Doctors already refusing to accept Medicare Patients?
This week I was looking for a GYN physician and found a couple which I tried to make an appointment with. I was told they are accepting no more Medicare patients! I pay extra for a Medicare Advantage Plan but was told since it is involved with Medicare they no longer accept it. I called several other gyns in my area and was told the same thing! Has any of you found this same problem when trying to get in with a new physician. I think those who already are in with doctors accepting Medicare are kept but now new patients are out of luck!
I know it is because our gov has cut the amounts they pay to the physicians for Medicare and even the Advantage Plans and have written many letters to my Senator about this for months. I just did not expect it to happen so soon. What is the good of telling the elderly they have Medicare if they are going to make it impossible for us to find a doctor when we need one? I would be interested to know if any one else is already having this problem with Medicare or is it just hitting my area first. Thanks!
Comments
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JB; As horrible as it is that this is hitting the Medicaid indigent, we have to realize, they are not paying for their coverage. The taxpayers are. But now taxpayers like ourselves have to subsidize the poor, and pay thousands of dollars for our Medicare/Advantage premiums and "still" can't get to see the doctors we need! This is a sad pathetic condition for a country like the US to be in. I just finished an email to the CEO of AARP. Whether even AARP can do anything about this horror is questionable. The health of our people are being jeopardized by idiots in Washington who waste our tax dollars and now have to make the elderly and poor pay for their actions!
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Medigal, physicians' refusal to accept new Medicare patients is not a new problem... but it's getting worse. Here are some examples of articles discussing the problem:
http://www.nytimes.com/1992/04/12/us/physicians-refuse-medicare-patients.html
Physicians Refuse Medicare Patients
By Milt Freudenheim
Published: April 12, 1992
"Many doctors in Manhattan, Miami and other places where medical care is expensive say they are curtailing services for the elderly because of sharp reductions in the payments they receive from Medicare...."http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html
Doctors Are Opting Out Of Medicare
By JULIE CONNELLY
Published: April 1, 2009
"Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle...."http://www.usatoday.com/news/washington/2010-06-20-medicare_N.htm
Doctors limit new Medicare patients
By Richard Wolf, USA TODAY
Updated 6/21/2010 8:04 AM
WASHINGTON — "The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program...."++++++++++++++
I realize that it doesn't help to know this has been going on for nearly 20 years. It's a consequence of federal legislation that limits reimbursement for Medicare claims. (I don't understand the Medicare reimbursement laws at all, so I'm not going there.) I've read some sources that claimed the bottleneck was worst with primary care doctors; but other sources said it's most difficult to find specialists who take new Medicare patients. In either case, the problem will just get bigger as more and more people are switched over to Medicare.
My primary care doc is older than I am, and I'm 6 years away from Medicare eligibility. So, as much as I like him, I might have to find another, younger doctor to take over my primary care before Medicare becomes an issue. I have a good private (group) policy, but it will become secondary when I hit 65 and go on Medicare.
otter
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Just today, I just tried to get my friend (who is in her 90s, obviously under Medicare) in to a Palliative care doc (for pain control). The doc opted out of Medicare coverage, and it would be $360 for one visit.
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leaf: So sorry to hear about your friend. So what is she expected to do? Just spend the rest of her days in pain because our crappy idiots in Washington are blowing our tax dollars and causing Medicare to implode? If we use the attitude, we can't do anything about it, we are ALL going to end up one way or the other in your friend's predicament. My fingers are sore typing to my senators and calling them. PLEASE, on behalf of your friend and yourself, contact your senators and let them know they cannot destroy Medicare to cover up their wasteful spending! Thanks!
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A friend clued me in to this two years ago when my husband went on Medicare - I just got shoved onto it and off of BC/BS May 1 because I have been disable two years. What I found is that the local docs would "grandfather" you in if you were a patient but would not take any new patients on Medicare. We've been with the family doc for 7 or 8 years. Most of the docs in my area will only allow around 25% of patient load to be Medicare - this has been going on for at least 2 years. When they reach 25% - thats it.
This won't help you now but I spent three months before the Medicare switch getting every doc I thought I would ever need lined up. I didn't line up the Cardiologist until the month of April - right under the wire. I also found out that the docs and the University Cancer Center are not all that fond of the Advantage plans - they prefer Medicare combined with United (or something else) as a secondary payor - like we have.
For those that think that the insurance companies were paying docs throught the nose, let me tell you to look at your bills. Major difference between what is billed and what is paid. My urologist installed new stints for me 3 months ago. He billed BC/BS $1400 for around 45 minutes of surgery - they paid $400. The hospital billed around $14,000 for the operating room and got around $4000.
