Physicians refusing Medicare Patients

[Tuckamore]

Hi All,

I don't often post but today my pain and frustrations are high. I had to share them. As many of you know I am spending six months in Florida. Thankfully I have found a good PMP although it took more time then I would have liked. He provided me with several names of PCP for my medical needs.

In January I became eligible for Medicare as I am on SSDI due to this horrid chronic pain. In my home state of WI that is not a huge issue. So today after weeks on not feeling well I decided I had not choice but to consult a PCP. I took the list that my PMP provided me. Well in this state the first questioned asked when you call to make an appointment is, "What is your insurance." When I respond, "Medicare with a supplement" I have been told by everyone on that list that they do not take Medicare patients.  WHAT??? When I ask if they had any suggestions I am told, "Just keep calling around."

I am fortunate to have always been insured.....and I pay dearly for the supplement. I am a responsible adult and know the value of medical insurance.  I can't find a physician that will take a sick patient because they don't have the "right insurance." My eyes have been opened. My parents have been on Medicare for years. I have never had this issue with this fact in WI. No physician has turned them away because they were on Medicare. Is it because my home state has a different philosophy on patient care...or is this state (FL) an exception? Is the refusal to see Medicare Patients happening across the USA with the exception of my area of WI?

I have finally gone to Medicare's Site to seek a physician's name that may see me. I am truly sick....and getting sicker. If this fails I will be forced to go to Urgent Care. The Urgent Cares I have found in this area will only take Medicare patients IF they PAY UP-FRONT. They won't even bill Medicare!  We discovered that when my husband had an Urgent Ear problem a few months ago. In my state you are not refused care based on your ability to pay....and you never have to pay up front....unless it's a co-pay and then they'll ask if you are able to pay all or at least part of the co-pay.

I am fuming!!! What's wrong with this system and is there any fixing it?

Sorry for venting. I had to let some of this steam off before I continue these calls. I don't want to display a bad attitude. Who would want to see an ornery disabled person??

Thanks for listening. :o)

Blessings,
~Tuck    

[Tuckamore]

Hi Mike,

I am so sorry that you have experienced issues with the health care delivery system. In my experience it can change when you are a medicare patient. However I am brand new to the "system" as I just became eligible for Medicare like you, due to a disability.

I found huge care discrepancy in the area of our US that I lived for 5 months.....back home in WI I've noted no difference thus far. I never realized that money or insurance determines who gets what care and that it can even effect the quality of care.  Sadly, Health Care is not a "right."  

I can only suggest that you keep looking even though you have been dismissed there should be a PMP that will take your case. Best of luck to you.

~Tuck

[nurseaudrea]

Why in the world would they accuse you of selling your scripts for money. Did you have a neg. UA. Why did they have those suspicions? What do they think is going on? Did I understand correctly that you see a PM specialist for the methadone and the doctor for your hip also gives you percosets? Do both doctors know about the drugs you are receiving. The only reason I ask is because  a pain contract says you must inform your PM doc if you take meds from other doctors. Just wondering if that is why they are accusing you of that. At any rate that must be horrible for you.

[mikeman246]

Hi, Tuck, wow I do feel your pain!! I actually googled this problem because it is what I am going though now. My story: I worked as an RT in the hospital I go to for care as I always did. My problem started with a rare skin disease that gives you large ulcers usually on the legs. During a crisis they gave me a large amount of prednisone as it was the only thing that worked. I developed Avasc. Necrosis and it severely damaged my hips. I was treated for 5 years by the same doctors I see now. It seems and is true that when I had traditional insurance BC/BS through work. They treated as a king and a very special patient. Now I am on SSDI and am on Medicare. They treat me as a criminal. I take methadone for pain now, It works tremendous. I like it because of minimal side effect. I am very careful in following the pain contract I have. I will say that I only have to call once a month to pick up my script. I almost think they do that because they don't get the money they used to with each office visit. Today when I called they were very rude. Even though I follow the pain contract closely. They have accused me lately of selling my scripts for cash!! This is the hospital that I worked for almost twenty years. I have a cardiac issue as well that is why I cannot have hip surgery. The cardiologists even though I only see them for cardiac probs, are not the nicest either. The staff in that clinic is decent though. I was getting percs for pain that I would only take on my days off. I could not stand the pain anymore though so I could not work anymore. I am stuck because I cannot work, I cannot have hip surgery, so I could possibly go back to work. So here I am now. I am a legitimate person seeking control of my pain. I gave them good years of my life. I was a model employee. Now I could not be treated worse. I guess they could take my meds away and let me suffer in agony?

