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Medicare Pricing Follies.

Ema

Senior Member
Messages
4,729
Location
Midwest USA
I thought this was a great piece that captures the frustrations with Medicare...

The Medicare coverage and price schedule is so complex that if you call Medicare for instruction, and ask different personnel, you will get widely varying answers, as documented by a number of studies. But if a physician makes a mistake and bills for something not covered, he or she has committed fraud, punishable by jail. Moreover, one cannot rely on advice from Medicare personnel as a legal defense. It is not surprising that a significant number of doctors, estimated at 15% but much higher in some areas, refuse to treat Medicare patients, and the number is likely to grow rapidly.

http://www.anh-usa.org/medicare-pricing-follies/
 

Ema

Senior Member
Messages
4,729
Location
Midwest USA
This one is pretty spot on as well:

He asks us to imagine for a moment a grocery store run along healthcare industry lines. In this case, he notes:


  • Product prices will not be posted.
  • The price will vary even within the same store, depending on who is buying and paying.
  • You won’t be able to shop during evenings or weekends.
  • If you need something, it probably won’t be there in the store. You may be told to come back days or weeks later.
  • Even if you find the item, you may have a long wait to be able to buy it.
  • If you want to charge your purchase, it won’t be at an automated machine; the transaction may be rejected; the necessary records may be missing; and someone from outside the store will have to approve the amount of the purchase. Since this all takes time, you may not be able to charge at all.
  • You won’t have the right to return anything. Even defective merchandise will not be reimbursed. As a result there will be no incentive to maintain product quality.
  • Your degree of satisfaction will not matter much to the store. What will count is the satisfaction of third-party payers, and the store will focus on how to get the most from their formula. If the third-party payer formula says you may not buy cherry pie and ice cream on the same day, you may grumble, but most likely you will have to return to get what you want.
  • There will be very few brands to guide you in your selection. Labels and quantities will be all over the map, so direct comparison shopping will be impossible.
  • Your chief protection against injury or death from what you buy will be hiring a lawyer to sue. These suits will in turn greatly increase the cost of the food you buy.
  • The purchase of many food items will require permission from a licensed professional. The professional, fearing a lawsuit, will require you to buy items you do not need or want.

http://www.anh-usa.org/what-if-grocery-stores-were-run-like-healthcare/
 

minkeygirl

But I Look So Good.
Messages
4,678
Location
Left Coast
I thought this was a great piece that captures the frustrations with Medicare...



http://www.anh-usa.org/medicare-pricing-follies/

I've learned over the years that you can call Medicare 5 times and get 5 different answers.

I've had good doctors opt out because they dont want to deal with Medicare. Not just for that reason but because they do t want to be hamstrung by the constraints.

Is it any wonder there are no ME docs in Medicare? 15 minute appointments, treatments not approved, labs not covered. Who'd want to have to deal with that?
 

Ema

Senior Member
Messages
4,729
Location
Midwest USA
I've learned over the years that you can call Medicare 5 times and get 5 different answers.

I've had good doctors opt out because they dont want to deal with Medicare. Not just for that reason but because they do t want to be hamstrung by the constraints.

Is it any wonder there are no ME docs in Medicare? 15 minute appointments, treatments not approved, labs not covered. Who'd want to have to deal with that?
Actually, Lerner does take Medicare patients. If he didn't, I would never have been able to afford cidofovir with all the associated travel expenses. But you're right that the vast majority don't. My LLMD, for example, does not participate with any insurance companies at all which is also typical. You can't take a thorough history in 15 min.
 

minkeygirl

But I Look So Good.
Messages
4,678
Location
Left Coast
@Ema I should have clarified and said medicare HMO's which I think are even more restrictive.

My PCP does do 1/2 appts but she's clueless and ME
 
Messages
2,565
Location
US
Actually, Lerner does take Medicare patients.

Maybe because he can bill as a specialist? I believe specialists get around 160%-167% payment that a GP gets. (And maybe more?) Copay is 160%-167% for many of the Medicare Advantage plans. It may depend on the specialty, what diagnosis code is used, and other factors.