Medicare and Doctors

[Larry]

I'm planing to change my doctor.  Family medicine type general practitioner.  Find a doctor that looks like a good fit for me.  Call the office.  Are you taking new patients?  Yes  Will you take my UHC Medicare Advantage plan?  No, the doctor is not taking any new patients with Medicare.

Is this common?  I understand that Doctors do not think medicare pay is high enough to cover expenses.  Maybe this is just a local issue?

[B.C.C. Lapp]

Good luck Larry.  And I really mean that.  Health care in the US is a mess. 

[doc henderson]

It is a mess.  If the doc bills a hundred bucks.  Medicare and Medicaid pay 30 cents on the dollar.  you do not have to participate, but there go many patients, especially kids and elderly folks.  If we accept you and your insurance, then that means we accept whatever they are willing to pay.  When I first got out of residency, and went to private practice, the office manager asked how many Medicaid patients I would accept.  She told me my partner took 50.  I told her 5,000.  In pediatrics it is many patients, and any insurance (including BCBS) only paid so many pennies on the dollar.  All was fine until I got a denial for an admission I did.  A girl passing out in school many times, waited a month for an appointment, and drove several hours from Goodland, KS on a Fryday to get some answers.  She had missed tons of school and was at risk of not passing.  i admitted her to run tests, so I could safely send her home if all was well.  Just in overnight.  It would have taken weeks and several trips to do as an outpatient.  A few months later I got a denial letter stating it could have all been done as an outpatient.  Reviewed by two of their doctors that know about such things.  The gave a number to call if I had questions.  Sadly, they did not answer, but I was given the opportunity to leave a massage.  Well, I left about a 15-minute message detailing why it was potential malpractice to send her home, and the recommendation that I ignored years prior and multiplied it by 100.  I told them just to unsign me up for Medicaid.  I did get a call with both docs on the phone, and they admitted that they did not fully understand the reasons that I used to prompt the admission.  they begged me not to revert to only 50 patients.  I agreed and they paid for the admit to the hospital.  I was so mad; my hands were shaking.  Imagine having to do that for every patient!  I never had another denial.  They must have put me on a list.  Medicare and Medicaid are 'administrated by CMS, that follow BCBS rules.  I think they make money based on how much money they save the government.  so, the money goes to them and not to pay for your medical care.

[beenthere]

Medicare and Medicaid pay 30 cents on the dollar.

And the missing 70 cents is made up by the other patients that have health insurance. Prolly why my insurance for wife and I costs me $60 per day.

[21incher]

When we first started with our doctor he was independent and didn't take Medicare.  Most visits were billed to our insurance at about $160.00 with under a 2 week wait for a visit. A couple years ago he joined a regional care system,  I think because Obamacare issues. Now he takes medicad and Medicare but the average billing  rate per visit is about $640.00 with a 2 month wait for a visit . Same service but looks like they just use funny numbers now due to the actual reimbursement rates. We now are overloaded with illegals being shipped up from NYC jamming up the medical facilities like the ERs that don't pay a penny.

[Magicman]

AT&T is switching us from Humana to United HealthCare next year.  We haven't gotten all of the paperwork yet, but I suspect that it will be different.  Especially meds, dental, eye, etc.  We don't know which of our doctors take UHC yet. ??

[doc henderson]

If a large employer in your area switches, there is a push for the docs to accept that or they lose a ton of patients.  same with my wife working at a pharmacy.

[Larry]

I've been on AT&T UHC Medicare Advantage for about 4 years and like it.  Almost all providers in my area accept it.  The rub for me is finding a new Doctor.  Most say they are not taking new patients and the reason is my plan is connected to Medicare.  Seems like double talk to me.  It did not used to be this way.

The UHC website lists all the providers.  Find the ones you have now and verify they will accept your insurance after the switch.

[Gary_C]

It is a mess. 

Indeed, it is even more of a dysfunctional mess than what you have described. From what I know and have experienced, the many problems can be vastly different depending on where you live and your personal situation. Even here in MN where we have relatively good healthcare for a variety of reasons, my general feelings which are supported by many healthcare professionals are that our healthcare system is failing. Just try to get an appointment to see even a primary care physician in any time frame less than three months and you will see what I am saying. Even then you will likely only be able to see a NP or PA. 
One of the topics not yet discussed here is what is going on with the insurance side of healthcare. Here is a very informative U-tube  video that is very long but describes some of the many issues with Medicare and Medicare Advantage plans. (It's about how insurance companies are milking the system plus about prior authorizations.)

[Magicman]

My AT&T coverage is switching from Humana to UHC.  I hope that it is OK because I have no choice regarding the Plan, Coverage, nor Doctors. 

They did say that I could opt out and have nothing. 

[LeeB]

Lindy is eligible for medicare in April and i will be the following October. Trying to research on the subject has proven to be difficult. Everything you look at has a different set of information. I guess we will have to go to an insurance professional for help but who do you or can you trust there?