[namnam46]

Hi Flower,

Yes, UNFORTUNATELY, the Health Care Reform IS what's doing this.  They are taking money FROM Medicare to fund this INSTEAD of taking the money from OTHER sources!! It's going to get MUCH worse!!!  The Doctor's are going to be leaving the Mdeicare Patients by the droves.  We will be left with NO top Doctor's at all.  I'm SOOOO FRIGHTENED by all of this. They've ALREADY announced there will be MAJOR CUTS to the Medicare system BUT haven't said WHAT those cuts will be.  

I've been following this for a LONG time now as I've been on SSDI since 2003 and Medicare since 2005.  It's getting worse daily. :{

I'll be sending you a PM later today Flower - right now I'm leaving to get to my PM Doctor. :)

Love to you and MEGA {{{{{{{HUGS}}}}}}}.............Mama Sherry  :)

[flower12345]

Hi Tuck. I'm sorry that you're sick, but I'm glad that you found out what's going on. I hope that your steroids don't keep you up.

What a thread. It's very interesting to me, as I had NO idea that this was happening. It's scary, to say the least. I'm going to read more about it online. Question...will the health care reform change this at all? Just curious.

Thanks for posting this.

Hugs,

Flower

[cocochennel]

I don't know whee u got ur info but it is wrong. I helped medic*re set these rs that bill for procedures that r not preformed but medicafe promply pays for services that I was billed fOr and they alreAdy paid but I never received bc I go ovr my bill. Very carefully and caught many fraud mistakes.

[Tuckamore]

You're all so kind! Thank you.

Something in three of new prescriptions is causing me sleepiness. ...and I haven't taken the 4th on yet...which notoriously causes insomnia, a steroid! I was up most all night! Darn.

You are all so right...and Mellie it IS frightening what is happening to our Health Care Delivery System! I never worried either. Like you I worked hard and had great health insurance. I just went to the doctor when I needed or took my kids when they were sick. I paid little for a great HMO and thought it would always be that easy. I WAS part of the Health Care Delivery System and we took care of one another....until the loaded dump truck decided differently.  

Now what??? Where to from here for this fine country? What kind of a mess have we gotten ourselves in.. and how did I....or we... miss that turn?  Unfortunately there is no law that says we all have equal rights to equal health care.  There are laws against discriminating against me as a woman but you can let me lay in the street and die because I am now Disabled and on Medicare! That may be over stated...but believe me, not by much.

I'll shut up for now and take my meds. :o)

[mellie4]

So sorry, Tuck, for all of what's going on with you.  Hopefully your antibiotics will have you on the mend sooner rather than later.

Health care in this country truly is frightening.  Who knows what's going to happen.  I never worried about this stuff before ... when I was working and had great insurance, I took it for granted.  

Feel better, Tuck.  Take advantage of your bad weather and rest and relax and be kind to yourself.

[geminigirl1963]

So glad you had a pleasant experience at the clinic and that you got a good exam.  It's hard to tell sometimes with health clinics, sometimes they are good, but other times I guess they are just so busy that you pretty muh feel like a number being whisked along a conveyor belt.

I'm sorry to hear what they discovered was causing your illness, but glad that they did - if that makes any sense!  LOL  What I mean is that now that they/you know what it wrong, they can treat it and you can start to feel better again and once again enjoy your new paradise surroundings!

Please continue to follow doctor's orders - REST AND GET BETTER!!!  Know that my thoughts and prayers are with you!

[squirtatious]

A netti pot will help your sinus issues and good ole fashioned garlic will treat AND clear up your ear infections!!

[namnam46]

Tuck,

I'm SO GLAD that you found out what has been causing you to feel so "crummy" lately.  That DEFINITELY explains ALL that's been happening to you, INCLUDING that back pain that you've been experiencing as pneumonia can CERTAINLY do that to you.

