Re: Old Folks Only: Medicare & Plan F

Posted by Bruce Abell-2 on
URL: http://friam.383.s1.nabble.com/Old-Folks-Only-Medicare-Plan-F-tp7492705p7492781.html

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

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--
Bruce Abell
7 Morning Glory
Santa Fe, NM  87506
Tel: [phone]

============================================================
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