I think a couple of things might help. The University Hospitals and the docs that practice there seem to have less of an issue with this. I would also look into the Advantage thing vs secondary payor for your end of year switch. I've lined up my Urologist, Psycologist, Family Doctor, Cardiologist, Eye Doctor, Oncologist,and Neurologist and hope I won't need anything else soon.
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They have been denying Medicare for long before, I remember my Family doctor had a sign about No Medicare new patients. for the last 10 years.
Thank God the old ones we can still be seen.
'But if one needs a new doctor it is a problem, I could not get a GYN, Dermatologist asap because I have Medicare and private insurance,
My family doctor had to make calls and get the appointments.
Now I post the names of doctors that refuse Medicare,after all soon or later everybody will have Medicare.
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Wow! Ladies, thanks for the additional info! I had no idea it has been going on for this long. From what you wrote, it seems the docs I am already with may still keep me but the "new" gyn I need may throw me and my "one" leftover ovary to the dogs! May I draw on your brains for one thing more? In March of this year I had my annual exam and she said I needed no more pap smears since I had a partial hysterectomy in my 30's. I only had one ovary left (for whatever reason!) and it is a shriveled up prune now. So I won't need another annual exam until next year. My main concern is that by that time, there won't be a gyn left who will accept me with my Medicare. The United Healthcare Advantage Plan is what AARP uses but it is quite a bit more expensive than the Humana we use. Since we have to pay for two plans (DP and myself) with Medicare premiums, it can be quite expensive. My former gyn who did the complete exam in March has closed her office and that is why I have to get a new one.
My question is do any of you know of any way I can get on as a patient "now" with a new gyn that I might find who will still take Medicare since I don't need another annual exam and do not have any gyn problems at this time I can use as an excuse to see them. Have any of you come up with ways to do this that I could use? I thought of telling them I want to be reexamined for any Vaginal Atrophy the Arimidex could be causing but don't know if that would work. Any ideas or info you can share will be greatly appreciated! Thanks!
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I would try the atrophy issue or vaginal dryness due to meds. She will end up recommending some over the counter lube but that may get you in the door. Also look for new practices where you will be one of those filling the 25% quota.
I was so grateful to my friend for telling me all this so I could load up or make changes before Medicare and also help my husband two years ago when he made the switch from BC/BS.
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nurse-ann: Thanks! I think I will see if I can find someone who still accepts Medicare and try the vaginal atrophy and make sure the shrunked ovary is ok. Hope it works!
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Well, v*ginal atrophy is a bona fide medical diagnosis; so you could make an appt with a new GYN because of that specific problem, especially because you're on Arimidex.
As for finding a doc who will accept Medicare, here's what the reporter said in the NYTimes article I cited in my earlier post:
++++++++quote begins++++++++++++
"When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.
"Doctors who have opted out of Medicare can charge whatever they want, but they cannot bill Medicare for reimbursement, nor may their patients. Medigap, or supplemental insurance, policies usually do not provide coverage when Medicare doesn’t, so the entire bill is the patient’s responsibility.
"The solution to this problem is to find doctors who accept Medicare insurance — and to do it well before reaching age 65. But that is not always easy, especially if you are looking for an internist, a primary care doctor who deals with adults. Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.
"Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients."++++++++++end quote++++++++++
It seems to me that, of all the healthcare-related things Congress is trying to fix, this one ought to be at or near the top of the list. Seniors (65+) have been covered by Medicare since 1965 (https://www.cms.gov/History/), so the Federal Gov't must have considered them worthy of the investment. What I can't understand is why no one is addressing this problem.
I don't mean for Medigal's thread to turn into another debate on healthcare reform. I just hope people will continue to post their observations, plus any solutions they might have found.
In the meantime, I'm going to start hunting around for an internist who accepts Medicare. My med onco told me last fall that the most important specialist for me from now on will be a good internist. I do think it might be easier to find docs who accept new Medicare patients in the large group practices that are affiliated with big hospital systems. I read somewhere that those big systems can afford to take Medicare patients because the losses are covered by their other revenue.
otter
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The last few days, my 90 year old friend reported her pain is better. (I don't know if she 'just doesn't want to cause trouble'. I will see her this Friday.) I am going to try to find out (if I can) what coverage she has. One employee at work who is very much over 65 says he can use his health coverage at work to cover his medical bills and completely avoid Medicare, so I guess there are different types of private insurance coverage for those over 65. From another co-worker, I got the name of a GP who accepts Medicare (for her mother). I don't know hardly anything about Medicare, so I'm going to be doing some learning, I guess.
