MDS SCT and Medicare
I had a stem cell transplant for my MDS. Medicare denied payment on the SCT stating that they only pay if you have an approved clinical trial before your transplant. It went on to say that even though they would not pay, I was not responsible to pay either. I did participate in a trial that is listed on clinicaltrials.gov as still recruiting.
The charge for SCT was $131,000. Medicare paid all other expenses including all expenses while I was in hospital for the SCT. So far the total bill charged by the hospitals and doctors came to $1,188,000. Medicare negotiated payment was $161,000.
Do other patients have similar problems with Medicare denying charges?
With Medicare paying about 14% of the charge master amount are the hospitals losing big time on treating Medicare patients? If so why accept them? Or are the hospitals making 700%+ profit on those unfortunate patients without insurance?