An advocacy group is raising questions about how much the elderly pay on Medicare claims. Citizen Action argues that too many physicians still don't accept Medicare-determined fees as 100 percent payment, and all should be required to do so.
But Citizen Action frames the issue too narrowly.The question should not be whether Medicare patients deserve a discount from what regular patients pay. If a doctor accepts a payment as reasonable when the money is from Medicare, the same amount should be just as adequate when it's from a private insurer or an individual.
On 23 percent of the Medicare claims submitted in fiscal 1987, doctors charged more than what the government said was reasonable.
Under the Medicare program, if doctors are participating physicians, they must accept as full payment the amount set by Medicare. Non-participants can accept that amount as sufficient if and when they feel like it.
Of the Medicare amount, the government pays 80 percent and the patient pays 20. If the doctor charges more, the patient picks up the rest.
To decide what's reasonable, Medicare takes the lowest of the actual charge, the physician's customary charge or the usual charge in the community. It adjusts the community figure yearly for inflation.
But in Utah, that index hasn't kept pace with doctors' prices, says a Utah Medical Association official. Is that because the index is inadequate or because the physicians are raking in too much profit?
Utah is far from being one of the worst states as far as accepting Medicare payments. In September, the payments were accepted as sufficient on 75 percent of Utah claims and on 80 percent of the dollars involved.
The UMA official said many of the claims involving excess charges are for well-to-do elderly patients who can afford to pay.
But whether they can afford to pay is not the issue. Medicare is not a welfare program - that's Medicaid.
The issue is how a doctor who charges a Medicare patient $11 for an office call can justify charging his other patients $20 for the same visit.