THe pains of finding a primary care dr. with Medicare

Discussion in 'Fibromyalgia Main Forum' started by wiseeagle, Sep 8, 2005.

  1. wiseeagle

    wiseeagle New Member

    Hi,

    Two days ago I spoke to my family dr., He refused to see me
    because he said that he couldn't help me anymore!! All I wanted was for him to call a Chronic Lyme spec. here in NC.
    He flatly refused. I told him I needed pain med's and his
    repley was go to the pain clinic. I don't know how many of you have tryed them but here in Raleigh there is only one!! They suck--won't give pain med's and want to do invasive procedures..I refused 2yrs ago. I then told him I was going to report him to the NC Medical board for unethical treatment, and NO treatment. THe big problem I have here is NO primary care dr. will accept medicare. also I just got my long term
    disability forms that have to be filled out in 20 days, or I loose my payments....I am in a big jam!!

    anyone out there with any suggestions, Please I need help!

    THanks,

    Valerie
  2. fivesue

    fivesue New Member

    Why not? Millions of seniors have Medicare and doctors accept it for them. I guess I just don't understand? I really don't understand why he wouldn't refer you to the specialist you suggested...????? Just doesn't make sense.

    So, have you found anyone? Could you check with your local or state medical board to see which doctors in your area will accept you?

    My best wishes to you in finding a way out of this problem. Let us know what you find out.

    Sue
  3. justlooking

    justlooking New Member

    I thought one of the great benefits to having Medicare was that everyone accepted it.

    I live in California and all of the Drs here love it. I can go where ever I choose, without referrals and so far I think all I've ever paid is a $100 deductible in 18 months and I have at least 18-20 Dr appts per year.

    I see both a primary Dr and a Pain Dr, both are incredible resources for me in different ways.

    Is it possible you can go to a surrounding city or town for another Dr? I'm not really familiar with your area but there must be other Drs close by. Maybe do an internet search by primary Dr and pain Dr for your area and see what comes up. Call the offices that come up and ask if they take Medicare. Ask the questions you need to know pertinent to your illnesses and if you feel comfortable with the answers and they take Medicare, ask for an immediate appointment.

    I hope you find something soon!

    Sincerely
    JL

    PS try going to an insurance website, like Blue Cross, Blue Shield and look at their provider lists. I would bet most who take those insurances also take Medicare, since those companies have a Medicare supplimental insurance.[This Message was Edited on 09/09/2005]

    Funny I just got my mail and there was a Drs bill in it, actually two bills but combined they are only $28, so ok I've had to pay a total of $128 LOL[This Message was Edited on 09/09/2005]
  4. jake123

    jake123 New Member

    I think I understand but I call it NOT getting Any-care, not Medicare. I am currently looking for a new doctor, it is exhausting tohave to explain it. I can't stand my present doctor. I tell him my hips and legs and ankles ache and he gives me Flexeril. He does all the talking. He won't even ask me a question about the pain. What a flake.
  5. wiseeagle

    wiseeagle New Member

    Thank you everyone that replyed to my post. I have spent 2 days searching thru the medicare list on line. I went thru l65
    drs. most of them are not listed (must have left the state) the others will not accept new patients. This is how they get around not taking medicare. I can see any specialist without any problem. Medicare differs from state to state. I'm orginally from NY and you can find plenty of primary care dr.s
    but can't find a specialist. I have chronic lyme so it limits me in driving-=-plus when you go to a doctor you usually feel sick--I really can't drive to far.

    I just found out that there is going to be a Lyme disease fundraiser here in Raleigh tomorrow, I plan to go and hope that I can find someone who can help me.

    I also just might go to NY, I found a lyme spec. that will
    see me soon as a can get there. But I have to check with
    medicare to make sure that they will cover the treatment out
    of state.

    I'll keep you posted as to what is happening.

    Love and Light to all!

    Valerie
  6. Mikie

    Mikie Moderator

    Are you talking about Medicare or Medicaid? With Medicare, there are no restrictions on getting treated by any doc who accepts Medicare anywhere in the contiguous U.S. Most docs do accept Medicare but they may limit the number of Medicare patients they will see.

    Is Medicare all you have or do you have supplemental insurance to cover the co-insurance part? If you are in a managed care program, then there are restrictions and out-of-area treatment usually isn't covered except for emergencies. In that case, you would have to drop the HMO or PPO and go back to straight Medicare for such treatment.

    It's hard to understand why finding a doc who takes Medicare would be that difficult unless there is a large older population and few docs.

