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Old 10-04-2012, 12:27 AM   #41
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all the hub bub over a potential bacon shortage, when one is talking about a 15% increase in the price
I'll teach you all how to make bacon from old used up dryer sheets, come-on tags that annuity companies leave on your door knob, etc.

I'm stilll standing. Yeah, yeah, yeah.
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Old 10-04-2012, 06:14 AM   #42
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I agree with this. PAs and NPs are likely to become the primary gateway to care, especially when tens of millions of new patients will get into the system in 2014, many of them with pre-existing conditions and comorbidities.
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I think we will move to where the NP is the gateway to medical care, referring up the chain as need be. (This is the model for the various clinics at drug stores and the like where the physicians guild permits). For a cold or a sprain etc, the treatment is standardized so it does not require 8 years of post bachelors study.
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Old 10-05-2012, 10:53 PM   #43
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DW and I have gone to the same dermatologist for years. We go at the same time for our yearly check ups. No PCP involved. We both have a couple of spots he is watching. So far all our visits have been routine. He may freeze a spot or two. his receptionist will not let us leave the office until we make the next yearly appointment. I don't know how long it would take to get an appointment if we called cold.

Ou dermatolgist (and most dermatologists around here) does not accept Medicare assignment. In other words we have to pay at our appointment and we are reimbursed by Medicare in a couple of weeks. We WOULD have a problem if we could only go to a dermatolgist who would accept Medicare assignment.

Neither traditional Medicare nor my MegaCorp Medicare supplement require me to have a PCP.
I experienced something similar with local dermatologists. I wanted to go in for an initial visit and get skin cancer screening for a couple slightly odd spots. Called a few places and could never actually get anyone to pick up or call me back. A co-worker recommended an out of network dermatologist on the other side of town, but I'm not that worried about the freckles/moles to pay $$$ (the other dermatologist MAY have been affiliated with a hospital hence $$$$$$$$ for services rendered in a hospital setting AND out of network).

Our family doc is great about seeing us for urgent things (never turned down for last minute Friday afternoon appts for example), but try getting a physical scheduled and expect to go out a few months before anything is available.

I'm not too worried about diminution in quality of services or access to services, since it seems sub par in some respects now. Just got to work the system a little sometimes.
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Old 10-06-2012, 10:03 AM   #44
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That was true before I qualified for Medicare (6 years ago) whether or not I had Blue Cross or GEHA coverage in Portland or Seattle Metro.
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Old 11-09-2012, 06:45 PM   #45
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One data point:

We visited FIL in Houston recently. He had recently visited his primary care doctor to get a referral to a dermatologist to check out a funny-looking spot on his face (he had skin cancer on his nose removed a few years back). The PCP told him what it was and that he didn't need to see the dermatologist. FIL insisted and PCP said the wait for an appointment would be at least 3 months. PCP had tried to get an appointment for his mother with a dermatologist who was a personal friend and it still took almost a month.

Again, just one data point, though...
Another data point- Couple years ago my mother hurt her knee & needed ligament repair. Could not find Orthopedic surgeon in west Detroit suburbs who took new Medicare patients. My sister eventually called in a favor from a guy she knew back in high school who is now doc in local area & had an Ortho buddy.

Another data point- At least one Mayo Clinic site is NOT accepting Medicare.
Mayo Clinic Family Medicine - Arrowhead, Arizona

In some areas Medicare patient access to physicians is so bad US Gov't is even offering physician "bonus payments" in some localities-
HRSA - Find Shortage Areas: HPSAs Eligible for the Medicare Physician Bonus Payment - Version 2.0

No one can predict future but with provider payment cuts from PPACA ("ObamaCare") and it's IPAB (Independent Payment Advisory Board) it seems logical that Medicare patient access to care may only get tighter- at least in some local areas.

IMHO- Seems best to find doc (& hospital) you like now as more providers seem to be declining new Medicare patients but continuing with their established patients.
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Old 11-09-2012, 06:48 PM   #46
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Does having a Medicare Advantage plan get you in the door at doctors who don't accept basic Medicare?
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Old 11-10-2012, 10:42 AM   #47
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Does having a Medicare Advantage plan get you in the door at doctors who don't accept basic Medicare?
Sometimes it does, as the reimbursement from the insurance carrier may be a bit more than they can get directly from Medicare.

Look at the provider list for the Medicare Advantage plans.

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Old 11-10-2012, 11:06 AM   #48
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Sometimes it does, as the reimbursement from the insurance carrier may be a bit more than they can get directly from Medicare.

Look at the provider list for the Medicare Advantage plans.

-- Rita
I would agree.

My adult (disabled) son is on Medicare, and has an Advantage Plan.

Unfortunately, his premium was rased 40% for 2013, and his benefits are reduced.

So much for for the "medical improvement" (I don't want to get political )...
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