Medicare Cancer Patients Charged Two to Six Fold Amount Insurance Will Pay, Report Finds

Feb 23, 2018

Analysis of recent hospital billing records across the country found that charges for outpatient cancer services vary widely from facility to facility, but on average, exceed what Medicare patients are charged by two to six fold.

The researchers looked at the billing records for more than 3,000 hospitals across all 50 states. They compared the rate hospitals charged patients to the Medicare allowable amount, which is the set amount Medicare will pay for a specific service. Researchers then calculated the markup amount hospitals charged. For instance, if Medicare will pay a $1000 dollars for a service and the hospital charges $4000 then the mark up is 4.0.

The research team found that of the almost 3500 hospitals, specialty departments charged anywhere from 2.4 to 4.1 times more than what Medicare paid for those services. The markup often serves as an unpredictable financial burden for cancer patients and their families.

West Virginia ties with Maine for highest percentage of residents on Medicare.

The report was compiled by researchers at the Johns Hopkins School of Medicine and was published this month in the American Journal of Managed Care.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.