    Love, Mikie
  7. wiseeagle

    wiseeagle New Member

    Mikie,

    I really don't think you know their system. I have had medicare now for 13yrs. I am NOT in a HMO ( use to work for
    one) got Leionnaire's disease from that bldg., but I couldn't prove it--NY law there had to be 3 other people in the office and I was the only one. After 12yrs. they finally flatten the
    bldg. is really was a sick bldg. (it was a HMO) I was Nurse
    coordinator at the time. It was way to late to get workers
    comp. I know all the ins and outs of medicare--again I say
    each state is different. Yes, I do have an secondary insurance, but Medicare is primary!! that's the problem.

    Hope you never find out how PITIFUL medicare really is!!


    THanks for your input.

    Valerie
  8. Mikie

    Mikie Moderator

    I am an insurance agent who isn't presently working. I worked for years in Medicare insurance, both supplementary plans and HMO's. Except for a few small differences, Medicare is the same all over the U.S. The medical part is still an 80/20 plan with a $100 annual deductible. That is nationwide. Some supplements pick up the $100 and some do not.

    The same co-insurance is applicable to in-patient hospitalization all over the U.S. too. There are several regions in the U.S. which can differ slightly in what is covered but the above is the basics of Medicare. In fact, the Medicare guide, which is printed by the govt. is distributed nationwide, and is the same document.

    Doctors may not be willing to participate in Medicare assignment where they are able to only bill what Medicare allows for any particular procedure or treatment. Otherwise, they can bill up to 115 percent and the patient picks up the difference. What doctors receive for particular procedures or treatments can vary from one region to another. Still, almost anywhere, there are docs who accept Medicare patients.

    I do understand how Medicare works. It really isn't worthless and if one has Medicare and a supplement, one is really well covered. If you can explain to me what it is I am not understanding about your difficulty, perhaps it would help.

    Love, Mikie
    [This Message was Edited on 09/10/2005]
  9. wiseeagle

    wiseeagle New Member

    thank you again for your post. Again I will say that I can't find a primary care dr. in Raleigh that will accept medicare. When I do find them their answer is "we are not accepting any new patients". THat is why I can't find a primary care, family or internist in Raleigh. THe only one's that will accept are new dr. out of school. Well in the beginning of this month I went to one--she took up my time and then proceed to tell me "I was too ill to take care of" have you ever heard that one?? Look not many dr. like to handle fibromyalgia pt.-- what works for one does work for another!! it is that simple!! I was running a fever @ that time and she
    wouldn't even treat me for a fever of unknown orgin!

    I'm on SS disability, I can't afford to pay out of pocket.
    As I said before I can find a specialitist without a problem
    here NOT a family dr. In NY it's the opposite you can get plenty of family dr's will will find it extremely difficult to have a specialist that will accept medicare.

    Your lucky that you can work..and don't have to rely on Medicare! I have been to Medicare site for dr's that accept
    medicare they are very out of date more than half on the list don't exist anymore ( maybe retired, left the state, I really don't know) they rest say their are not accepting
    new patients-- they maybe see 2-3 new pt. a year!!

    Now can you understand where I am coming from--It's extremely upsetting.

    THank you beanbox for your referral I do hope he will accept
    medicare!!

    Love and Light to all!

    Valerie
  10. Mikie

    Mikie Moderator

    I am not working anymore. I am on disability Medicare but here in FL, because of the large elderly population, it is easier to find docs who will accept Medicare. As I said earlier, where there are too few primary care docs, it can be hard because docs can decide not to accept new Medicare patients. It sounds as though that is what is happening where you live.

    Have you looked for a specialist who is knowledgeable about FMS or is willing to learn? I don't generally think rheumies are the best docs to treat us but there are exceptions and some rheumies who are knowledgeable. My pain specialist was very knowledgeable. I eventually found a good specialist who is a doctor of physical medicine, a physiatrist (not psychiatrist). I heard him speak at a meeting on FMS at our local hospital. He has been great. Some of these docs call their speciality, sports medicine.

    You may have to see several specialists to handle different aspects of your illness. If the docs accept Medicare assignment, you should have no out-of-pocket expense. Medicare will pay 80 percent and your supplement will pick up the other 20 percent. Just ask if the doc accepts Medicare assignment when you call to make an appt.

    If there is a good Medicare HMO in the area, there may be more PCP's available through them. As you know, though, there are network restrictions on HMO's. I do not pay a previum for mine but I do pay a $10 co-pay when I see my PCP. I pay $20 to see a specialist. There are co-pays for other procedures. Still, for me, it's cheaper because disability supplements are about $3,000 a year here.

