utilize hospital services. The problem with a person going outside the group practice network is that a fee will change. A doctor outside the network has not agreed on the flat fee that a physician in the network all ready has as part of his agreement.
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