Patient Guide

Insurance Information


Your Medicare Benefits Are Changing

As the 16th century English poet Edmund Spenser once observed, "times do change and move continually." That observation is as true today as it was in Spenser's time, and it certainly applies to health care and the policies that govern it. That's why we make a special effort at Lourdes to keep our community aware of the changes which affect us and the patients we serve.

With that point in mind, we think you should know that as of August 1 the Medicare program has changed the way it pays for hospital outpatient services. These changes mean patients eligible for Medicare will notice their Medicare Explanation of Benefits notice and Medicare Summary notice will look different.

When you receive services on an outpatient basis, you are typically responsible for a fee that the Medicare program does not cover. This fee is called coinsurance or co-payment.

The Centers for Medicare & Medicaid Services (CMS) says that "overtime" Medicare's new system will ultimately lower the overall coinsurance for outpatient services. However, at the outset, your coinsurance is likely to increase because CMS based the new Medicare rates on national averages, and New York hospital's outpatient charges have been below national averages.

If you have a Medigap policy or another supplemental insurance such as Medicaid, your private insurance probably already pays your co-payment or deductible. As a result, changes in your co-payments may not affect you directly. If you do not have this insurance, you may notice that your co-payments have changed.

The government has drastically reduced payments to hospitals for the key health care services you depend on. Initially, while some patients may pay a slightly higher coinsurance for certain outpatient services, the government still pays hospitals less than the cost of providing your care.

Our constant Mission at Lourdes is to serve our patients to the best of our ability and to continue providing the essential services our community needs. We assure you these changes will not affect the quality of care you expect from us.

If you have questions about your bill or the new system, please call CMS' Medicare Helpline at 1-800-MEDICARE (1-800-633-4227), or call our Community Relations Department at 607-772-1302.

Please remember that this is an enormous change for all of us, and it is to be a work in progress. That means we all will be searching for answers to complex questions regarding policy changes that are still taking shape.

For information about Medicare premiums and coinsurance rates for 2010, visit the Web site.

At the outset, however, here are some key points to keep in mind:

  • In 1997, Congress mandated a new payment for Medicare hospital outpatient services. 
  • It has taken this much time to covert that mandate into something close to detailed policy, and some key details are still being developed. 
  • Reimbursement under the the new payment system is based on national, rather than hospital-specific charges. 
  • Despite the transition to a new system, no change will occur in the way hospitals, including Lourdes, deliver care. The mission of physicians, nurses, and other care givers in the hospital is to put patients' needs first.
  • The Centers for Medicare & Medicaid Services (CMS) will set the payment rates of outpatient services hospitals provide to Medicare beneficiaries. Because of this, hospitals will have no control over whether a senior's coinsurance will increase or decrease at the onset.
  • However, CMS says overall coinsurance is supposed to decrease nationally, and "over time" seniors should ultimately pay less for outpatient services under the new system. That's why the senior group AARP fully supported this move.
  • Medicare beneficiaries who have Medigap coverage do not have to pay out-of-pocket expenses for hospital outpatient services.
  • Many hospitals are not financially able to voluntarily reduce a beneficiary's coinsurance. Hospitals have historically been paid less than their costs for Medicare outpatient services. This is due in large part to the federal government's continual ratcheting down of Medicare payments. As it is, hospitals are walking a tightrope ---having to provide the same high quality services with fewer resources. Many are struggling to make ends meet so they can continue providing the same services to their parents. Some hospitals, including Lourdes, have already had to cut services to their patients.
  • But Lourdes will not compromise on our Mission to provide the best care we possibly can to the Medicare beneficiaries and all the patients we serve.

Questions? Please call the Lourdes Physician Referral Number at 1-877-9LOURDES.

LOURDES Hospital | 169 Riverside Drive • Binghamton, NY 13905 | Phone: 607-798-5111 / Directory | Email: