Health Care At Your Fingertips

Health care. Now there’s an app for that.  At Georgia Medicare Plans we believe in open access to health care information. When patients, consumers and their medical providers have access to relevant information the level of health care goes up and the cost of health care comes down.

OK, the video is a bit corny but it get’s the point across.

Something that isn’t corny is saving money on your Medigap plans. One carrier lowered rates while others are raising rates. Maybe your Medicare supplement carrier is increasing rates. Shop and compare GA Medigap quotes now. 

Your data is never sold.

 

Health care and iBlueButton

It is surprising how many retirees on Medicare are not aware they can view their health care records online by logging in to MyMedicare.gov. If you have not already created a user account, do it now. Optimized-iBlueButton

You will also need to install iBlueButton on your mobile device or Chrome enabled computer.

Once you have installed iBlueButton you can download your medical data from MyMedicare directly to your smartphone or tablet.

It’s that simple!

 

Medical Identity Theft

Anthem made headlines recently when they disclosed that their computers had been hacked and 80 million current and former policyholders personal information had been compromised.

ibulebuttonvideoMost of the headlines and news reports have focused on traditional identity theft. Things like using your name and Social Security number to create a “new you” so someone in Bangladesh can buy a Ford.

No doubt someone can pretend to be you and establish a new line of credit but the bigger threat is medical identity theft. Georgia Medicare Plans has posted on this before and you might want to review our earlier posts.

We also found this online WSJ article to contain very useful information.

Medical records typically sell on the black market for about $50 each, says Mr. Pascual. The thieves, often hackers from overseas, are rarely caught, and medical clinics and hospitals compound the problem by having poor record security and holding personal data for long periods.

This widespread problem of medical-record theft, which often targets children and the elderly, shows no signs of slowing.

The theft (of your medical records) can mean canceled insurance plans, damaged credit, misdiagnosed illnesses and unwarranted medical charges that can take over a year to fix. – Wall Street Journal

Unfortunately too many view medical identity fraud as a victim-less crime since, in most cases, the money loss comes from insurance carriers or Medicare. But theft always comes back in the form of higher prices, higher premiums and higher taxes.

 

Improving your health care

As we age we often go from one or two doctor visits a year to several. Our little black book usually has more names that end in M.D.

And as our medication list expands we may purchase prescriptions by mail as well as retail. Your doctor(s) need to know which medications you are taking before prescribing something new or even evaluating your current list of complaints.

When was the last time you had your Medicare prescription drug coverage reviewed? Over the last few years we have saved our clients anywhere from a few hundred dollars per year in out of pocket prescription costs to several thousand. Just last year we saved one client over $7,000 per year by showing them a Part D plan with a lower premium but more importantly, significantly lower drug costs.

We also find that most retirees do not have a Medicare plan that meets their needs and budget. Many are overpaying for Medicare supplement plan F. They bought plan F because that’s what their friends have. Almost without exception you can save anywhere from $300 per year to over $1,000 by making a switch.

Georgia Medicare Plans has access to over 170 different Medigap plans. Somewhere in that mix is a plan that is right for you and will save you a lot of money. When you pay more you don’t get more, you simply paid too much.

Shop and compare now. Instant online quotes.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

 

With iBlueButton you can take charge of your health care and have access to all your medical records at the touch of a button.

 

#iBlueButton  #Medicare  #IdentityTheft #GAMedigapQuotes

Doctors That Take Medicare

Do all doctors take Medicare? The answer may surprise you. Which Medicare plans are widely accepted by Georgia doctors? Can my doctor refuse to take my Medicare plan? What happens then? How do I find physicians that take Medicare?

The I-Team investigates

Undercover investigation by ABC affiliate channel 11 in North Carolina discovers many medical practitioners are not taking new Medicare patients. At least part of the reason is low reimbursement by the government for treating Medicare patients. Cuts in Medicare funding brought about by Obamacare leaves many physicians wondering if they can afford to keep treating retirees over age 65.

The investigation discovered that 50% of physicians in the Raleigh-Durham area were not accepting Medicare patients

 

Do all Georgia Doctors take Medicare?

The short answer is no. A better answer is, most doctors DO accept Medicare patients. But many Georgia medical practices are not currently taking new Medicare patients or may have a waiting list for new patients.

Your challenge is even more diverse when you break it down by:

  • Doctors that take Medicare patients
  • Physicians that accept Medicare assignment
  • Doctors that do not participate in Medicare
  • Medical practices that participate in Medicare but not Medicare Advantage

medicare doctorThe good news is, most doctors participate in Medicare and do treat Medicare patients. About 96% of physicians that do take Medicare also accept assignment of benefits. Doctors that may opt out of Medicare are usually in the mental health field and some chiropractic doctors.

In Georgia about half the physicians accept Medicare Advantage patients and most of them will only participate in a few plans but not all. The number dwindles down further when you have an Advantage HMO plan.

Doctors can refuse to accept your Medicare Advantage plan if they are not in network. If that happens they are still required to file with original Medicare and then wait on Medicare to pay you. In these situations they are allowed to bill excess charges.

If you have an Advantage plan make sure you understand the rules and how your liability is determined.

 

Medicare participation

Finding physicians that participate in Medicare is relatively easy. If you Google “doctors that take Medicare” you will find an array of choices including other search engines and referral services. My advice is to go direct to the source, Medicare.gov.doc not taking Medicare

The Medicare physician finder is a useful tool for finding doctors, hospitals, DME suppliers and other medical facilities in your area that participate in original Medicare.

When you just use Google you will find doctors that

  • advertise locally on Google
  • are registered with referral services
  • are listed on Medicare plan sites
  • may be reviewed by Yelp or Angies List

While some of those sites may be useful the Medicare physician finder tool has been the most helpful for my clients.

Medicare supplement plans can be quite affordable and do not require network participation.

Your information is NEVER sold

New to Georgia

Jean moved from California to Georgia a few months before turning 65. She was covered by Kaiser in California but her plan offered only limited coverage in Georgia where she was considered a “visitor”. Jean had some medical conditions that required a specialist and she wanted freedom of choice when it comes to finding a doctor.

This meant saying no to Medicare Advantage plans with their limited doctor choice, high out of pocket and yearly changes in benefits.

Living on a fixed income, the one thing Jean needed most was a way to budget for her care. Original Medicare and a Medigap Medicare supplement plan F ratesplan was exactly what she needed.

When Jean contact me she was living with local relatives and didn’t want a bunch of insurance sales people coming to see her. At Georgia Medicare Plans we believe in personal consultation in the privacy of your home. We know that many people do not feel comfortable having strangers in their home and several do not want to travel to see us. Our focus is 100% client centered and we believe in respecting your “space”. That is why all of our clients receive information and advice by phone and email. There is never any pressure to make a decision and you move forward based on your time frame once you are comfortable you understand the Medicare system and can afford the coverage you want.

We spent several hours on the phone discussing her needs and looking at options. We emailed Jean information based on the benefits she needed and plans that fit her budget. We also provided her with details on Medicare Extra Help, a service that can reduce her out of pocket expenses for medication.

After reviewing all her options Jean selected Medicare supplement plan N from a carrier with a long history in covering Medicare clients. While most agents that talked with Jean pushed Medigap plan F she knew that plan was not going to fit her budget.

Blue Cross wanted $176 for plan F and United Health Care (AARP) even more at $180. The lowest premium she was quoted for plan F was $141 from Continental (Aetna) but that was still too much.

We talked about the differences in plan F, G and N and how each plan was more affordable due to cost sharing. Plan N coverer her Medicare Part A expenses at 100% but does require her to pay the Part B annual deductible + a $20 copay for doctor visits.

Jean’s premium for plan N was $86 from New Era insurance company. Even with the cost sharing she still cut her premium in half vs. most of the plan F plans.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

 

Finding a Medicare physician

As mentioned above, the Medicare physician finder is the most reliable tool in your arsenal for finding doctors in your area. Once you find some doctors that fit your needs, make some phone calls.

Here is what you need to know.

  • Does the doctor participate in Medicare?
  • Are they taking new patients?
  • If you have an Advantage plan, are they CURRENTLY participating in that plans network?
  • Do they accept Medicare assignment?
  • Does the doctor require up front payment for Medicare patients?

Again, most doctors DO participate in Medicare and most take assignment. A medical practice that accepts Medicare assignment means

  • you never have to pay up front for Medicare covered services
  • you never have to file claim forms with Medicare
  • Medicare and your supplement plan will pay your doctor direct, not you
  • your doctor can never bill you for excess charges

find medicare informationThe video report above missed the mark on a few things. Doctors that do not take assignment are not allowed to bill you up front. They are required to file your claims with Medicare and must wait until Medicare (and your supplement plan) pays you once the claim is adjudicated.

Finding doctors that take Medicare is not that difficult, but finding an affordable plan that meets your needs and budget can be difficult. In some parts of Georgia you may only have half a dozen Advantage plan choices and many of them may not include your doctor or hospital in their network.

However there are more than 170 Medicare supplement plans statewide. Finding a plan with our help is as simple as getting a personalized Medigap quote in the privacy of your home, picking up the phone or sending us an email.

Let us know how we can help.

 

#MedicareDoctors  #GeorgiaMedicareDoctors  #Turning65 #GAMedigapQuotes

When Your Medicare Plan Doesn’t Pay

What happens when your Medicare plan doesn’t pay a claim? Do you still owe the bill? Can your doctor or other medical provider make you pay a claim denied by Medicare? Can your doctor balance bill you for the difference in the Medicare allowance and what they would like to charge?grumpy old person

What does it mean when a provider does not accept assignment? Can a provider opt out of Medicare entirely?

What are my options?

Choose original Medicare and the right Medicare supplement plan

 

Your Medicare plan doesn’t pay

Most of the time Medicare pays for treatment that is deemed to be medically necessary. But sometimes they don’t pay. What happens then?

Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.

He was blindsided, though, by a bill of about $117,000 from an “assistant surgeon,” a Queens-based neurosurgeon whom Mr. Drier did not recall meeting.

N Y Times

What is an assistant surgeon and who is this masked man?

More importantly, why did Mr. Drier’s health insurance plan balk at the $117,000 fee from the assistant?

Anthem, the carrier in Mr. Drier’s case paid the primary surgeon $6,200 (out of $133,000 originally billed) and the doctor accepted that as “paid in full”.

Dr. Mu, the assistant surgeon, refused to negotiate for a lower amount.

Eventually Anthem relented and paid $116,862 and Dr. Mu accepted the payment.

This is out of the ordinary and not to be expected routinely.

While Mr. Drier was covered by a traditional health insurance plan (similar to Medicare Advantage) he was not a Medicare beneficiary. Original Medicare does not have any networks and in most cases the doctor would not be allowed to bill any amount over and above the Medicare allowance.

Situations where original Medicare doesn’t pay for medically necessary treatment are rare.

 

How does Medicare work?

Original Medicare is quite simple. About 96% of medical providers participate in Medicare and accept the Medicare allowance as paid in full.

KFF Medicare provider billing

 

Notice the above applies to original Medicare only.

Medicare Advantage plan have much smaller networks. In some situations the patient is subject to balance billing by a non-par provider and in other cases the patient is liable for the FULL AMOUNT BILLED.

 

Patient protection with Medicare

When you are covered by original Medicare you are protected from financial surprises by the law.

The participating provider program was enacted in 1984 for two purposes: (1) to assist Medicare patients with identifying and choosing providers who charge Medicare-approved rates; and (2) to encourage providers to accept these rates. Given this program’s strong provider incentives, the number of participating providers grew rapidly across all states and today, the vast majority (96%) of eligible physicians and practitioners are “participating providers”—agreeing to charge Medicare’s standard fees when they see beneficiaries.

KFF

For the last 30 years Medicare has “had your back” when it comes to shielding you from medical bankruptcy. The ability to choose any provider plus the guaranteed acceptance (by most providers) of Medicare’s fee schedule is a primary reason why so many retirees on a fixed income choose original Medicare and a Medigap plan over private company Advantage plans.

 

Paying your share

When your Medicare plan doesn’t pay because you used a non-participating provider, or one that has opted out of Medicare, what do you owe?

 

KFF Medicare cost sharing

 

Select Medigap plans will pay any excess billed charges when you use a non-par provider.

Medigap plans are supplemental to original Medicare. When you use a Medicare par or non-par provider there is never any problem in using your Medicare supplement plan. All par and non-par providers will accept ANY Medigap plan, regardless of the issuing carrier.

With more than 170 different Medigap plans in Georgia, how do you choose the right one? 

Picking the right plan is easy with our help. We only recommend Medicare supplement plans from carriers that have 5 or more years direct experience in underwriting and issuing Medigap coverage.

With original Medicare you will rarely ask yourself “What if my Medicare plan doesn’t pay?

 

 

#Medicare    #Medigap

What Causes Heart Disease – Science or Sham?

What really causes heart disease? Diet? Lifestyle? Does Dr. Dwight Lundell have the answer? Or is it all a sham? Can damage to the heart be dr lundellreversed?

 

Causes of Heart Disease

Can we prevent heart disease? Can the damage be reversed with diet?

An Arizona heart surgeon’s claim that a diet of unprocessed foods – not necessarily low-fat foods – can prevent and even reverse heart disease has ignited the Internet.

Dr. Dwight Lundell has dished the dirt on ‘what really causes heart disease’ and he admits prescribing cholesterol-lowering medications, and a low-fat, high-simple carbohydrate diet for two-and-a-half decades was misguided.

‘These recommendations are no longer scientifically or morally defensible,’

Daily Mail UK

I doubt if anyone will disagree with Dr. Lundell’s basic premise that diet and lifestyle are major contributors to heart disease.

Daily doses of high fat foods, processed grains and fats aren’t healthy. But who really eats like that?

He explains that this once ‘healthy’ diet actively destroys the walls of our blood vessels by causing chronic inflammation. This inflammation makes cholesterol stick to the walls, forming the plaques that eventually block them, resulting in a heart attack or stroke.

Sounds logical.

Build of up cholesterol leads to hardening of the arteries, restricting blood flow and leading to heart disease. And his comments just seem to resonate.

Don’t eat anything your grandmother wouldn’t recognize as food, eat plenty of fruits and vegetables, and lean protein, he recommends

But is he oversimplifying things? Is his Marcus Welby approach helpful?

And is he giving us the kind of advice that really works or is this all a sham?

medigap quote CW

Science or Sham?

Is Dr. Lundell a real doctor or is there something about his past we need to know?

Dr. Stephen Barrett takes a look at this approach to curing heart disease.

Dwight C. Lundell, M.D. lost medical license in 2008. Since that time he has been promoting books that clash with established scientific knowledge of heart disease prevention and treatment. His book,The Great Cholesterol Lie, invites people to “forget about everything you have been told about low-fat diets, saturated fats, cholesterol and the causes of heart disease.” 

Quackwatch

In his post, Dr. Barrett attacks the character of Dr. Lundell without really addressing the underlying issue.

Is the advice offered by Dr. Lundell factual and sound or is it quackery just to sell books?

There is nothing in Dr. Barretts post to indicate if the advice is good or not. Instead he closes with a comment stating he does not trust the advice of Dr. Lundell.

You decide.

Medicare Advice – Good or bad?

When you turned 65 and went on Medicare, did you really understand how the various parts work? Or were you more confused than ever?

A simple 15 minute phone conversation with Bob Vineyard at Georgia Medicare Plans will reveal more about how Medicare works than you can gain from weeks and months of studying Medicare brochures, attending seminars, having a parade of agents in your home, talking to your friends or going online.

Over 98% of the people we talk with picked the wrong Medicare plan (based on their needs and budget) and are paying too much. On average, we save our Medigap clients more than $450 per year on the exact same coverage they have now. A simple switch in plans can add another $300 in savings.

How much can you save?

medicareplansgeorgia

The Medicare Advantage Convenience Factor

Why choose a Medicare Advantage plan over original Medicare? Is it the Medicare Advantage convenience factor as proposed by Dr. David Mokotoff at KevinMD? Is one-stop-shopping the driving force or is it the attractive low premiums? lucy peanuts

Let’s look at what Dr. Mokotoff has to say.

 

Medicare Advantage Convenience

Dr. Mokotoff starts with the basic assumption that most patients choose Medicare Advantage plans over original Medicare and a supplement because the Advantage premiums are low.

He should have stopped there, because that is indeed the driving factor. But let’s at least look at what he has to say about Medicare Advantage convenience.

Despite my knowledge in this field, I had assumed this would be a snap.

I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has been nothing short of an eye-opener. I should have of course known better, embarking on any venture with a government agency.

So far, so good.

The doc is correct about venturing into Medicare. Government bureaucracy make it anything BUT a snap.

He signed up for Medicare Part A online but said Part B was a challenge since he was past age 65 and was not collecting Social Security.

This makes me wonder why he (apparently) didn’t Medicare Part A when he turned 65. It’s “automatic” for most and free. Even with his group health plan in place Medicare Part A will pay little or nothing but then he paid nothing for it. Starting up Part A AFTER you turn 65 is a real challenge.

Medicare Part B is relatively easy so I don’t understand the doctor’s comments.

A hit and a miss

Dr. Mokotoff tackles the choices in Medicare Advantage vs. original Medicare and does a decent job at first.

Medicare HMO’s combine A, B and D for one set fee and are known as Medicare Part C, or Medicare Advantage. However, hospital, physician, and drug choices are severely limited when signing up for Part C, no matter what the insurance company’s marketing advertises.

Your provider choices are very limited under Advantage plans, especially if you choose an HMO.

peanuts hit and missStay in the network, you have decent coverage.

Go outside the network for non-emergency treatment, you have no coverage.

“Medigap” plans can be purchased to fill in the many holes which A and B do not cover, for another premium. This is also called Medicare Part F. Are you still with me?

Now there is also Medicare Parts E, G, H, I, J, K and L.

Medigap, also known as Medicare supplement plans, do fill the gaps in original Medicare.

If you have an Advantage plan, you do NOT need a Medigap plan or a Medicare Advantage “plus” plan.

And the letters the doctor referred to above ( E, F, G . . . .) are Medicare plans, not parts. It may seem like semantics to the casual observer but there is a distinct difference.

If you do decide on a Medicare supplement plan, you probably don’t need to pay for plan F. Medigap plan F is the most oversold and overpriced plan in Georgia.

Have You Lost That Loving Feeling for Your Medicare Plan?

Finally, some good advice

The time frame is jumpy, making it very hard to follow which cam first, but the good doctor admits the Medicare Advantage convenience isn’t so convenient after all.

By late spring of this year, my head was spinning. I threw in the towel and used an insurance expert to help me navigate this alphabetical morass.

Insurance expert!

There is no reason for anyone, even a doctor, to spend time trying to learn something they will have to re-learn next year. It’s like your 1040. You can do it yourself or hire someone to do it for you.

Most everything you learned the first time has either been forgotten or has changed since the last time you tackled your taxes.

The same thing with Medicare, and especially so if you signed up for a Medicare Advantage plan.

My epiphany was that many of my former patients probably chose Medicare Part C or HMO plans, not just to save money, but also not to have to deal with this endless maze of paperwork and redundancy. This system is so cumbersome, arbitrary, and difficult to understand that only another government agency, the IRS, can make it look simple.

So where is the convenience factor?

You can’t have a Medicare Advantage plan or a Medigap plan until you have Medicare Part A and Part B in place. peanuts linus no problem

After having spent over 40 years in the health insurance business I can tell you two things with absolute certainty.

  1. Compared to traditional health insurance with networks, copay’s, deductibles, etc Medicare is simple
  2. If you want complicated, go with a Medicare Advantage plan

I thought when I transitioned my business focus from regular health insurance to Medicare it would be easy.

I was wrong.

Something that should have taken a couple of days to learn took me almost a month before the light bulb came on. I can imagine someone who doesn’t deal with this every day is confused, and that’s where I come in.

 

Learn Medicare in 15 minutes

My promise to you is this. Give me 15 minutes to answer your Medicare questions. If you don’t feel it is worth your time to continue move on.  Do it yourself, talk to the folks at Medicare or find another agent to assist. My belief is this. You will learn more in a 15 minute phone conversation than weeks or months of reading, going to seminars and inviting agents into your home.

If you want Medicare convenience, give me a call. That’s what I am here for.

Lucy of Peanuts fame claims she can answer any question for only 5 cents. I love Peanuts, but her advice, while often humorous, is horrible.

Bob Vineyard has been answering health insurance related questions on consumer forums for years and never charged a dime (or a nickel). Shop and compare plans at our online quote engine, then give us a call. You will be glad you did.

 

 

My Doctor Was Fired – What Now?

What happens if your doctor was fired by your Medicare Advantage plan? It happens. With reduced Medicare funding under Obamacare it will be more difficult to keep your doctor no matter how much you like them. my medicare doctor was fired

Just ask Mary Ann Catalano

GA Medicare Advantage

My doctor was fired

Mary Ann Catalano has been using the doctors at Dermatological Care for over 40 years. But all this is about to change. Her doctor was fired.

In 1990, doctors found two types of cancer on her face and scalp. Years later they flagged a type of cancer that they warned could also be on her colon. That led her to a colonoscopy and subsequent removal of pre-cancerous spot on her colon. Recently, they discovered her husband’s skin cancer.

Now, at 68 and in the middle of her contract term, UnitedHealthcare is kicking the entire Dermatological Care staff out of her Medicare Advantage network.

St Louis Post

This would not have happened if Mary Ann had original Medicare and a Medigap plan.

Funding cuts required by Obamacare mean all Medicare Advantage plans will have to get skinny if they are to survive.

United Health Care sent out pink slips to almost 1,000 docs in Missouri the first part of June. Medicare Advantage patients can still see their doctor if they want but out of network penalties may apply.

With 17 eligibilities for special enrollment, (insurance agent Bill) Steinlage said there’s an “excellent chance” many consumers will qualify for one. The best thing to do, he said, is visit an independent broker who can help you navigate the system.

Yes, but if your doctor was fired from the plan that is not one of those 17 SEP opportunities.

Mary Ann makes a tough choice after her doctor was fired

Moving to another doctor was not an option in Mary Ann’s mind.

For Catalano, in St. Louis County, she plans to stay with Dr. Larry Wang at Dermatological Care and pay out of pocket.