    If your supplement is provided to you through a retirement plan or a spouse and does not cost anything, it is better to stick with that. If there are no HMO's available, there isn't much choice. Some HMO's are better than others.

    My doc is brand new and seems to be thorough and concerned although I don't think he is particularly knowledgeable of FMS and CFIDS, both of which I have. I have United Health Care Medicare Complete and I don't have to have referrals to see specialists.

    I sincerely hope you can find a good doc who accepts Medicare assignment. Perhaps the referral given to you here will work out. I pray it does. Why not post asking for a doc referral with Raleigh in the title. You may get other referrals. It couldn't hurt.

    Love, Mikie
    [This Message was Edited on 09/11/2005]
  11. wiseeagle

    wiseeagle New Member

    Thanks,

    Yes, I know about FL. I have posted the topic looking for a family dr. in Raleigh..no replies. The dr. beanbox referred to is a rhemie. Yes, your right they really don't understand
    CFS and fibromyalgia, but I'll give him a shot. I hope I don't effend you. I am just very frustated @ this point.

    I am single and have to pay dearly for my seconday insurance,
    actually I have tryed to change company's but noone wants me because I'm medicare underage. There is only one other co.
    I can apply to next year because I went to the ER and saw a psy. I have to wait for 2 yrs. and not go to the hosp, er, or saw a psy. dr. or they won't accept me. I current have United
    American. I pay $275.00 per month which I really can't afford, but I fear since I have chronic lyme I can't drop them. I haven't been treat yet for lyme and I'm going to NY for treatment for chronic lyme.

    Thanks again!!

    Love and LIght
    Valerie
  12. wiseeagle

    wiseeagle New Member

    Thanks for your referral. Have you tryied both dr. in that office there is a Dr. Douglas Freeman in there to. Are they
    rhemies? I'd really like your input regarding Dr. Strader.
    If you could please get back to me I'd greatly appreciate it.

    Love and Light

    Valerie
  13. Mikie

    Mikie Moderator

    I'm not offended and I can tell how frustrating this must be for you. United American is one of the top ins. companies in the US but it is expensive. It would be my only alternative if I weren't able to be in the HMO. I'm lucky in that the HMO I belong to has most of the good docs in our area and is a good plan.

    Good luck to you. I hope you can find someone who can help you.

    Love, Mikie
  14. JLH

    JLH New Member

    You do sound soooo frustrated in trying to find a doctor who accepts Medicare.

    I am on Medicare (primary) and have Anthem Blue Cross Blue Shield as a secondary.

    I have never found a doctor, family practice or a specialist, in my area who does not accept Medicare! And ... they all accept assignment from Medicare.

    The ONLY problem that I have ever encountered with Medicare is when I scheduled a sleep study. I have had 4 sleep studies over the last 6 or 7 years.

    For the first study, I had to wait 3 months to get an appointment. I found out by accident (overhearing a clerk scheduling an appt in a doctor's office) that one of the hospitals in our area only schedule 2 Medicare patients per month for studies.

    When I heard this, I asked if it was because of the amount of money that Medicare would reimburse the hospital for the test. She said yes, that the hospital can not afford to have too many Medicare sleep studies done in one month, or they would lose money in that area. I found that to be true when I received my bills! The cost of the study was $1500, which a person's "regular" insurance would pay for most of it vs. Medicare who only allowed $250 for the sleep study and they paid 80% of that!! Big difference!!

    After being on Medicare, I have been very observent to what my bills are vs. what Medicare will allow. I know that any doctor who sees mostly Medicare patients will not become rich!!

    Medicare is good for the patient, but bad for the doctors!!!

    Anyway ..... I know this is off subject for what your concerns are!

    I do hope that you can find adequate medical treatment close to your home.

    Hugs,
    Janet
  15. wiseeagle

    wiseeagle New Member

    Thanks for the input. Yes that is part of the problem, what medicare will pay for services. BUt look at the overinflated
    prices that are charged for services even a in and out dr.s
    appointment these days ( $150.00 per visit) I think that that's inflated!! That's why we pay such high prices for medical insurance and why some medical insurance give you such a hard time getting specialized tests, ect. THe state of Medicare is sxtrememly poor. They will pay (their rules) for rental of a wheelchair for 18 months even though a dr. writes the prescribtion for life ( that means buy it). THey could have bought 5 wheelchairs by the time they have paid for 18 months of
    rental. I have seen and experienced many of these wasteful
    practices of medicare. I see that Medicare only adgenda is to give the least amount of care and equipment to it's
    beneficiaries so they die and get off the roles!! THey also
    won't pay for well care. LIke I can only get a pap test every two years, (they just change it -- it use to be every four years!!) I hope that this opens up people's eyes to the major problems with medicare.