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My insurance coverage comes through the military but I am only seen by on-base physicians for very routine medical care. If I need a specialist I am referred through Tricare (Humana) to a network of participating physicians. These participating physicians are obligated to accept me as a patient and accept what ever payment is the pre-approved amount paid by Tricare for the service provided, and I have access to the listing of network providers. All of my BC care has been worked this way, with the exception of echocardiograms done on the military base. Is there any way to contact Medicare and find regional/local physicians that are accepting Medicare patients? It might be a more expedient way to search for a new physician. I also wonder if your GP might have some sway with a specific specialty doc and personally ask for you to be seen as a new patient. Sometimes those personal relationships between docs go a long way and I say use whatever means you can!
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SpecialK, what you said about your "participating physicians" is true for coverage by other insurance plans, too. *All* of the physicians in my area -- heck, probably all of them in my state -- are participating physicians in my group plan, which is managed by Blue Cross/Blue Shield. They have to provide care, and they have to accept whatever the negotiated charge is.
All bets are off once Medicare kicks in, though. Medicare trumps everything for many private and group plans. Many comprehensive, full-coverage plans require that Medicare-eligible policyholders use Medicare as their primary coverage once they hit 65. The full-coverage plans then revert to secondary status. What that means for me is that my plan will not cover anything Medicare says is not an eligible charge. My plan will pay the percentage of the eligible charge that Medicare does not pay, but only after I've met the Medicare deductible. I have no deductible right now (except for Major Medical claims), so that alone will be extra money out of my pocket.
What I don't know about Medicare is this: What will happen if I go to a doctor who is not "enrolled" with Medicare, or who is enrolled but is "non-participating"? Will my own insurance plan cover anything for that visit, or will they reject the claim because the doctor's office did not even bother to file for Medicare reimbursement? My parents' plan, which was a big group plan similar to mine, would not pay anything until Medicare paid or at least until Medicare made a decision on the claim.
I had no experience with health insurance coverage for elderly people in the U.S. until my mom died 2 months ago. Since then, I've had a sudden immersion in Medicare, HMO's, Medicare Advantage, "in-network" vs. "out-of-network" physicians (mine are all in-network; my parents' weren't), and high-deductible coverage. Wow. I don't know how elderly people figure all this out.
It just does not make sense that people whose health coverage is provided through the federal government need to worry about which doctors will accept their insurance.
otter
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Insurance companies stink. My cousin is a dental hygenist and the major insurer they deal with announced they were cutting back reimbursement on services to what they paid 10 years ago. Mind you, the dentist's cost of operation and equiptment are not the same as they were 10 years ago but what the heck. They simply can't afford to do the work at that price so they must drop the program.
Not to fear, the insurance company is showing a profit. . . .
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A patient who has Medicare most likely has the best opportunity to locate a physician willing to accept Medicare benefits at a hospital associated with a major medical school - a University Medical Center hospital. Generally, there are a greater number of physicians practicing at hospitals such as this who will accept Medicare benefits.
Not all doctors at these facilities will accept Medicare, but a larger percentage will. There is a national shortage of docs who are primary care physicians and as a result, they are often less likely to take Medicare patients. SHAME on them!
Sadly, it is a good idea to establish a complete team of doctors while you have regular insurance prior to turning 65! Most docs will continue to see a long standing patient even when they are not accepting new Medicare patients.
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Interestingly I had an issue with the Mammaprint test done during my biopsy. All my care through Tricare requires a referral in advance of the action - surgery, MRI, tests or whatever. The BS did not request a referral for this test separate from this biopsy. My primary insurance refused it because they termed it "experimental" so I received an appeal letter from Tricare that the Agendia (Mammaprint) people had submitted outlining my rights. This is a $5000 test! Needless to say I freaked! Then I started thinking about it - I never signed anything saying I would be responsible to pay for this test if my insurance refused it. The BS staff who ordered it didn't ask me first if I wanted it, or determine if my insurance would pay for it. I looked on Agendia's website and determined that if I signed an AOB (Assignment of Benefits) they would accept whatever insurance paid and adjust off the difference. I requested an AOB from Agendia over the phone, they faxed it, I signed it and sent it back. Tricare paid $61 for something - probably processing of some kind - but that is all I needed. Agendia gets $61, and I pay nothing. As Charlie Sheen says - winning!
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Ladies: I want to thank you for your help and your suggestions! I just returned from my gyn exam and found the ONLY male gyn in a group which still accepts Medicare! I was so concerned about the exam since I have had painful exams with other male gyns and this guy was a dream come true! He was so gentle, used lots of cream on the instrument and even was going to use a "Pediatric" scope until he found that the regular one went in very easily with the cream. He was amazed "any" gyn could do the exam without using the cream! He was so kind and even gave me an example of something besides Replens I might want to discuss with my Oncologist next week. It is Vagifem and goes into the area 2x a week. He said the estrogen in it is so miniscule that reports have shown it can be used safely by cancer patients.
