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Sat Jun 21, 2014, 04:34 PM

"I'm a Medicare Patient. Please Don't Hate Me!"

Last edited Sat Jun 21, 2014, 05:13 PM - Edit history (1)

Those who aren't on Medicare might be surprised to discover that it is next to impossible for some folks on the insurance program to find a doctor. If you are a healthy, wealthy senior, you should have no problem. You'll be able to afford traditional Medicare with a traditional Medicare supplement--those will open many doors, especially if you live in an urban area with lots of providers. Or, you can hire one of the concierge doctors, who sign up to treat a handful of people. If you are wealthy enough, you can even go outside Medicare altogether and pay cash---though most rich people that I know are very tight with their money and will try anything before they resort to this one.

However, if you are an extremely sick Medicare patient and/or you are poor---sickness and poverty often go hand in hand in this country---you may find that there are no doctors willing to accept the extremely meager reimbursement that your Medicare so called managed care insurance pays them for coordinating your very complicated and time consuming care. You may find that the only place you can get an appointment is at the local "free" clinic or charity hospital, which is required by law to accept all comers. And you may find that even here, you are not wanted, since most of the poorly paid, overwhelmed physicians would rather see 40 somethings with allergies than spend an hour wading through your medical records, coordinating your care with your cardiologist (heart failure and CAD with Afib on Coumadin), your gastroenterologist (GI bleeding controlled by double dose Nexium), your endocrinologist (severe osteoporosis) and psychiatrist (a whole handful of medications). Did I mention your breast cancer? It's in remission. And your kidneys shut down whenever you get pneumonia which is every winter. Your insurance keeps changing its formulary so you keep running out of the medications that keep you alive, so your doctor's nurse or your doctor spend hours on the phone every month changing your meds or appealing a denial of coverage from your insurer which is doing its best to drive you off its Medicare managed plan and on to its competitor's Medicare managed plan.

Why did you sign up for a Medicare managed care plan if it is so yucky? Because it was the only one you could afford. You are poor. And sick. You really need to use your insurance. Deductibles will kill you. So you chose the plan with the least out of pocket, not realizing that it is also the plan that throws up the most barriers to care in the form of limited reimbursement for providers and limited treatment options---

Does that even make any sense?

Our nation is at war with sick people. Correction, the private insurance industry which makes a bet that it will take in more in premiums than it pays out in claims is at war with sick people. And somehow, the private insurance industry did not just get itself a seat at the table of Affordable Care and Medicare and Medicaid. In some places, it is the table. And the chairs it has reserved for the chronically ill are the ricketiest, flimsiest chairs it could find, and it has its employees stationed behind the chronically ill ready to pull those chairs out from under them at any moment. And pretty soon, private insurance is going to take a chunk out of the VA----the VA's funding, that is. Not the VA's work load. Have you seen Tricare rates?

Where was I? Oh yes. I was vomiting blood into the toilet, because my insurer decided to stop paying for my ulcer drug this month on a Friday and it is Sunday and my doctor won't be in until Monday to change my prescription. I should stop my blood thinner, but if I do that, I'll have a stroke. Here. Let me wipe the blood off my lips. I'm lucky to have a doctor. I waited nine months to get my appointment at the county clinic. No private doctor in my community will accept new patients on my Medicare plan. I had been getting my "care" from the emergency rooms, which can not turn anyone away, but they were getting tired of seeing me. I worry that my doctor has so many patients like me and keeps getting more and more. It is getting hard to schedule an appointment with him. He is booked out two months in advance. My old family doctor, from the days when I was young and healthy, could get you in that same day or at least that same week. And everyone in the waiting room looks like me---prematurely aged, tired, tied to an oxygen cannister and a walker with a huge bag of medicine. Just going through all those drugs must take 15 minutes. Most doctors are in and out of the room in 15 minutes seeing an "average" patient---

Oops. There goes the stomach again. I think I've lost enough blood that the ER doctor won't think I'm a hypochondriac for coming in by ambulance. When the clerk asks for my insurance info, I'll hand her my Medicare card. In the old days, that used to mean you were insured. Now it means that the doctor will groan and think about how little he will be paid for how much he will have to do.

Please, don't hate me, because I am a Medicare patient.

P.S. Edited so that I can remind folks at DU that I'm a doctor and my health is great. This is me sharing some of the things I know my patients would tell you if they could afford a computer and internet access.

