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Responding to your letter of July 1, I am pleased to offer the following comments and
With respect to your question concerning what percentage of our operation is non-profit
BOARD OF DIRECTORS
• JOSEPH G. MATTHEWS, MD
AND AES CAPI MD
FRANK B HOONETTE, M.O.
WILLIAM M HOWARD, PhD
WALTER C JONES, HII, M.D
*THOMAS E MCKELL, MD
WILLIAM V ROY
rates we wish to charge for all new contracts. The fact that we are a not-for-profit organization and have always had the policy of carrying people regardless of their attained age and thus had many people over 65 enrolled, made us feel that we should ask for the privilege of participating in the Medicare B program. The only advantage that we saw was the opportunity of being of further service to the people of Florida. In response to your question concerning the information that eight private companies expressed a desire to take over Part B operations in Miami, I would like to say that we are not familiar with that information and would suggest that you solicit this from the Social Security Administration. In response to your question about why our company was selected to head the program in Florida, I believe I have indicated our reason for doing this in answering the first question. As a Florida not-for-profit corporation engaged in the offering of medical and surgical coverages to the residents of Florida we felt that this could be an extension of our service. We did not envision the growth of the program which came about from the very wide-open scope of benefits offered and the increased number of residents of Florida over the age of 65, as well as the fact that all tourists in the state hod to have their claims handled by the carrier chosen for the state of Florida instead of filing them with the carrier covering their place of residence when they returned there. With respect to the information about our funding and operations, I have touched on that in the answer to the first question and hope this would give you sufficient information. I am enclosing a copy of our Annual Audit Report made up by Coopers & Lybrand, who also assist in the preparation of the annual statement we must prepare for the Insurance Department of the State of Florida. Also enclosed is a copy of "25 Years of Progress" which is a history of Blue Shield of Florida from 1946 - 1971. Trusting that this information will be helpful, and if I may be of further service, please
let me know.
[From the Miami Herald, June 19, 1975)
LETTERS TO THE EDITOR-How To CURE MEDICARE'S ILLS
(By Edward Morrow, Naples)
"... on average Medicare enrollees are paying substantially more for health
service than they did before they signed up ..." HEW has announced that it intends to limit payments to doctors under Medicare because costs are getting out of bounds. HEW may limit payments to doctors, sure enough, and save money. But the savings will come out of the hides of the people over 65 who are enrolled in Medicare. The doctors' lobby will see to it that they get their ever-rising fees, whoever pays for them.
In the eight years since I was enrolled in Medicare, Blue Shield of Florida the state's Medicare carrier, has almost invariably "allowed" less than the doctors' actual charges—and of course it pays only 80 per cent of this "allowance."
When office visits were $12, for example, Medicare "allowed" $10. When office visits went up to $15, Medicare "allowed” $12. If a surgeon's fee were $500, Medicare would probably allow about $400. I know of one case where the surgeon's fee was $1,000, and Medicare actually paid the patient $320.
Medicare's "allowable" fees are supposed to be based on the prevailing rate in the area in which the patient lives. They are not.
And all the doctors I know refuse to take assignments of Medicare's payments because they would then be compelled to take Medicare's "allowance"-paid 80 per cent by Medicare and 20 per cent by the patient. For the lack of an assignment, the patient must pay whatever fee the doctor fixes, and collect from Medicare what he can.
Under Medicare, many people are simply being denied medical care because of Medicare's rule that the patient must pay the first $60 under Part B, in addition to at least 20 per cent of any charges over that.
It is a provable fact that on average Medicare enrollees are paying substantially more for health services than they did before they signed up for Medicare. This is a health insurance program?
If Medicare is to set a ceiling on doctors' fees lower than the present "allowables," it should have the guts to brave the doctors' wrath and see to it that the over-65s don't get stuck even more than they are now. This could be done easily. All that would be needed would be a rule that Medicare would pay no claims submitted by patients, but only those submitted by doctors who have accepted an assignment.
To be sure, the AMA will explode like Vesuvius at such a proposal. It will solemnly declare that this will destroy "the sacred doctor-patient relationship"though why this relationship usually seems to be based on money is a puzzle.
Some doctors may continue to refuse to accept assignment-for a time. The will come around. Most practicing doctors derive a substantial part of their incomes from Medicare patients. And if they refuse to accept assignments, and thus force their elderly patients to pay their entire bills out of their own pockets, the Medicare patients will desert them by droves and go to doctors working to work within a framework that will to some extent fit into the concept of health insurance.
REQUEST FOR MEDICARE PAYMENT
PART I PATIENT TO FILL IN ITEMS 1 THROUGH 6 ONLY
Copy from Name of patient (First name, Middle initial, Last name)
CARD 2 Health Insurance claim number
Was your illness or
Policy or Medical Assistance Number
ECF-Extended Care Facility OL-Other Locations
HOW TO FILL OUT YOUR MEDICARE FORM There are two ways that Medicare can help pay your doctor bills
One way is for Medicare to pay your doctor.— you and your doctor agrae, Medicare will pay him directly. This is the assignmont method. You do not submit any claim; the doctor does. All you do is fill out Part 1 of this form and leave it with your doctor. Under this method the doctor agrees to accept the charge deter. mination of the Modicare carrier as the full charge; you aro responsible for the deductible and coinsurance. Please read Your Medicare Handbook to help you understand about the deductible and coinsurance. (Because Medicare has special payment ar. rangements with group practice prepayment plans these plans handle aft claims for covered services they furnish to their members.) The other way is for Medicare to pay you.-Medicare can also pay you directly before or after you have paid your doctor, If you
submit the claim yourself, fill out Part I and ask your doctor to fill out Part II. If you have an itemized bill from him, you may submit it rather than have him completo Part II. (This form, with Part I completed by you, may be used to send in several itemized bills from different doctors and suppliers.) Bills should show who furnished the services, the patient's name and number, dates of Services, where the services were furnished, a description of the services, and charges for each separate service. It is helpful if the diagnosis is also shown. Then mail itemized bills and this form to the address shown in the upper left-hand corner. If no address is shown there, use the address listed in Your Medicare Handbook-or get advice from any social security office,
Enter your mailing address and telephone 3
number, if any. 4
Describe your illness or injury.
If you have other health insurance or ex5
pect a welfare agency to pay part of the expenses, complete item 5. Be sure to sign your name. If you cannot write your name, sign by mark (x), and have a witness sign his name and enter his address on this line. If the claim is filed for the patient by an. other person he should enter the patient's name and write "By," sign his own name and address in this space, show his rela. tionship to the patient, and why the patient cannot sign. (If the patient has died, the survivor should contact any social security office for information on what to do.)
IMPORTANT NOTES FOR PHYSICIANS AND SUPPLIERS
If the physician or supplier does not want Part II information released to the organization named in item 5, he should write "No further release" in item 7C following the description of services.
Item 12: In assigned cases the patient is responsible only for the deductible, coinsurance, and non-covered services. Coinsurance and the deductible are based upon the charge determination of the carrier if this is less than the charge submitted, This form may also be used by a supplier, or by the patient to claim reimbursement for charges by a supplier for services such as the use of an ambulance or medical appliances.