I told him I cannot use anything but Replens unless my Onc gives me the OK for the Vagifem. I was wondering if any of you have used this particular Vagifem which is an RX and if your Oncs approved it. He said the Replens was working well on me from what his exam showed so if my Onc prefers it, I should stick with it. I was so impressed by his gentleness and his concern to do his best by me. I will be using him now for my annual exams. He said I don't need Pap smears any longer but since I had cancer, he would like to exam me thoroughly internally annually to make sure my leftover ovary is ok and everything else is still fine. It is SO great to have a male GYN I can trust again and to know he accepts my Medicare Advantage plan too!! Thanks for the advice you gave me about what to use to get another gyn appt!
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Yay!
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Medigal, I think this is the first time I've felt happy about someone's GYN exam. Congrats on finding a compassionate doctor who accepts your insurance!
otter
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Ladies: My blood pressure was so high before the exam that I think they thought I was going to have a stroke! I knew I was in good hands when I saw his trash can full of used kleenexs other women had used and a big tube of "lubricant" sitting on the counter! It seems "men" gyns just don't understand how painful the exam can be if no lubricant is used and a big scope is pushed in you. My DD's friend said she reported her male gyn to the Medical Society because he caused her so much pain and refused to stop when she screamed at him!
So I am a "happy camper" tonight. No pain and I have a great gyn who will accept my insurance. I feel like I won the lottery!
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Hi there girls. I am from UK.
We have President Obama over here on a 4 day visit. In one of our papers this morning I read that Obama 'has sorted out the healthcare situation' in your country, and is now turning his attention to 'getting the nation working' again ...sounds like your experiences are telling a completely different story !!!!!!!!!!!!!!!!
Isabella.
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Hi there girls. I am from UK.
We have President Obama over here on a 4 day visit. In one of our papers this morning I read that Obama 'has sorted out the healthcare situation' in your country, and is now turning his attention to 'getting the nation working' again ...sounds like your experiences are telling a completely different story !!!!!!!!!!!!!!!!
Isabella.
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Isabella, I am so glad to know that our President has sorted out our healthcare situation. I would not have know that if you hadn't told us. I am feeling very sarcastic today. NJ
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I'm not on SSDI or medicare, yet; however, only a matter of time (probably sooner than later). Can any of you advise how much of the oncology charges are covered by medicare?
Does the oncologist reject you once you're on medicare?
What about obtaining a secondary insur. to medicare, do they reject you because of the cancer or raise the cost so high you can't afford it?
Thanks ...
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SyrMom.
Medicare benefits are very dificult to understand. Hopefully, you are being treated at a large teaching hospital for if you are, they tend to be more inclined to "write off" a large part of their charges for Medicare patients. When they do this you are not responsible for paying most of the remaining balance of the difference between what Medicare pays and what the facility actually charges. This doesn't mean you will owe nothing but you will owe much less than you would if the writeoff weren't there.
Unless you are 65, I don't think it is possible to get a Medeicare supplement to help pay the remaining balance and that is very sad. I know this is very unfair and I know this makes no sense, but I think this is the way things are at this time. Some states have different rules so I would recommend you check into it.
Most docs do not reject you if you are an existing patient. That is good news at least!
Hugs,
Sandy
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Re: doctors opting out of Medicare...
I saw some news today that was disappointing, but not very surprising. Apparently, the Department of Health & Human Services, which oversees Medicare, has no clue how many physicians in the U.S. are refusing to accept Medicare for payment of their services. Obviously, then, they have no idea which specialty areas, much less which physicians, are likely to be unavailable to patients who are depending on Medicare for their medical coverage.
"OIG: Feds Don't Know Who's Opted Out of Medicare"
<sigh> That means nobody has any idea how big this problem really is.
otter
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otter: It is a big problem. I could not find a gyn under my Medicare Advantage Plan who would take another Medicare patient. They all had their "quotas". I ended up with one which I really dislike but he was the only one who was willing to accept me. (I wonder why??) I really hate the thought of going back to him when the time comes. This is a BIG problem that the government needs to address, imo.
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Hi, I read the whole thread and I saw on May 12, 2011, you had found a gyn that would take you and you had an exam. You indicated you liked him and would go back. I see here where you are saying that you really dislike him and hate going back to him. Is this the same doctor you mentioned on May 12 ? Could you explain what happened ?
Thank you for any reply.
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I live in a rural area in a town with the Regional Medical Center. I have not heard of any doctor refusing Medicare. I wonder if this is a "big city" problem.
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My parents never had a problem, but they had regular Medicare insurance plus a supplemental plan, not one of those hmo's, or "advantage plans" or whatever they're called. I think doctors are paid differently by each of those plans, and many opt not to accept them, just like other HMO's, where they pick and choose the plans they are willing to accept - sometimes taking 1 plan and not another within the same carrier!! Since my parents never had one doctor refuse their insurance, I don't know how widespread the problem is.
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