25 replies, 2366 views

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Arrow 25 replies Author Time Post
Reply "I'm a Medicare Patient. Please Don't Hate Me!" (Original post)
McCamy Taylor Jun 2014 OP
Mojorabbit Jun 2014 #1
pinto Jun 2014 #2
McCamy Taylor Jun 2014 #3
pinto Jun 2014 #4
McCamy Taylor Jun 2014 #5
Louisiana1976 Jun 2014 #6
RebelOne Jun 2014 #8
840high Jun 2014 #11
dem in texas Jun 2014 #9
malokvale77 Jun 2014 #17
FarPoint Jun 2014 #7
mnhtnbb Jun 2014 #10
FarPoint Jun 2014 #18
Overseas Jun 2014 #12
donco Jun 2014 #13
Thinkingabout Jun 2014 #14
WillyT Jun 2014 #15
Ghost in the Machine Jun 2014 #16
McCamy Taylor Jun 2014 #19
freshwest Jun 2014 #23
Dragonfli Jun 2014 #20
slipslidingaway Jun 2014 #22
Dragonfli Jun 2014 #24
slipslidingaway Jul 2014 #25
slipslidingaway Jun 2014 #21

Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 04:53 PM

1. It is why I have plain medicare

Most docs take it and I am lucky enough to be able to afford the copays. Many people cannot absorb that cost.

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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 05:08 PM

2. Sorry to hear you're having such a rocky medical road. Sounds like it's complex. I'm on Medicare.

Part A, B and D (for meds). Medicaid is my secondary payer after Medicare. I don't use a Medicare supplement. Nor would I buy one if I could afford it. Medicare and Medicaid cover my health care costs adequately. My situation my be different than yours - I'm very low income and disabled so I qualify for both programs.

My experiences have been very different. It's worked really well for me. Outpatient care, pharmacy, routine medical care, in-patient care when medically necessary and ER when needed. No questions asked.

My only idea is that you may benefit by contacting local health related agencies for some support in getting your needs met. And they may have some pointers on navigating the systems. I know it can seem a maze at times.

Best of luck, take care. ~ pinto

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Response to pinto (Reply #2)

Sat Jun 21, 2014, 05:09 PM

3. No, no----this is me speaking for my patients. I better add an explanation to the OP.

My health is fine. I'm a doctor who sees a lot of patients like this.

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Response to McCamy Taylor (Reply #3)

Sat Jun 21, 2014, 05:13 PM

4. Ah geez. Sorry. Totally misread your post. And now remember - you're a medical provider.

(aside) And I hear you - lots of people have a real hard time navigating the systems or connecting to resources that are out there. I got lucky.

Take care.

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Response to pinto (Reply #4)

Sat Jun 21, 2014, 05:14 PM

5. No problem. It proves you have a kind and caring heart.

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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 05:29 PM

6. I'm on Medicare and Medicaid and so far haven't had any trouble getting the

health care I need. But what I think would be best for people on Medicare who are having trouble would be if this country went to single payer health care like they have in Canada. That would solve that problem.

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Response to Louisiana1976 (Reply #6)

Sat Jun 21, 2014, 06:20 PM

8. Same here. I am on Medicare and have not had any problems

with finding health care providers. I have been to a general family clinic for a pre-op examination and Medicare paid 100%. Then I had cataract surgery from a well-known doctor in the Atlanta area. Medicare paid 80% of the cost, but because I didn't have a supplemental policy I had to pay the difference. But without Medicare, I could never have afforded the surgery.

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Response to RebelOne (Reply #8)

Sat Jun 21, 2014, 07:07 PM

11. I've had no problems.

 

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Response to Louisiana1976 (Reply #6)

Sat Jun 21, 2014, 06:34 PM

9. Be thankful you don't live in Texas

I have a 50 year old nephew who is autistic and a severe diabetic, he has lost one leg and is losing his vision. Anyway, he has SS Disability and Medicare. Texas Medicaid paid for his supplemental insurance. They cut him off at the end of last year, so he now he has to pay for his own supplemental insurance. Makes me sick to see Rick Perry prance around and brag about how well the state is doing, when I know that the a lot of the prosperity is coming off the backs of the people like my nephew.

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Response to dem in texas (Reply #9)

Sat Jun 21, 2014, 07:55 PM

17. ^^^ this ^^^

I'm not going to go into the rant raging in my head about Texas.

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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 06:16 PM

7. Medicare clients are fine....

It's the insane paperwork that is overwhelming.

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Response to FarPoint (Reply #7)

Sat Jun 21, 2014, 06:58 PM

10. My husband is a psychiatrist who accepts Medicare

and has a very small private practice since he, himself, is semi-retired.

The paperwork with Medicare is driving him nuts--BUT--he says, the fee
he is getting from Medicare has gone up.

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Response to mnhtnbb (Reply #10)

Sat Jun 21, 2014, 08:16 PM

18. I'm an RN doing IV home infusions.

The paperwork we do is equal to or worse than filing taxes...and we recert every 60 days.

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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 07:22 PM

12. K&R. Well said.

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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 07:30 PM

13. I have a Medicare advantage(Coventry ) plan

that seems to do a pretty good job of taking care of me but don’t have any health issues other than the occasional gout attack(allopurinol )which I have had since my twenty’s. But I live in a large metro area that could have something to do with the care that I get.

