Friam

Old Folks Only: Medicare & Plan F

Classic

List

Threaded

8 messages Options

Owen Densmore

Old Folks Only: Medicare & Plan F

Administrator

Today I had my first experience of a doctor refusing my medicare insurance.

This was particularly surprising because I have the Plan F supplement which purports to pay the difference between the Medicare schedule and the doctor's normal fee. I even offered to pay for it all myself and was refused as it's being against the law to pay for treatment while having insurance of any kind!

The best they could offer is referring me to a doctor in Los Alamos. (I think if I'm going to have to move my medical services, I'd more likely choose Abq, but I'm not sure if that indeed would be better.)

This is spooky!

Have any of us had similar experiences? I'm trying to figure out what my alternatives are.

- Get off Medicare + supplement plan and pay a great deal for standard blue cross/shield?
- Move from standard Medicare to the alternative "Advantage" plans?

- Call the doctor every week to see if she's now accepting Medicare?
- Suck it up and start looking outside of Santa Fe?

- Go find a hip doctor and ask what the best approach is!

Please let me/us know what your experiences are in this area! Yikes!

-- Owen

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
lectures, archives, unsubscribe, maps at http://www.friam.org

Robert Holmes-3

Re: Old Folks Only: Medicare & Plan F

Move to Europe?

—R

On Mon, Apr 23, 2012 at 11:47 AM, Owen Densmore <[hidden email]> wrote:

Today I had my first experience of a doctor refusing my medicare insurance.

This was particularly surprising because I have the Plan F supplement which purports to pay the difference between the Medicare schedule and the doctor's normal fee. I even offered to pay for it all myself and was refused as it's being against the law to pay for treatment while having insurance of any kind!

The best they could offer is referring me to a doctor in Los Alamos. (I think if I'm going to have to move my medical services, I'd more likely choose Abq, but I'm not sure if that indeed would be better.)

This is spooky!

Have any of us had similar experiences? I'm trying to figure out what my alternatives are.

- Get off Medicare + supplement plan and pay a great deal for standard blue cross/shield?
- Move from standard Medicare to the alternative "Advantage" plans?

- Call the doctor every week to see if she's now accepting Medicare?
- Suck it up and start looking outside of Santa Fe?

- Go find a hip doctor and ask what the best approach is!

Please let me/us know what your experiences are in this area! Yikes!

-- Owen

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
lectures, archives, unsubscribe, maps at http://www.friam.org

Bruce Abell-2

Re: Old Folks Only: Medicare & Plan F

In reply to this post by Owen Densmore

Owen--

I have that same type of coverage, A, B, and F (as well as D).

Medigap does not pay the difference between the Medicare B payment and the doctor's normal fee. If that were the case you'd be readily accepted. But it only pays the difference between the amount Medicare B pays (something like 80 percent of the approved Medicare fee) and the approved Medicare fee. That approved fee is always less than the doctor's retail fee, and usually dramatically less. That's why some doctors won't accept Medicare.

But many, if not most, do accept Medicare. You can search around to see if you can find a doctor you trust and one who would accept you. I think there are some in Santa Fe, but it may take some looking. I think someone new recently joined the Adult Medicine Specialists at 1650 Hospital Drive. You might call there to see if there are openings (though the individual doctors in that practice maintain their own patient rosters).

The Medicare Advantage plans put you into whatever network they use. You might find that Blue Cross will enroll you in an Advantage plan and let Medicare pay for it. The important thing there is to know who your providers are going to be. I believe if you're in an Advantage plan there's no question of being accepted as a patient.

--Bruce Abell

On Mon, Apr 23, 2012 at 11:47 AM, Owen Densmore <[hidden email]> wrote:

Today I had my first experience of a doctor refusing my medicare insurance.

This was particularly surprising because I have the Plan F supplement which purports to pay the difference between the Medicare schedule and the doctor's normal fee. I even offered to pay for it all myself and was refused as it's being against the law to pay for treatment while having insurance of any kind!

The best they could offer is referring me to a doctor in Los Alamos. (I think if I'm going to have to move my medical services, I'd more likely choose Abq, but I'm not sure if that indeed would be better.)

This is spooky!

Have any of us had similar experiences? I'm trying to figure out what my alternatives are.

