An unexpected sticky wicket has crossed my monitor–the Medicare blood deductible!

Unless a private plan picks up the cost, Medicare patients must pay for those first three pints of blood by law (A., B.,) Clearly, this is a health care service no one wants.  However, if one day you find yourself in need of blood products, and didn’t know about Medicare’s blood payment policies, you might be surprised at the hospital’s blood bill.  Medicare doesn’t tell us what that cost may be. Just this:

Part A covers blood you get as a hospital inpatient. Part B covers blood you get as a hospital outpatient.  In 2013, you pay either the provider customary charges for the first 3 units of blood you get in a calendar year, or you must arrange (with limited exceptions) to have the blood replaced (donated by you or someone else) if the provider has to buy blood for you. In general, if the provider doesn’t have to pay the blood bank for the blood, you won’t have to pay for it or arrange for it to be replaced.

Blood processing & handling

Hospitals generally charge for blood processing and handling for each unit of blood you got, whether the blood is donated or purchased. Part A covers this service for an inpatient. Part B covers this service for an outpatient. In 2013, you pay a copayment for blood processing and handling services for each unit of blood you get as a hospital outpatient.

Of course, not all blood is donatable.  Enter the world of confusing and expensive world of private Medigap insurance.  Plans: A, B, C, D, F, G, M and N cover those first three pints 100%. But  K 50% and  L 75%.   (Out-of-Pocket Limits apply in K $4,640 L $2,320.)

Depending on location,  blood itself, sells for under $300 a pint.  A Forbes article about a new company, General Blood, sheds some light on the current blood business but finding the usual and customary charges for transfusions is proving elusive.  Ohio is apparently requiring hospitals to post their charges online but alas, no blood information: See: U Toledo.

But this out-of-pocket calculator for private insurance or uninsured people, is really cool for learning about the procedure’s cost using a CPT codes: 36430.   

http://www.fairhealthconsumer.org/medicalcostlookup/

Medical coding is no easy task since each insurance company has their own transfusuion rules but here are some from Blue Cross.  Other charges will likely to show up.   

For veterans being treated for leukemia or lymphomas, co-payment assistance may be available from charities.  So, I’m still searching for current “usual and customary” charges for blood.  Why, of all things, is blood singled out for special treatment?  If you have experience with this subject, let us know.