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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 07:37 PM

14. I live in a large urban area and have been successful in being able to keep my doctor.

Can't say this is going to be the case next year with my supplement insurance changing next year.
I wish our health care workers received the money paid towards health care. I see where there has been an increase in Medicare payments to the providers. Our health care needs improvement and perhaps a single payer system but I am happy there has been a breakthrough with ACA. The whiny Republicans wants it to fail but if they tried they could get credit for fixing the flaws.

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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 07:40 PM

15. K & R !!!

 


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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 07:46 PM

16. I'll have to politely disagree with you on this point:

However, if you are an extremely sick Medicare patient and/or you are poor---sickness and poverty often go hand in hand in this country---you may find that there are no doctors willing to accept the extremely meager reimbursement that your Medicare so called managed care insurance pays them for coordinating your very complicated and time consuming care. You may find that the only place you can get an appointment is at the local "free" clinic or charity hospital, which is required by law to accept all comers. And you may find that even here, you are not wanted, since most of the poorly paid, overwhelmed physicians would rather see 40 somethings with allergies than spend an hour wading through your medical records, coordinating your care with your cardiologist (heart failure and CAD with Afib on Coumadin), your gastroenterologist (GI bleeding controlled by double dose Nexium), your endocrinologist (severe osteoporosis) and psychiatrist (a whole handful of medications).


I live in a very small, poor, rural area and most doctors around here gladly take the Medicare, so much so that they double and triple book appointments for the same time slot, and patients sit for 2 and 3 hours past their appointment time waiting to see the doctor. They also overcharge for services, then take what Medicare pays.

I am disabled, and in pain management. I always check my monthly statements and have noticed some of the overcharges from one pain clinic I was going to. They had it set up where patients had to come in every two weeks. We were also *required* to get a "trigger point injection" at the site where we hurt. I was there due to a broken back and neck. They would draw up ONE SYRINGE with lidocaine and give us a shot in the muscle. Sometimes I would just get one shot in my back, because it hurt there more than my neck, but I noticed that when I gt a shot in my neck and my back, they would charge $375 for EACH injection.. even though it was the same needle with the same lidocaine. If I only got one shot, they squirt the rest of the lidocaine into the garbage can and toss the syringe into the "sharp container". They were also charging $375 office visit, where cash customers were $250! It was costing near $1000 every two weeks to go there. That didn't include me having to pay double, and sometimes triple, co-pays on my meds on the months when my appointment date fell 3 times... like the 1st, 15th & 31st... and my gas going there and back.

I finally found a place a lot closer to home and only have to go once a month. They don't *require* the shots, either. I'm also in and out in about 45 mins and have never had to wait more than 10 past my appointment time to be called back.

It might be harder in the big cities, but doctors *depend* on Medicare and Medicaid in the poor, rural areas.

Peace,

Ghost

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Response to Ghost in the Machine (Reply #16)

Sat Jun 21, 2014, 09:50 PM

19. Rural docs will take most insurance because there is so much uninsured.

Suburbs seem to be the worst for Medicare. There are so many people with "good" insurance in the suburbs that providers can be choosy.

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Response to McCamy Taylor (Reply #19)

Sun Jun 22, 2014, 01:01 AM

23. That was my experience in the suburbs, too. They made a point of humiliating you if they saw you.

Specialists would not see you no matter what the doctor ordered. I had one great doctor who died, and another who did all he could but was about to give it all up fighting with insurers, etc.

The one I had to see later made a point to be upfront and hostile in our first 'encounter,' said she was losing money for every Medicare patient that came in and she was doing me a big favor to even take me as a patient. This was a formerly rural, then up and coming with very expensive homes being built, a prosperous righ wing area.

The staff tried to coerce me into signing a initiative about 'frivolous lawsuits.' I said I was there to see the doctor and didn't want to get into politics. After that they treated me like a leper whenever I came in for a periodic prescription review.

It was one of many lessons about the social classes in this country. So I stayed away from doctors for over 5 years, couldn't take the emotional abuse when I was sick and in severe pain any more. Once the insurance found they were double billing and said they would pay the first but not wouldn't pay the second, so she started calling me up at night and yelling at me, pretending to be her billing staff. All the payments were finally arranged. I moved away.

Then I moved close to town and saw some liberal doctors. I'd've rather died than put up with more of the financial and mental abuse they gave me.

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Response to McCamy Taylor (Original post)

Sat Jun 21, 2014, 11:11 PM

20. I fully understand the problem, I am on Medicaid and nearly zero doctors will see me.

I believe Medicare and Medicaid share the same issues. The reimbursement rates grow smaller and smaller and fewer and fewer health care professionals will see you, I do not know how one compares to the other (will not for a couple of years yet if I make it that far) as far as how low the rates are, but this is becoming a very serious issue. I do not believe it has anything to do with the health care professionals "hating" one for being poor, although I am sure there are some that do, I believe it is because the rates are below what is needed to actually pay for the service (including the paid support staff, equipment and insurance required by the doctor or clinic) to be anything more than a recipe for bankruptcy.