- Get off Medicare + supplement plan and pay a great deal for standard blue cross/shield?
- Move from standard Medicare to the alternative "Advantage" plans?

- Call the doctor every week to see if she's now accepting Medicare?
- Suck it up and start looking outside of Santa Fe?

- Go find a hip doctor and ask what the best approach is!

Please let me/us know what your experiences are in this area! Yikes!

-- Owen

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
lectures, archives, unsubscribe, maps at http://www.friam.org

--
Bruce Abell
7 Morning Glory
Santa Fe, NM 87506
Tel: 505 986 9039

Nick Thompson

Re: Old Folks Only: Medicare & Plan F

In reply to this post by Robert Holmes-3

Hi, Robert,

I find the local medical situation terrifying. My daughter had to be admitted to St. V. for an emergency a couple of X-masses ago, and I swear to god there were blood splatters on the wall behind her bed in her room. I am fighting allergies so bad right now they are preventing me from singing in the Chorus I sing for, and all the medical people I talk to are clueless. The feed-back from patients to doctors is non-existent. There’s no way a Doctor can tell when he prescribes you medicine whether it has killed you or cured you. Either way, you don’t come back. I think folks like you could get rich in the Obama technocrat age AND do a heluva lot of good by designing feedback systems so Doctors actually find out whether they have killed you or not.

As for hip surgery. I have been a “candidate” for hip surgery for years but never elected. But arthritic hips are different from osteomyelitic hips.

One good thing about medicare is that it doesn’t give a rat’s ass where you get your medical care. So, I went to Boston for high end carotic surgery a few years ago…. Massachusetts General Hospital, Harvard …., the whole nine yards. It didn

‘t cost me a dime. I had relatives in Boston, so that helped a lot.

Good luck with this, Robert.

Nick

Ooops. I forgot I was exiled. N

From: [hidden email] [mailto:[hidden email]] On Behalf Of Robert Holmes
Sent: Monday, April 23, 2012 11:53 AM
To: The Friday Morning Applied Complexity Coffee Group
Subject: Re: [FRIAM] Old Folks Only: Medicare & Plan F

Move to Europe?

—R

On Mon, Apr 23, 2012 at 11:47 AM, Owen Densmore <[hidden email]> wrote:

Today I had my first experience of a doctor refusing my medicare insurance.

This is spooky!

Have any of us had similar experiences? I'm trying to figure out what my alternatives are.

- Get off Medicare + supplement plan and pay a great deal for standard blue cross/shield?
- Move from standard Medicare to the alternative "Advantage" plans?
- Call the doctor every week to see if she's now accepting Medicare?
- Suck it up and start looking outside of Santa Fe?
- Go find a hip doctor and ask what the best approach is!

Please let me/us know what your experiences are in this area! Yikes!

-- Owen

Pamela McCorduck

Re: Old Folks Only: Medicare & Plan F

<base href="x-msg://10/">Robert, nearly none of my Manhattan doctors takes Medicare, and that's been true for about a decade. Luckily, Joe is still working, and we pay for the Columbia faculty medical plan, but when that stops, I don't know what we'll do. I can't blame the docs--the fees from Medicare are negligible compared to Manhattan expenses.

Free market medicine working so, so well.

What you're complaining about, Nick (and I agree) is a result of docs taking on far too many patients, giving them too little time, again a function of the crackpot non-system we have. With single-payer, we would immediately save thirty percent at least of what we shell out, and patients and doctors could split that savings. As most of you know, we are surrounded in Santa Fe by people who have no insurance at all.

I had dinner the other night with the guy in charge of Google's medical records effort... Google's defunct medical records effort. As they were getting acquainted with the general non-system, they realized that privacy laws would keep them from verifying that their record-keeping programs actually worked! Impossible to penetrate the silos that exist from one medical center to the next. Google pulled the plug.

Is it do-able technically? Of course. The Veterans Administration does it handily. Will it be done in our lifetimes? Unlikely. So the next time you hear someone tell you how much money we're going to save through electronic medical records, you can smile. Wryly.