You KNOW I HOPE and PRAY that you are back on your feet ASAP!!!!

Much Love and MEGA - but soft - {{{{{{{{HUGS}}}}}}}}..............Sherry  :)

[Tuckamore]

Well another update.

I went to the clinic today. It was a much better experience then I had anticipated. Ppl were friendly and there were other Medicare Patients seeking care also. No I am not old enough to collect regular SS...but I do receive SSDI. I learned that there are private physicians, usually single practice that do except Medicare. However I was told they know of none in the large city where I was attempting to obtain an appointment. They assured me that I could continue to obtain care there.  

The Clinic was clean and the staff was extremely friendly and helpful. I received a good and thorough examination. Everyone seemed concerned. Appropriate tests were ordered. I was very satisfied with the entire appointment. I will continue my Primary Care at the Clinic. That's the good news.

The bad news is I have been feeling pretty crummy for well over a month. When you think you're in Paradise you simply don't want to take a break to find a PCP. Big mistake. I have pneumonia, bilateral ear infection and sinusitis. Ugh!  I promised to take it easy and get lots of rest and was given four prescriptions. After spending $140.00 at the pharmacy I am home trying to follow doctor's orders.. rest! Thank goodness the weather is almost as bad as I feel.... so resting is not so bad.

Thanks for all your well wishes. It is appreciated.... it proves once again that you all are a wonderful group of compassionate and caring ppl!

My Best,
~Tuck

[namnam46]

Hi Tuck,

It's SO SAD that you, of ALL people, have had to go through ALL of this nonsense!!  After ALL the years of working {over 30 years as a Nurse} not counting ALL the OTHER incredible positions that you've held and NOW you have this to deal with!!!  

                                                 ABSOLUTELY LUDICROUS!!  

Unfortunately, I could VERY well be facing the same thing that you are right.  I DO know what's behind all of this and that is "OUR UNITED STATES CONGRESS"!!  They are the ones that have LOWERED what is paid to our Doctor's that take Medicare.  Not only that BUT the Doctor's are preparing themselves for what is yet to come in the cuts that are ONLY BEGINNING!!  

Here's what you ALL can do and that is to join with AARP and START to solicit Congress to "STOP THE CUTS TO MEDICARE"!!!  AARP is e-mailing ALL of their members EVERYTIME there is a vote that is about to come up so that we can INUNDATE our Congressional Delegations telling them NOT TO CUT MEDICARE ANYMORE!!  It's up to us to add OUR voices to this as this is where the cuts are coming from.  It's REALLY sad but we HAVE to speak up or it's going to be EVEN worse with the budget probleDisabled ANYMORE!!!

Didn't mean to get on my soap box BUT it's ONLY going to get worse unless they hear from ALL of us.  

I KNOW that the Mayo Clinic here is AZ quit taking Medicare Patients about a year ago because they weren't being reimbursed enough and couldn't afford to keep seeing all of the Senior Citizens that used their services.

SO SAD!!!

Best of Luck to ALL of us!!!............Sherry  :)

[Suda]

Dear Namnam46,

Again, I do so apologize.  I did just that and I'm hoping that I will get some much needed advice.  

Just as I hope I didn't totally screw up Tuckamore's query.

Thanks,

Suda

[namnam46]

Hi Suda,

Would you mind re-posting this on a separate thread??  That way you will get your question answered as this thread is about Medicare.  :)

Just go up to the top of the page and click on the Green Tab that says "Post a Question" and then you'll get you own responses.

Thank you and we'll ALL be looking for your question..........Sherry  :)

[Suda]

Dearest Tuckamore,

I apologize for my error in posting!!!  Please forgive me?  The first post in your query was for that subject, but my second post was me being an idiot and not realizing that I was only adding my question onto your post.

Again, I apologize, and I do so hope that you get the help that you need so desperately!!

Big Hug,

Suda

[Suda]

Dear PMG,

Here I come again!!!!  It's been about 7-8 months or more now that I have been on 30 mg. MS-Contin three (3) times a day, with up to four (4) Percocet 10/325 mg. for breakthough pain.

Well, as I've said earlier, now we come to the part where my body just doesn't really care what I've taken, nor that it could fell a horse.