She recognizes this could turn into a financial burden after office visit fees, biopsies and more, but “that doctor knows everything about us,” she said. “I’ll just tell them I gotta make payments.”

Financial burden’s are not something seniors should stress about during their retirement years. Unfortunately, most seniors choose Medicare Advantage plans based on the low going in premium. They never think about how costly these plans can be once your health changes.

Nor do they consider the cost of health care when their doctor is fired.

United Health Care is not alone

Other carries will do likewise. Someone had to be the first. United Health Care has more seniors on Medicare Advantage plans than any other carrier in the country. If United is firing doctors to save money, how long before their competitors do the same?

 CMS released guidelines in April that will allow Medicare patients to change coverage one time during the year for whatever reason. Those guidelines won’t be implemented until 2015, though, and there’s one other catch. The guidelines state it would have to be a five-star plan, which are the highest rated Advantage plans.

In Georgia there is only one 5 star plan and it isn’t United Health Care.

Unless you qualify for an SEP under Medicare guidelines, if your doctor is fired you change docs or wait until the next open enrollment. Finding a new doc is especially challenging if you live in a rural area and have a medical condition that few doctors are able to treat.

 

Dave and Alice

I have clients that live in rural Georgia. At one time they had a Blue Cross Medicare Advantage plan, and then it went away. That did create a Special Enrollment Period for them. Both were in reasonably good health but living in a small town meant limited doctor choices. Their family doctor was not in any of the new plans and the only way for them to have the ability to use a doctor of THEIR CHOICE was to return to original Medicare and pick up a supplement plan.

Georgia Medicare Plans has access to over 170 different Medigap plans and can usually find a plan that meets YOUR needs and budget. We helped Dave and Alice find an affordable plan that allowed them to keep their doctors.

We can do the same for you. Shop and compare Medigap plans now.  Don’t wait until your doctor is fired or your plan is discontinued.

medicareplansgeorgia

 

 

#Cancer #UnitedHealthCare #Medicare Advantage #SEP #GeorgiaMedicarePlans #BobVineyard

Can My Doctor Refuse to Treat Medicare Patients

Can my doctor refuse to treat me now that I am on Medicare? In some situations, yes. Your doctor can refuse to treat Medicare patients. If you have a Medicare Advantage plan, your doctor may refuse to see you. If you are being treated for psychiatric conditions, your doctor may treat you but refuse to accept Medicare.  happy old man in yard

 

Can My Doctor Refuse to Treat Medicare Patients

Doctors are not obligated to treat any patients and this is no different if you are on Medicare or Medicaid.

Many doctors limit the number of Medicare patients they will treat. Medicare and Medicaid reimbursements are lower than private insurance so it is not unusual for doctors to prefer private insurance over any of the Medicare options.

Most Medicare Advantage plans have networks. If your doctor does not participate in that plan they may refuse treatment.

 

Ed had COPD

One of my first Medicare clients was a fellow named Ed. He was a very nice gentleman and when his primary care doctor told him to find another doctor for follow up treatment Ed was upset.

Ed knew me as a result of some advice and counsel I had given his wife a few years earlier. When Ed’s doctor “fired” him Ed called me for advice.

The Medicare Advantage plan Ed chose a few months earlier had a doctor network. Ed bought the Blue Cross Medicare Advantage plan because “all doctors take Blue Cross“.

That’s when he found out that some doctors DON’T take Blue Cross, at least when it comes to Medicare Advantage plans.

Due to Ed’s COPD he could not qualify for a Medicare supplement plan through normal channels and it was too late to switch to another Advantage plan that would include his doctor.

But Ed did qualify for a Medigap plan due to a little known escape hatch in the Medicare laws.

It took some doing, but I was able to get Ed off his Medicare Advantage plan and back into original Medicare and a solid Medicare supplement plan. By returning to original Medicare and a supplement plan, Ed’s doctor would once more agree to treat Ed and help him manage his COPD.

Ed lived another 2 years after that and hardly a month went by without someone calling saying “Ed told me to contact you about Medigap coverage”.

 

Your doctor may treat you but refuse Medicare

There is another situation where your doctor may agree to treat you but refuse to bill Medicare. In that situation, you are responsible for the full bill.

Many medical practitioners that treat psychiatric conditions have opted out of the Medicare system.

A doctor that refuses to treat Medicare patients is well within their rights if they have opted out of Medicare.

