Because of sticker shock, I ignore what healthcare providers bill to Medicare and other insurance companies. In the case of Medicare, it is more about the "Medicare Approved" amount and not what is billed by my provider. We have a strange healthcare system where most healthcare providers take whatever reimbursement they can get from Medicare.

The VA system is even more strange. Legally, the VA can't bill Medicare because one government agency can't bill another government agency. However, the VA can bill my Medicare supplement because it is private insurance from United Healthcare. My supplemental insurance pays for the 20% that Medicare doesn't cover.

Provided Service: Tocilizumab infusion
Amount Charged $11,169.61
Medicare Approved Amount $3,396.64
Medicare Paid $2,717.31 (80% of the Medicare approved amount)
Supplemental Plan Paid $679.33

Fortunately, my copay is $0 for a hospital infusion of Actemra because the VA doesn't bill me for inpatient hospital services. Infusions are considered inpatient service for IV insertion and monitoring for the hour that Actemra is infused.

When I do my own injections weekly on an outpatient basis, I have a small copay for month supply of Actemra injections that the VA dispenses.. I wonder what each injection costs. I hope the VA gets the "bulk rate" because I'm extremely grateful to the VA.

It is no wonder insurance companies scrutinize healthcare claims.