I don't want to change medicines as I have such severe reactions to so many, many, medicines.  Like I've explained before anaphylactic shock reactions, so I really want to stay with what I'm on, but since it's not working anymore I'm at my wits end.

I have lupus (SLE), fibromyalgia, degenerative disc disease (which I have a feeling HA!!! HA!!! that this is getting much worse.  I also have severe osteoporosis which I take Boniva for, but haven't had a bone scan it quite some time now.

Next Tuesday I go to my doctor's office to get my meds refilled.  It used to be that I'd only go once every three (3) months, but thanks to the government, (DEA, FDA, take your pick) I now have to go into the office once every month.

Has anyone else out there ever taken what I'm taking and then it simply quits working?  If so, did you ask for an increase in either mg.s or amount of the pills taken.

I dread doing this, yet I have no quality of life anymore, i.e. washing myself, and as for cleaning up, well that's a big joke, just like trying to wash my bedding, and clothing.

If aksing to increase either mg.s or amount of pills with same amount of mgs. isn't reasonable, would someone out there please tell me.  I've obviously built up a tolerance, as is always the case, yet I still need some suggestions as to what to discuss trying with my doctor.

You guy/gals have always, always helped me with this predicament before and you were always correct, as I've always gone with your suggestions.

So, I'll shut up now, but please, please, help me once again as you've always helped me before.  I have absolutely no one else to discuss this with.

Thank you in advance!!!

Big Hug,

Suda

[Suda]

Dear Tuckamore,

You have always been there to help me with my questions.  Alas, I have no answers because I am having the exact same trouble.

Luckily, my Internal Medicine physician is also my pain management physician and she does take Medicare, but only if that is the only coverage you have, no supplemental coverage.

She is also good enough that when she has to refer me to another doctor for some specific medical problem she does not specialize in she only refers me to other doctors who accept medicare.

It's a terrible situation!!!  There is absolutely no rhyme nor reason as to which doctor will accept Medicare and which one will not.

I wish you luck and, as I'm sure you've already tried this, but still, just in case; call Medicare themselves and see if they can send you list of doctors of all specialties that accept Medicare.  I know that they can, it's just if they will.

Good luck with you horrible situation and I shall keep thinking good thoughts for you.

Big Hug,

Suda

[squirtatious]

I am so very sorry for your difficulties!!!! This is one of the reasons I began my journey into alternative healing so I can treat myself and my family instead of seeking western medicine. I am in the process of learning several methods of healing. Its a shame when a developed country such as ours has an under developed health care system!!! Time to get back to our earthly roots and utilize the old ways of healing. Mother earth provides us with all the natural resources to heal with...just have to reconnect with her healing abilities. I wis you the best, along with everyone else finding themselves in similiar shoes!!!! *hugs*

[Tuckamore]

Just an update. This is what I found out after hours of calling. Medicare patients in this area are seen in the local county building under a county health care system. No Private Clinic will see Medicare Patients!

Apparently they have rotating doctors that "volunteer" to take the amount of money that Medicare will pay for Physician's Visits. This is the same clinic that uninsured or Medicaid patients are seen. The COUNTY CLINIC!!  

Please don't get me wrong. I am no better and no worse then the next person. I am not above going to the county clinic. There is no shame in being poor.....but I am NOT poor. My insurance just happens to be Medicare....with a darn good supplement. You're correct Geminigirl. I almost forgot I also pay for Medicare, comes right out of my check. That means with what I pay for my Supplements and Medicare is OVER $425.00 a month! My goodness how do ppl do this that have to live only on a small SS Check or in my case an SSDI check?

So this morning I am going to the County Clinic. I will hold my head up high. I'm sure, like many of them I've worked my entire life....the last 18-20 years against doctors advice!! Often I even worked two jobs. I held good salaried, professional positions. I wouldn't give up, or give in to my pain. Those 20 years made a big difference in my SSDI check but any advantage I received from that has been eaten up in health insurance costs. .....and I STILL can't get a private doctor to see me!!!  SAD! Very Sad!  Here it doesn't matter if I have insurance/supplements or not....I will the same as the uninsured!

I'll let you know how it goes!