On Apr 23, 2012, at 2:39 PM, Nicholas Thompson wrote:

Hi, Robert,

I find the local medical situation terrifying. My daughter had to be admitted to St. V. for an emergency a couple of X-masses ago, and I swear to god there were blood splatters on the wall behind her bed in her room. I am fighting allergies so bad right now they are preventing me from singing in the Chorus I sing for, and all the medical people I talk to are clueless. The feed-back from patients to doctors is non-existent. There’s no way a Doctor can tell when he prescribes you medicine whether it has killed you or cured you. Either way, you don’t come back. I think folks like you could get rich in the Obama technocrat age AND do a heluva lot of good by designing feedback systems so Doctors actually find out whether they have killed you or not.

As for hip surgery. I have been a “candidate” for hip surgery for years but never elected. But arthritic hips are different from osteomyelitic hips.

One good thing about medicare is that it doesn’t give a rat’s ass where you get your medical care. So, I went to Boston for high end carotic surgery a few years ago…. Massachusetts General Hospital, Harvard …., the whole nine yards. It didn
‘t cost me a dime. I had relatives in Boston, so that helped a lot.

Good luck with this, Robert.

Nick

Ooops. I forgot I was exiled. N

\

From: [hidden email] [mailto:[hidden email]] On Behalf Of Robert Holmes
Sent: Monday, April 23, 2012 11:53 AM
To: The Friday Morning Applied Complexity Coffee Group
Subject: Re: [FRIAM] Old Folks Only: Medicare & Plan F

Move to Europe?

—R
On Mon, Apr 23, 2012 at 11:47 AM, Owen Densmore <[hidden email]> wrote:
Today I had my first experience of a doctor refusing my medicare insurance.

This was particularly surprising because I have the Plan F supplement which purports to pay the difference between the Medicare schedule and the doctor's normal fee. I even offered to pay for it all myself and was refused as it's being against the law to pay for treatment while having insurance of any kind!

The best they could offer is referring me to a doctor in Los Alamos. (I think if I'm going to have to move my medical services, I'd more likely choose Abq, but I'm not sure if that indeed would be better.)

This is spooky!

Have any of us had similar experiences? I'm trying to figure out what my alternatives are.
- Get off Medicare + supplement plan and pay a great deal for standard blue cross/shield?
- Move from standard Medicare to the alternative "Advantage" plans?
- Call the doctor every week to see if she's now accepting Medicare?
- Suck it up and start looking outside of Santa Fe?
- Go find a hip doctor and ask what the best approach is!

Please let me/us know what your experiences are in this area! Yikes!

-- Owen

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
lectures, archives, unsubscribe, maps at http://www.friam.org

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
lectures, archives, unsubscribe, maps at http://www.friam.org

"She instructed me as if out of bitter personal experience; she brooded along the edges of my childhood like someone living out a long Tennysonian regret."

	Wallace Stegner, "Angle of Repose"

Nick Thompson

Re: Old Folks Only: Medicare & Plan F

My fantasy is that we all get together to form a Dr/patients association and conspire against the insurance companies.

From: [hidden email] [mailto:[hidden email]] On Behalf Of Pamela McCorduck
Sent: Monday, April 23, 2012 1:33 PM
To: The Friday Morning Applied Complexity Coffee Group
Subject: Re: [FRIAM] Old Folks Only: Medicare & Plan F

Robert, nearly none of my Manhattan doctors takes Medicare, and that's been true for about a decade. Luckily, Joe is still working, and we pay for the Columbia faculty medical plan, but when that stops, I don't know what we'll do. I can't blame the docs--the fees from Medicare are negligible compared to Manhattan expenses.

Free market medicine working so, so well.

On Apr 23, 2012, at 2:39 PM, Nicholas Thompson wrote:

Hi, Robert,

As for hip surgery. I have been a “candidate” for hip surgery for years but never elected. But arthritic hips are different from osteomyelitic hips.

‘t cost me a dime. I had relatives in Boston, so that helped a lot.

Good luck with this, Robert.

Nick

Ooops. I forgot I was exiled. N

From: [hidden email] [hidden email] On Behalf Of Robert Holmes
Sent: Monday, April 23, 2012 11:53 AM
To: The Friday Morning Applied Complexity Coffee Group
Subject: Re: [FRIAM] Old Folks Only: Medicare & Plan F

Move to Europe?

—R

On Mon, Apr 23, 2012 at 11:47 AM, Owen Densmore <[hidden email]> wrote:

Today I had my first experience of a doctor refusing my medicare insurance.