[Ianab]

Current court case about how UHC are using an AI model to estimate how much post hospital followup care you are going to need. While that might give a good guideline, sometimes complications mean care needs to be extended. Examples given are patients contracting pneumonia or Covid while recovering from some other condition. The computer model denies them extended care, in spite of the opinion of their actual Drs. This of course reduces the $$ the insurance Co has to pay out, but sucks if the patient is still sick. 

UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges | Ars Technica

[Magicman]

Well that ain't good. 

[B.C.C. Lapp]

Lindy is eligible for medicare in April and i will be the following October. Trying to research on the subject has proven to be difficult. Everything you look at has a different set of information. I guess we will have to go to an insurance professional for help but who do you or can you trust there?

Happened to us the last time our insurance was changed.  We went to the new doc for the wellness checkup and blood work they always want you to do.   We presented our new insurance cards at that first visit.   They made copies of them and alls well right?   Nope.  after we did all that and my wife had already done a second appointment that they send us a letter telling us they DO NOT in fact take our plan and we now have a bill of about $1700.  I call and the battle starts.  After being transferred from person to person on the phone I find myself talking to a very nasty lady that I pretty much felt like is their axe lady and shes no longer being polite and she has worked around to threatening me if I dont pay in full.   Then she puts me on hold.  And I get lucky.  I'm listening to their canned music while on hold and the music is occasionally interrupted by commercials for their practice.   I'm listening.  One commercial states the are "experts" in navigating our insurance problems and come to them with any questions and their experts will know the answer.  Huh. Interesting.  
The nasty lady comes back on and continues to maintain that this is all my fault and I should have checked into my insurance better and they are blameless.  I say "So I should have consulted an expert?"
Sensing  victory she jumps on that and lectures me about not getting professional expert answers.  
. Got her. I tell her about her own commercial.  She denighs  it. I suggest maybe she should check it herself before we get any farther.  She calls back 10 minutes later and we settle on me paying $390. and they ate the rest.  
A win for me? Not hardly.  Lots of time and money wasted.    They care not.

[TroyC]

Medicare and United Health Care Plan F. F is no longer available (was phased out by Congress several years ago) but next best thing is plan G. No deductible, go to any doctor, no referrals, except plan G does have an annual Medicare deductible of about 180.00 or so. Deductible is covered in Plan F if you were grandfathered in. Good for any doctor that takes Medicare.

[doc henderson]

Troy that is good for you.  Medicare and Medicaid have contractual write-offs and pay about 40 cents on the dollar.  part of why charges are so inflated to make enough to keep the doors open.  That is what it means accept an insurance carrier.  you accept what they decide to pay.  It is good for internists and pediatricians who may have many patients with no other means, and they get paid on a regular basis, prob on a 90 day out.  Most offices have fulltime employees that do nothing but try to get things paid by insurance.  another expense.  But, if you have paid taxes, you in theory have funded these insurances, so we all do not have to work forever.  This is part of why I do not have my own practice, and just try to take good care of patients.  I was taught that if you do that, the money will follow.  I never check to see what if any insurance a patient has.  the exception is if the patient or family is asking for things that are expensive that I do not think are needed.  I explain that if you do not have insurance, it will be expensive.  I in theory should not order any test or treatment I do not think is necessary, as that is insurance fraud.  Some days...

[TroyC]

Doc, I understand where you are coming from. I don't use the medical coverage nearly as much as I should, but when I go to the dermatologist I see a 1200.00 bill that usually gets paid at about 150.00 or so.  My visit is usually 5 minutes or less but I do understand fixed cost and overhead of running a business. My girlfriend has been battling cancer for the last 20 years and I shudder to think of all the cost of her treatments.

When I retired I did not want to worry about 80% coverage, deductibles, referrals, etc. Many people do not understand the importance of good insurance. I'm reasonable healthy but a good accident or a severe medical issue could be financially devastating with only Medicare. I have friends that use the Advantage Plans and it usually comes back to bite them. The Plan F cost more than Medicare and it only picks up the remaining 20%. Some things you just can't afford to cheap on.......

[Raider Bill]

Medicare and United Health Care Plan F. F is no longer available (was phased out by Congress several years ago) but next best thing is plan G. No deductible, go to any doctor, no referrals, except plan G does have an annual Medicare deductible of about 180.00 or so. Deductible is covered in Plan F if you were grandfathered in. Good for any doctor that takes Medicare.

I have a Blue cross G plan. Been good to me.
When I was looking for coverage my agent said she had 50 different plans but the G was hassle free and so far it has been.
4 operations in 3 years, zip out of pocket.

[TroyC]

Yeah, the G plan now is about as good as it gets. I got the F plan in July and the cutoff date was December about 4 years ago. My girlfriend got it a year after me and her G plan and my F plan are about the same cost after figuring her small annual deductible. It's nice to go to the Dr, hand them the cards and not worry about deductibles or bills.

[Gary_C]

Trying to research on the subject has proven to be difficult. Everything you look at has a different set of information. I guess we will have to go to an insurance professional for help but who do you or can you trust there?

CMS publishes a book every year and the latest one is called "Medicare & you 2024" and in the back it has a reference to plans in your area. Here is the link. https://www.medicare.gov/plan-compare/#/?year=2024&lang=en
You have to enter your zip code for your area to see what is available in your area.