[mellie4]

So sorry you're running into this problem.  I'm not sure if private physicians here (in Massachusetts) can deny care based on the insurance.  I suppose they can.  On my worker's comp, my surgeon accepts my WC for my hand surgeries and the pain clinic as well, though I know it's at a much reduced rate.  A friend from work who is also out with a hand injury but lives  in a different area has had a very difficult time trying to find a doctor that will cover her through worker's comp.  

I do know you can't be refused care at a hospital due to an inability to pay.  So I guess your option then is for any little or big thing you go to the ER and then pay it off a little at at a time or declare bankruptcy.  

At the moment, the only insurance I have is my worker's comp, which only covers my hand.  My ex had carried our insurance, got fired, never signed up for the COBRA plan, never told me and I found out nearly a year later when I received a mountain of medical bills (both boys had been seen in the ER and had CAT scans, x-rays, orthopedic consults, etc.  I'm trying to pay a little off at a time.

Since I'm still technically an employee of the state, I am going to see if I can get us back on our insurance at the open enrollment we have in May.  Hopefully I can come up with a bit of money to pay the monthly premium (it's really high) and I'm just getting by on the worker's comp income as it is.

I'm not sure what the answer is but there has to be a better way!

[lupiemomof2]

I am blessed to have insurance thru my spouse as I am also on SSDI for SLE and qualified for Medicare.I opted out of the program from the getgo(unfortunately they had approved,backpaid,and insurance enrolled and billed me b4 I got the paperwork for approval).

i opted out because NONE of my drs take medicare except my rheumy(signs up at all offices)they bill your primary first,and I would have had to pay over 100 a month for 1 dr who bills me a 40 copay.The 100 was not including drug coverage.

Medicare is horrible-I dont know about payment/billing/insurance but to simply deal with.It took me 9 MONTHS to get unenrolled-never used the insurance and get my money back-after I had sent in forms from get go to NOT be enrolled(they never got them or any correspondence-no record of calls,etc.)I finally had to go thru local SSA office,write a certified letter and even then they told me I wouldnt get all the money back because I had waited to long to decide I didnt want it(not true)-I had an awful time trying to get away from the program and get my money back. I cant imagine trying to deal with them to find drs that want to take the insurance-I have heard thru receptionists they are hard to bill,take forever to pay,and deny procedures and treatments that drs deem necessary to perform and then the drs get stuck eating the charges they tried to bill or taking 4ever to get paid for services that medicare deems ok.

Good luck tuck I wish you alot of it.

[cocochennel]

Is this something we cld put a class action lawesuit against those dr's refusing to see us ssd people I think someone needs to stand up for our rights as we are people in need of healthcare if not moreso bc of our disability, who gave those drs the right to treat us as 2nd class citizens.?

[geminigirl1963]

Unfortunately, you're not alone in your situation with the healthcare system.  I also am on SSDI and have Medicare.  I'm fotunate that my PCP has always accepted Medicare and continues to do so, however, the rheuamtologist that I was seeing no longer accepts it so I had to stop seeing her.  I simply cannot afford to pay out of pocket for her.

My mother also has the same problem as you.  She's always been very healthy and actually is not all that confident in the medical field, so she has never really had a PCP - at least not since they moved here over 15 years ago.  She now is unable to find a PCP who will accept her because of her Medicare.  Even my dad's doctor - who treats him, who is also on Medicare (they still married and have the exact same insurance) - will not take new patients with Medicare.  So, like you and your husband, if my mom needs a doctor, she is basically forced to either go to an Urgent Care faciility or the ER.
No wonder our country and healhcare situation are financial trouble - it most certainly is not more inexpensive for insurance of any kind to pay for an ER or urgent care visit than it would be for an office visit!

The other sad thing is that we are being treated as if Medicare coverage is simply GIVEN to us at no cost to us.  We pay for Medicare, the same as anyone pays for insurance coverage - with monthly premiums and copays.

I've also very often run into the same thing you did when calling aroudn to doctors.  it used to be the first question they asked was "what are your symptoms or what is wrong", but now, the first question is always "what insurance do you have"?  Pretty bad when your type of insurance supercedes teh hypocratic oath!

I hope you get to feeling better Tuck!