This is spooky!

Have any of us had similar experiences? I'm trying to figure out what my alternatives are.

- Get off Medicare + supplement plan and pay a great deal for standard blue cross/shield?
- Move from standard Medicare to the alternative "Advantage" plans?
- Call the doctor every week to see if she's now accepting Medicare?
- Suck it up and start looking outside of Santa Fe?
- Go find a hip doctor and ask what the best approach is!

Please let me/us know what your experiences are in this area! Yikes!

-- Owen

"She instructed me as if out of bitter personal experience; she brooded along the edges of my childhood like someone living out a long Tennysonian regret."

               Wallace Stegner, "Angle of Repose"

Parks, Raymond

Re: [EXTERNAL] Re: Old Folks Only: Medicare & Plan F

<base href="x-msg://10/"> I like the idea of returning to the way we were before WWII and the wage freeze - paying the doctor what he needs, possibly through a retainer relationship.

There was a doctor in NYC who tried to set up a business model where his patients paid him $70 per month (he calculated that amount based on office overhead and his income) and they had the right to visit him X number of times per month. The various one-payer systems (Medicare, insurance) called in the insurance regulators, claiming that he was operating as an insurance company.

I have friend who recently retired from being an Ob/Gyn. He worked in ABQ but followed his wife to Winslow. There he worked for what his patients could give him - many times including livestock (mostly chickens). He told me that he made more money through that informal system than he made here through the whole office/insurance/hospital privileges/etc. system.

My wife once found out (through having to bully the insurance company to pay the doctor) that her Ob/Gyn (different one) pocketed a whopping $125.00 for the emergency surgery he did for her. This was after the cost of having an office, paying the hospital to use it, processing the insurance, and paying malpractice. We figured he was probably worth more than $25.00/hour.

The whole insurance/government regulation/government fee structure we've built ever since medical insurance was used to hide salary increases has gotten us to where we are today - a mess.

On Apr 23, 2012, at 2:53 PM, Nicholas Thompson wrote:

My fantasy is that we all get together to form a Dr/patients association and conspire against the insurance companies.

n

From: [hidden email] [mailto:[hidden email]] On Behalf Of Pamela McCorduck
Sent: Monday, April 23, 2012 1:33 PM
To: The Friday Morning Applied Complexity Coffee Group
Subject: Re: [FRIAM] Old Folks Only: Medicare & Plan F

Robert, nearly none of my Manhattan doctors takes Medicare, and that's been true for about a decade. Luckily, Joe is still working, and we pay for the Columbia faculty medical plan, but when that stops, I don't know what we'll do. I can't blame the docs--the fees from Medicare are negligible compared to Manhattan expenses.

Free market medicine working so, so well.

What you're complaining about, Nick (and I agree) is a result of docs taking on far too many patients, giving them too little time, again a function of the crackpot non-system we have. With single-payer, we would immediately save thirty percent at least of what we shell out, and patients and doctors could split that savings. As most of you know, we are surrounded in Santa Fe by people who have no insurance at all.

I had dinner the other night with the guy in charge of Google's medical records effort... Google's defunct medical records effort. As they were getting acquainted with the general non-system, they realized that privacy laws would keep them from verifying that their record-keeping programs actually worked! Impossible to penetrate the silos that exist from one medical center to the next. Google pulled the plug.

Is it do-able technically? Of course. The Veterans Administration does it handily. Will it be done in our lifetimes? Unlikely. So the next time you hear someone tell you how much money we're going to save through electronic medical records, you can smile. Wryly.



On Apr 23, 2012, at 2:39 PM, Nicholas Thompson wrote:

Hi, Robert,

I find the local medical situation terrifying. My daughter had to be admitted to St. V. for an emergency a couple of X-masses ago, and I swear to god there were blood splatters on the wall behind her bed in her room.   I am fighting allergies so bad right now they are preventing me from singing in the Chorus I sing for, and all the medical people I talk to are clueless. The feed-back from patients to doctors is non-existent. There’s no way a Doctor can tell when he prescribes you medicine whether it has killed you or cured you.   Either way, you don’t come back.     I think folks like you could get rich in the Obama technocrat age AND do a heluva lot of good by designing feedback systems so Doctors actually find out whether they have killed you or not.

