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Old 05-04-2010, 04:48 PM   #1
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health "care"

Warning: this is a rant...

Just spent hours tracking down doctors accepting a Medicare advantage plan for someone I know. First, health insurance plan website lists a bunch of doctors that would accept them right there. So, you'd think this is simple - just pick one from the list... but no, you call some doctors and they say, 'Yes we accept insurance X but not that specific plan'! Ok, then you call other few doctor from the list, and it turns out they don't work where the site has them listed; instead a different set of doctors work at that location but they don't accept this insurance... Call another doctor. They say, 'Uh, yes, we accept that plan but you have to call the insurance company and have them send you what exactly they will cover'. I say, 'Well, it's on their website.' They say, 'That was not enough in the past. For some reason the insurance does not send us what is covered and we require patients come with that information.' What the heck is that?! Never heard of this of kind thing before... And of course all of this has to be done before going to get a referral to one of those doctors... And of course when I say making a "call" that means waiting on hold, getting transferred once or twice, waiting for the person to find out, etc...

Now imagine a sick person doing all this... Hmm.. maybe you don't have to imagine?

What a great healthcare system! Clearly no need for a single straight-forward plan accepted everywhere...
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Old 05-04-2010, 05:27 PM   #2
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Reading this makes me break out in a cold sweat. I was almost to the point of banging my head against the wall when I had to deal with Medicare for DM. Problem is, you can't just throw your hands up and walk away.

FIL had to have nursing home care, then hospice care recently. What we read on Medicare's website was more or less the beginning-of-the-conversation with the nursing home. I have to be careful not to start another rant about the ping-pong process of crashing at the nursing home to being revived at emergency, only to go back to the nursing home to repeat the process...
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Old 05-04-2010, 05:37 PM   #3
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Quote:
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Reading this makes me break out in a cold sweat. I was almost to the point of banging my head against the wall when I had to deal with Medicare for DM. Problem is, you can't just throw your hands up and walk away.

FIL had to have nursing home care, then hospice care recently. What we read on Medicare's website was more or less the beginning-of-the-conversation with the nursing home. I have to be careful not to start another rant about the ping-pong process of crashing at the nursing home to being revived at emergency, only to go back to the nursing home to repeat the process...
That is what an advance directive is all about. Once you are on a hospice program you don't call an ambulance. Give the nursing home a DNR directive.
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Old 05-05-2010, 06:55 AM   #4
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Reading this makes me break out in a cold sweat. I was almost to the point of banging my head against the wall when I had to deal with Medicare for DM. Problem is, you can't just throw your hands up and walk away.
Interesting to see that Medicare Advantage (the private alternative to Medicare) is as big a mess as the public version. So why are we giving these guys an extra 14% to screw up as bad as any maligned bureaucrat?
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Old 05-05-2010, 08:53 AM   #5
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I've noticed increasingly that doctors require you to call the insurance company to verify coverage for a whole list of things, how much, etc. I had to do that last time after I hadn't seen the doctor for over a year so I was treated like a "new patient". Never had to do that before.

When MIL was being treated for cancer, they had very little trouble dealing with Medicare. They didn't have supplemental insurance, so maybe this simplified things.

Audrey
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Old 05-05-2010, 09:18 AM   #6
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I've noticed increasingly that doctors require you to call the insurance company to verify coverage for a whole list of things, how much, etc. I had to do that last time after I hadn't seen the doctor for over a year so I was treated like a "new patient". Never had to do that before.

When MIL was being treated for cancer, they had very little trouble dealing with Medicare. They didn't have supplemental insurance, so maybe this simplified things.

Audrey
A doctor's office should have the staff to do this for you....of course they want to verify it, they want to get paid! Whether they verify it or not, they can still bill you for it, but there is a much lower chance of being paid by a patient than by an insurance company.
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Old 05-06-2010, 03:01 AM   #7
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That is what an advance directive is all about. Once you are on a hospice program you don't call an ambulance. Give the nursing home a DNR directive.
FIL (93) went to emergency from home...presented DNR. He was sent from the hospital to the nursing home, where the DNR was presented. Problem is that the family had to INSIST that the DNR be enforced.

Here's the story...after FIL was admitted into the nursing home, family went home for the night...FIL crashed during the night and was sent to the hospital. Family was notified and arrived at emergency only to find that he had been "revived" and orders had been given to "release FIL back to the nursing home". After some heated words at the nursing home, they finally understood that FIL was only to be "kept comfortable". That brought on a slew of pencil pushers and grief counselors. The latter wanted to be sure we knew what we were doing in making the decision to "just keep him comfortable". I understand that...but they made MIL confirm the decision THREE times before they got all of the paperwork straight. Don't know if you've been there, but it was like ripping her heart out every time.

In the meantime, staff was trying to get FIL up to do physical therapy (PT)...if medicare pays, you have to get PT and food. Gees, FIL could no longer swallow and he was so far out of it that he couldn't get up to do PT. Finally, the pencil pushers arrived to confirm that we knew that medicare would pay for PT/nutrition, but would not pay for hospice. Yes, we knew.

It seems to me that there is something dreadfully wrong with this type of management...especially when a DNR had already been presented to hospital and nursing home. Sorry for the rant...pain/anger is still too fresh to be more objective.
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Old 05-06-2010, 07:13 AM   #8
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It sounds like a really good candidate for pain and suffering and mental anguish.
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Old 05-06-2010, 07:33 AM   #9
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It all depends on the Medicare Advantage plan you have. DW and I have United Health Care Secure Howizon and have never had that kind of problem. They have a phone book-size list of providers. Some of my past providers have left the area, retired or dropped out of that plan but those are few and far between. We chose that plan initially because most of our providers participated in Secure Horizons. If you go to the Medicare website and search various plans in your area, they will have a comparison of the plans. I guess word of mouth is the best recommendation. Don't forget, you can change plans at the end of the year.
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Old 05-06-2010, 03:31 PM   #10
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Take the DNR and any health care directives you have for your mother to a lawyer, together with a copy of her health care records for the previous (about) 10 days prior to their abrogating it. Have the attorney assess whether or not they violated the directives.

Assuming all is OK, this approach is a little aggressive but here is what I would do: Have your attorney contact the the nursing home that if they call 911 or transfer her to the hospital in the future that all the future cost of care is on their nickel. If they think they cannot meet her medical needs that they must call you immediately and you will evaluate the situation yourself. Send a letter to their physician stating that a DNR is on file and that s/he is legally obligated to comply with its instructions.
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