# Medicare Question



## MoonRiver (Sep 2, 2007)

I noticed something strange on my Medicare MSN.

Pneumococcal vaccine .... Amount Charged: $198.54
Med Approved Amount: $198.54
Amount Med Paid: $194.57​Does anyone know why amount approved and amount paid are different?

ETA: I know that Medicare pays 80% of the approved amount, but 80% of $198.54 is $158.83.


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## Cabin Fever (May 10, 2002)

Not sure, but maybe you have a 2% copay.

Or, maybe what they are saying that the charges are reasonable and covered by Medicare, but only up to an amount of $194.57


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## po boy (Jul 12, 2010)

Is that the flu shot?
I think they are free


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## MoonRiver (Sep 2, 2007)

po boy said:


> Is that the flu shot?
> I think they are free


That was pneumonia shot and in effect it is free. Walmart accepts Medicare payment as payment in full.


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## Danaus29 (Sep 12, 2005)

Nearly every place charges more than what the insurance company deems "reasonable and/or customary". They have a contract with your medical supplier to pay $x and $x is all they pay. The medical supplier normally charges the larger amount but has to accept what the insurance is willing to cover, usually listed as the negotiated or contracted amount. If it's a charge that is fully covered your "patient portion" would be $0.


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## MoonRiver (Sep 2, 2007)

Danaus29 said:


> Nearly every place charges more than what the insurance company deems "reasonable and/or customary". They have a contract with your medical supplier to pay $x and $x is all they pay. The medical supplier normally charges the larger amount but has to accept what the insurance is willing to cover, usually listed as the negotiated or contracted amount. If it's a charge that is fully covered your "patient portion" would be $0.


If you try matching that with my bill, you can see my bill makes no sense. I don't have to pay anything so it's not a big deal, but it would be nice if the bill actually made sense.


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## Danaus29 (Sep 12, 2005)

I believe the bills are made up with the intent to confuse patients. I never understand the bills. I can read and understand the explanation of benefits from the insurance company.


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## Wolf mom (Mar 8, 2005)

And if you call and ask that nameless voice on the other end of the call, they have NO idea....


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