As for hip surgery. I have been a “candidate” for hip surgery for years but never elected.   But arthritic hips are different from osteomyelitic hips.

One good thing about medicare is that it doesn’t give a rat’s ass where you get your medical care. So, I went to Boston for high end carotic surgery a few years ago…. Massachusetts General Hospital, Harvard …., the whole nine yards. It didn

‘t cost me a dime. I had relatives in Boston, so that helped a lot.

Good luck with this, Robert.

Nick

Ooops. I forgot I was exiled. N

\

From: [hidden email] [hidden email] On Behalf Of Robert Holmes
Sent: Monday, April 23, 2012 11:53 AM
To: The Friday Morning Applied Complexity Coffee Group
Subject: Re: [FRIAM] Old Folks Only: Medicare & Plan F

Move to Europe?

—R

On Mon, Apr 23, 2012 at 11:47 AM, Owen Densmore <[hidden email]> wrote:

Today I had my first experience of a doctor refusing my medicare insurance.

This was particularly surprising because I have the Plan F supplement which purports to pay the difference between the Medicare schedule and the doctor's normal fee. I even offered to pay for it all myself and was refused as it's being against the law to pay for treatment while having insurance of any kind!

The best they could offer is referring me to a doctor in Los Alamos. (I think if I'm going to have to move my medical services, I'd more likely choose Abq, but I'm not sure if that indeed would be better.)

This is spooky!

Have any of us had similar experiences? I'm trying to figure out what my alternatives are.

- Get off Medicare + supplement plan and pay a great deal for standard blue cross/shield?

- Move from standard Medicare to the alternative "Advantage" plans?

- Call the doctor every week to see if she's now accepting Medicare?

- Suck it up and start looking outside of Santa Fe?

- Go find a hip doctor and ask what the best approach is!

Please let me/us know what your experiences are in this area! Yikes!

-- Owen

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
lectures, archives, unsubscribe, maps at http://www.friam.org

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
lectures, archives, unsubscribe, maps at http://www.friam.org

"She instructed me as if out of bitter personal experience; she brooded along the edges of my childhood like someone living out a long Tennysonian regret."

               Wallace Stegner, "Angle of Repose"

Ray Parks

Consilient Heuristician/IDART Program Manager

V: 505-844-4024 M: 505-238-9359 P: 505-951-6084

NIPR: [hidden email]

SIPR: [hidden email] (send NIPR reminder)

JWICS: [hidden email] (send NIPR reminder)

glen ropella

Re: [EXTERNAL] Re: Old Folks Only: Medicare & Plan F

We have a patient/physician co-op, here. It was apparently modeled off
the one in Houston, TX.

http://www.ppcpdxcoop.org/

The general site is here: http://www.patientphysiciancoop.com/

My worry is that we have so few MDs on the list here in PDX. There seem
to be a lot more in Houston. I am extremely skeptical of alternative
medicines. But if enough people use them _and_ we collect enough data,
it should provide higher quality than allopathic clinical trials. So, I
encourage all of _you_ to use alternative medicine. I'll wait for the
data. ;-)

Parks, Raymond wrote at 04/23/2012 02:15 PM:

> There was a doctor in NYC who tried to set up a business model where
> his patients paid him $70 per month (he calculated that amount based
> on office overhead and his income) and they had the right to visit
> him X number of times per month. The various one-payer systems
> (Medicare, insurance) called in the insurance regulators, claiming
> that he was operating as an insurance company.
>
> I have friend who recently retired from being an Ob/Gyn. He worked
> in ABQ but followed his wife to Winslow. There he worked for what
> his patients could give him - many times including livestock (mostly
> chickens). He told me that he made more money through that informal
> system than he made here through the whole office/insurance/hospital
> privileges/etc. system.
> [...]
>
> On Apr 23, 2012, at 2:53 PM, Nicholas Thompson wrote:
>>
>> My fantasy is that we all get together to form a Dr/patients
>> association and conspire against the insurance companies.

--
glen

============================================================
FRIAM Applied Complexity Group listserv
Meets Fridays 9a-11:30 at cafe at St. John's College
lectures, archives, unsubscribe, maps at http://www.friam.org