I am very concerned with the latest political trend of cutting the rates further under the banner of of reducing "fraud, waste, and abuse". There have been many cuts recently to the rates paid by Medicare and Medicaid under that very banner and I have watched these cuts widdle down available doctors and clinics at an almost exponential rate. Stealth cuts to the safety net is what they are and they are very popular in our party these days and part of most of the bills proposed by Democrats. I suppose to appease the republicans or perhaps as part of the neoliberal economic philosophy that has replaced the economic liberal philosophy as the party has changed the past thirty years.

In any event, even tho I live in a city with many places available I can only find care at the county hospital or through the Catholic Charities network (where I found a clinic willing to act as "primary Care Physician".

It is also telling that the insurance companies have taken over Medicaid (at least where I live) and it is the insurance company that blocks every single one of my medications that is not cheap (or attempt to do so) driving my doctors crazy trying to justify my need for what they prescribe or scrambling trying to find something that may not work as well but may forestall the decline in my health less than no medication at all. They spend far more time with the back and forth with insurance companies than they do on my actual care.

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Response to Dragonfli (Reply #20)

Sun Jun 22, 2014, 12:59 AM

22. Unfortunately ...

the current salary for doctors entering practice is measured by collections, not even billable hours, but the rate of collections on those billable hours. Two, out of approximately 40, in my daughter's graduation class from residency were going into private practice. Some were continuing their education and others were working for larger practices ... many based on collections. Each year these students are graduating with larger students loans that need to need to be paid. Is it no wonder that an almost 30 year old resident is looking to earn money and begin to pay off the 200K+ debt they have accumulated. When can we discuss taking the profit out of HC?

We missed that step in the latest HC debate






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Response to slipslidingaway (Reply #22)

Sun Jun 22, 2014, 01:36 AM

24. The legislation accomplished exactly what it was supposed to

Which was the exact opposite of taking profit out of health care.

If the goal was to improve our health care system and subsequently the health of the citizenry it would have been a health care bill rather than an insurance bill. The entire purpose of insurance is profit and their method of procuring that profit is denying health care rather than providing it.

The cleverest thing about the law is it's use of out of pocket expenses to get people not to use the insurance at all. The most odious thing about it is that it is designed so those with the least amount of money to pay for the mandated product are forced to pay the highest deductibles and co pays making sure that they can't use it. They simply don't have the money after paying the premium and all their bills. Typically such people seldom have 50 dollars left after paying such bills (if that, many are in negative numbers and falling into debt) and can't come up with the hundreds or thousands of dollars that must be payed at point of service and they do not have a nest egg in the bank or an American Express card available to use like the upper middle class and wealthy likely would.

There are the rich valued as gold or platinum people, the middle class valued as silver people, and the working poor valued as bronze people. In a sane world those with the most would pay the most when receiving care and those with the least would pay the least when receiving care, it is the exact opposite making it regressive rather than progressive. In an even saner world we would all be equal under the system and we would pay as a society and face no bills for the service, the money being provided via fair and equitable taxes that all citizens would pay as their income allows.

Being on medicaid in some ways I am luckier than bronze people because they don't expect me to have money for co pays which I do not, but my insurance is worse than any as no one will take it (nearly no one outside of county and religious charity clinics) and I am always examined by students rather than doctors, I liken the insurance under medicaid (they use the same insurance companies) as the tin plan, so I am a tin valued person.

An actual health care system rather than an insurance scam would pay doctors a salary rather than pay them like used car salesmen in what you described that sounds like nearly a commission based system.

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Response to Dragonfli (Reply #24)

Sun Jul 6, 2014, 12:13 AM

25. You hit the nail on the head ...

it is becoming a commission based system, and that IMHO, is a disturbing trend. If your salary is based on the dollars collected then why bother with the low reimbursement patients.



But that is not how it should be in a country that wants to advance, it should be need based, unfortunately we were not allowed to have a full discussion.

So sorry for the very late reply!







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Response to McCamy Taylor (Original post)

Sun Jun 22, 2014, 12:05 AM

21. Not quite there yet but I can certainly imagine the day ...

with my husband being a stem cell transplant patient for MDS/AML. I do fear that the doors of treatment will be closed for being too costly.

On another note our daughter recently graduated from her three residency in internal medicine, the keynote speaker spoke of the 'seven deadly sins of medicine' which was an article written in the 1950's. I was happy to hear mention of the pitfalls that doctors could fall into as they move forward in their careers.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1823730/

Appreciate your posts very much, thank you for advocating for your patients!!!





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