    Love and Light,

    Valerie
  16. Mikie

    Mikie Moderator

    Without it, I would be paying more than $800 a month in premiums for private insurance providing I could pass underwriting, which is doubtful. If I had to be without insurance, I would be billed the inflated charge and expected to pay it all.

    Is Medicare inefficient? Yes, absolutely! Is it a sitting duck for fraud? Again, yes.

    Our healthcare problems are widespread and systemic. Medicare is only part of the problem. It is also part of the solution. Stop and think about where you would be without it. Could you afford private insurance and could you pass underwriting? I know you are having a hard time finding docs and that is frustrating, but the other alternative would be to pay full price for treatment or full price for health insurance, if you could get it.

    Medicare is responsible for longer life spans. If it were not for Medicare, many elderly people would die. They may not have wheelchairs, but they do get medical treatment to keep them alive and help treat their conditions. One of the beneifts of an HMO is that they do pay for routine preventive care. Medicare would be better if it took a more preventive stance.

    Health care providers are not only poorly reimbursed by Medicare but also by all the managed-care insurance plans, including the Medicare HMO I belong to.

    Our health care is a mess and we need some kind of national health care plan. I don't want a one-payer govt. plan, though. Ask someone in one of those plans how long the wait can be for things that are not critical. If we think finding health care with Medicare is a problem, consider what it would be like if the govt. ran everyone's health care.

    There is plenty of blame to go around for our mess. The govt. which oversees Medicare and subcontracts for handling claims has too many rules, is not preventive in scope, and does almost no auditing, making the fund wide open to fraud.

    Insurance companies inflate premiums to ensure that their profits remain high. If they are not good at investing their money, they squak for higher premiums. They often make it difficult to obtain needed procedures.

    Health care providers scam Medicare because it is so easy. A provider has to blatently defraud Medicare over a long period of time to risk being caught. For years, docs have done unnecessary surgeries and other procedures to increase their incomes. Some have taken kickbacks from pharmaceuticals or for referrals. Some have illegally owned other health care facilities to which they refer patients. For years, some docs have ridden a gravy train which is no longer running.

    The law, which allows settlements which are astronomical, needs reform so that people with valid malpractice claims get paid a reasonable amount but not like hitting the LOTTO. This only encourages lawsuits, clogs the courts, and causes doctors to perform many procedures just to cover their behinds. Malpractice insurance for docs is out of sight and that cost is passed on to us.

    Finally, the patients carry some of the blame. People who take risks with their health by indulging in unhealthy habits use a disproportionately high level of treatment. Despite the availability of some of the best health care in the world, Americans continue toward more obesity and inactivity. Smoking and overeating cost billions in health care. Everyone picks up the tab. When there are seat belt and helmet laws, people squawk about their individual rights. When they are in intensive care, though, we all pay for their individual rights.

    I hope this paints a broader picture of what is happening which is causing our health care crisis. Please do not think I am not sensitive to your frustration. You have a real problem and if it were me, I would be frustrated too. What is happening to you may be just the leading indicator that docs and hospitals cannot and/or will not continue to work for paltry reimbursements from Medicare and managed care plans and struggle from month to month. Our system is broken and unfortunately for you, it is most broken where you live. I am truly sorry that you are having such a hard time. I do hope and pray you can find a good doc or docs who can help you.

    Love, Mikie
    [This Message was Edited on 09/12/2005]
  17. wiseeagle

    wiseeagle New Member

    Hi Mikie,
    I do agree with most of what you have said. I on the other hand have had terrible experiences with HMO's-- as I say I worked for one--they in particular were only interested in making money--not patient care!! Part of my job was to get info. from people to diagnose over the phone how sick they really were this was to get an appoinment earier than 2 months which was the norm. Most of the dr.s were slow thinking (to put it mildly. The dr.'s only had 10 mins. per patient, they would get paid according to how many patients they could see in a day! Or coarse there is alway one dr. that's a true dr.
    that would refuse this time limit and would see pts until the center closed--the other dr.s resented him because I never could fit in those emergency app. for pts that were truly sick. Needless to say he was my doctor!! He helped alot with
    dx. fibromyalgia and filling out all those massive amt. of paper work for STD, LTD and then Social security.