 

Find out the facts BEFORE you make a mistake. Shop and compare Medicare plans in the comfort of your home.

medicareshopcompare2 (1)

 

 

Doctor’s Exam Rooms are Getting Crowded

Have you noticed your doctor’s exam rooms getting a bit crowded lately? Your private conversations are no longer private. Someone else is listening in and recording your discussion.  exam room eavesdropping

 

Exam Rooms Getting Crowded

In case you haven’t noticed, routine questions in your doctor’s office are not the same as before. While you are waiting to see your doctor you may be asked to complete a survey. This goes beyond your doctor’s concern for your well being. Many of these questions are now required by law.

Your answers are recorded and sent off to Washington for their massive database.

  • Do you use tobacco?
  • Do you use illegal drugs, including marijuana?
  • Do you have multiple sex partners?
  • How often do you have sex?
  • Do you drink alcoholic beverages? How many per day? What kind (wine, beer, cocktail)?
  • How often do you exercise?
  • Do you have trouble sleeping?
  • Do you have thoughts of suicide?

Some survey’s are several pages long and very intrusive.

CMS (Center for Medicare and Medicaid Services) wants this information so they can decide the most cost effective treatment plan that will be approved for Medicare and Medicaid patients. Washington figures if they are paying your medical bills they have a right to know what works and what doesn’t.

If you really want to know more, you can read about the IPAB here.

Briefly, the IPAB is the Independent Payment Advisory Board. This 15 member panel of politically appointed “experts” are responsible for reviewing medical records and treatment plans then making recommendations on what is cost effective and what isn’t.

In other words, your treatment would be decided by a bureaucracy, not your doctor.

But wait, there’s more!

 

Your State Legislature is Listening as Well

Intrusion in doctor’s exam rooms is not just nosy people at the federal level, your state wants a piece of the action as well.

The difference here is, some states are seeking to PROTECT your rights to privacy.

Florida has made it illegal for physicians to ask whether there are guns in the home.  This matters.  People who live in a home with a gun are three times more likely to be murdered–most frequently from domestic disputes.

In Connecticut, one of my patients was a middle-aged woman living with her schizophrenic son. He occasionally muttered he wanted to kill her.  “Do you have a gun in the home?” I asked.  This was important.  It would change how likely he was to succeed in his wish.  A gun with bullets in the home would increase her chances of dying dramatically.

“Yes,” she said.  “I keep a loaded gun on me at all times.” She ignored my advice to get the gun out of her home. Or at least take the bullets out. “It makes me feel safe,” she said. That was her right as a patient, to ignore my advice.  It was my duty as a physician to let her know the increased health risks.

After violence escalated in the home, and her son stabbed her with scissors, undeterred by the gun, my patient decided for herself to get rid of the gun before he used it on her or she used it on him.

Kevin MD

Admittedly, some questions can be beneficial to the health of the patient. At the same time, someone who is determined to commit a violent act will not be deterred by attempts to restrict access to firearms.

If laws protected people from violence there would be no crime.

 

Listening In

The next time you are in the doctors exam rooms, keep this in mind. Not all of your answers will stay within the confines of your doctor’s files. Someone else may be listening.

 

 

Georgia Medicare Plans – your one stop resource for Medigap advice and instant rate quotes.

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Kerry Kickback to Obamacare

Three years later we are finding out what was in Obamacare and the John Kerry kickback means Georgia hospitals will get less money from Medicare.  When Obamacare was cobbled together in back rooms and deals were cut to gain support many of these shady promises made the light of day.kerry kickback

The Cornhusker Deal with Nebraska Sen. Nelson, the Florida Gator Aid and the Louisiana Purchase are examples of payoffs to win Democrat votes for Obamacare.

Now we find out one other.

The Kerry kickback allowed Massachusetts hospitals to reap higher reimbursements at the expense of Medicare cuts in 40 states including Georgia.

At issue are the dollars that Medicare pays to hospitals for the wages of doctors and staff. Before the new health law, states were each allocated a pot of money to divvy among their hospitals. The states are required to follow rules in handing out the funds, in particular a requirement that state urban hospitals must be reimbursed for wages at least at the levels of state rural hospitals.

Enter Mr. Kerry, who slipped an opaque provision into the Obama health law to require that Medicare wage reimbursements now come from a national pool of money, rather than state allocations. The Kerry kickback didn’t get much notice, since it was cloaked in technicality and never specifically mentioned Massachusetts. But the senator knew exactly what he was doing.

You see, “rural” hospitals in Massachusetts are a class all their own. The Bay State has only one, a tiny facility on the tony playground of the superrich—Nantucket. Nantucket College Hospital’s relatively high wages set the floor for what all 81 of the state’s urban hospitals must also be paid. And since these dramatically inflated Massachusetts wages are now getting sucked out of a national pool, there’s little left for the rest of America.

WSJ

Massachusetts gets more Medicare money so we get less.

During their closed-room dealings with the Obama Administration, the hospital industry’s lobbyists agreed to support Obamacare—provided that the law placed restrictions on physician-owned “specialty” hospitals, noted WSJ. These innovative specialty hospitals frequently have quality outcomes better than most traditional facilities, but no matter—the big hospital lobbyists wanted to eliminate a source of competition. So Obamacare prohibits new physician-owned hospitals from receiving Medicare payments and prohibits most existing facilities from expanding if they wish to keep treating Medicare patients.

Forest Park Medical Center in Dallas has stopped accepting Medicare patients, allowing it to escape the law’s restrictions entirely…. Rejecting Medicare ‘was a big leap, but we felt like the law gave us no choice,’ said J. Robert Wyatt, a Forest Park founder….

Other doctor-owned facilities are asking the federal government to let them duck the law’s restrictions altogether. Doctors Hospital at Renaissance near McAllen, Texas, is trying to get a waiver allowing it to expand as more than 53% of its payments come through the Medicaid federal-state insurance program for the poor.

Heritage

This means lower quality of care for you if you are on Medicare or Medicaid, less access to health care.

If this doesn’t make you mad nothing does.

Obamacare deals like the Kerry kickback mean less care for you.

Welcome to Medicare, Sort Of

Have you recently turned 65 and looking at your Medicare options? Did you get your Welcome to Medicare package? Have you scheduled your “free” Welcome to Medicare preventive exam?   Welcome to Medicare

Here are some things you need to know.

  • If you currently have a doctor, make sure they accept new Medicare patients
  • If you don’t have a doctor, you may have to make a lot of calls to find one that accepts new Medicare patients
  • Medicare Advantage plans can be challenging
  • Paying for your “free” exam
  • Will your doctor take your Medicare supplement plan
  • Which Medigap plan is best?

 

Finding a Medicare Doctor

Before Medicare you probably never had a problem seeing a doctor, even if you are a new patient. You might have to wait a few weeks for a non-emergency situation, but almost never a month or more.

Welcome to Medicare where the rules are different.

Some doctors are not taking new Medicare patients, even if you have used them for years. Others will either say they are not taking new patients or will put you on a waiting list and call you back in a few months when they have an opening.

What is the problem? Doesn’t everyone want Medicare patients?

In a word, no.

You might find this comment from a MOM (medical office manager).

“Docs may limit how many Medicare patients they see or, like we did at my previous office, not give Medicare patients time slots preferred by commercial or cash paying patients.”

The problem is the low reimbursement from Medicare relative to “commercial” (private) health insurance and the uncertainty on how much they will be paid going forward.

 

Medicare Advantage Plans – Great Until You Need them

The good thing about Advantage plans is the low premium, in some cases $0. But the old adage is true, you get what you pay for.

Most Medicare Advantage plans have networks which are much smaller than the PPO networks you may have had with a major medical plan. Most major medical PPO networks include over 95% of doctors and hospitals in Georgia.

Advantage networks typically have fewer than 20% of doctors participating and many areas have no doctors or hospitals.

Your current doctor may take Medicare but does not take any Medicare Advantage plans or may just refuse to participate in the Advantage plan you picked.

Welcome to Medicare Advantage . . .

 

Your Free Welcome to Medicare Exam May Not Be Free

What’s not to love about something free, even if you have to see a doctor to get it?

The “all you can eat” preventive exam covers 118 situations but some of yours may not be free. The one that causes the most consternation is a “free” colonoscopy.

When a procedure is preventive, it MAY be free (only if you qualify under Medicare rules). But once a condition, such as polyps, are discovered the test or exam becomes diagnostic and YOU pay.

Welcome to Medicare is not always free.

 

Will Your Doctor Accept Your Medicare Supplement Plan?

Unlike Medicare Advantage plans, a Medigap or supplement plan keeps you in the original Medicare system. Any doctor, lab or hospital that accepts Medicare assignment will also accept your Medigap plan . . . even if it is from a carrier you (or the doctor) have never heard of.

Heads up.

All Medicare supplement plans with the same letter (Medigap plan F for example) offer IDENTICAL COVERAGE. The only difference is the premium you pay.

When you pay more you don’t get more, you simply paid too much.

It pays to shop and compare Medicare supplement plans, rates and costs before you buy.

The best Medigap plan is the one that meets YOUR needs and budget. Bob Vineyard at Georgia Medicare Plans has been helping people find the right plan since 1975 and he can help you.

Are you ready to review plans and rates? Get a Medigap quote now.

Who knew turning 65 and Welcome to Medicare had so many challenges?

 

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