    Yes in the state of Fl things are different because of the large population of elderly. I am so glad your HMO is working for you. But after working in one and really seeing
    from the inside what goes on --- A HMO will NEVER be a choice of mine--even all that I go thru here. I can never accept an HMO. THey really are in it for the money--not patient care! You have to practically haunt them to see a
    specialist-- the dr.s are told handle your pts. problem the best you can and if the pts. continously bothers you about a
    specialist then give the referral.

    On another subject, Beeanbox Dr. Stader's office doesn't
    accept medicare--you have to pay in full what they charge then you have to file with medicare youself!! that's a new one to me. I really can't afford that, but thank you soo
    much for that referral.

    Good News, I have found an internist here in Raleigh and I have an appointment today Sept. 13th (my birthday - what a great present for me) Hoping she will good, well I really don't have a choice-- I called all the dr.s in the yellow pages yesterday. She IS the only one that will accept new
    medicare pt. wish me good luck--I need it.

    THanks to all that posted and tryed their best to help me, I really do appreciate it esp. you Mikie!!

    Love and Light to all,

    Valerie
  18. Mikie

    Mikie Moderator

    I hope this works out for you. In any case, have a wonderful birthday.

    HMO's are not created equal. How one is structured makes all the difference. With Kaiser, a staff model, the HMO owns the clinics and hospitals, in many cases. All the docs and nurses are their employers. This is called a staff model.

    There are capitated plans where the docs get paid an amount percapita for each patient whether the doc sees the patient or not. It is up to the doc to pay for tests and specialists. This is one of the most restrictive plans.

    A fee-for-service plan is the best. Your doc is paid when he sees you. He usually shares a bonus at the end of the year if he has kept costs down. I am lucky becuase with my plan, I don't need a referral to see specialists. I can see docs in the area who are not in the network and my HMO pays 80 percent of what they allow. I pay the 20 percent and anything above what my HMO allows. I see an out-of-network eye doc.

    I enjoy a lot of benefits that people on Medicare and a supplement do not. I do have co-pays when I use my ins., but unless I have to have something pretty costly, it doesn't cost much, certainly less than the premiums for a supplement. The maximum I would have to pay for any year is $3,000 out of pocket. Again, that's slightly less than the supplement would cost. I have never hit the maximum out of pocket. It's usually $10 here or $20 there.

    I'm looking at moving and one of the criterium for the county I will consider is the Medicare HMO which is there. Luckily for me, my plan is pretty widespread.

    Again, I'm sorry your experience with both Medicare and HMO's has been so bad. I'm saying a little prayer that this doc works out for you.

    Love, Mikie
  19. lovethesun

    lovethesun New Member

    Hope you find a doctor soon.One of the nmany reasons I moved back to California is the medicalone.Medi-cal covers a lot and there are always several doctors that accept it.
  20. wiseeagle

    wiseeagle New Member

    Hi everyone,

    I went to see that new dr. and after an hour of questions and quick exam she came to the conclusion I have chronic pain. and she doesn't treat that kind of pain , she refers them a pain clinic.





    I told her there is only 1 in raleigh and I've seen them twice, two different occassions. I flatly refused they don't precribe pain med's they wanted me to get steriod injections into my spine - I refused then and now! I also told her I was the same dr. both times once as in pt. in the hospital when I had both lyme and RMSF. two years later my family dr. practically forced me to go, and of coarse I got the same dr. the first words out of his mouth was " so did you have RMSF) think he remembered me? I said yes, that doen't have anything to do with that I am here for today!
    He ordered an MRI of my back @ that time and told me to come back in 2 month--giving me NO pain meds--saying I have to evaluate you first before I can prescribe something for you.
    I never went back nor will I ever! she then said go to Duke,
    I asked her could she drive me since I can't drive myself?
    She told me to take a cab! I broke down and started to cry, so she gave me a prescribtion for Vicodan 5/500--take 1 per if need and gave me 30 pills!!! then told me to come back to
    see her in 2 months!! I don't get it. She did see my severe pain..but got out of it by saying it was chronic.
    She had NO clue what chronic lyme was! I don't know what to do -- maybe I'll just buy med's online..there very costly but I won't go this horror.

    Beanbox does Dr. Strader give you adaquate pain med's?
    I really need to know -- I just can't go thru another insensitive dr. again.

    anyone out there with any suggestions? Mikie?

    Valerie