Good visit with new doctor (!) - Glendale, CA

[Mary]

I had a tele-appointment with a doctor in Glendale -it's about 60 -90 minutes from me, depending on traffic but today's visit was by phone. She's a regular MD and also is trained in functional medicine. She's in her 30's I think, very smart and very nice. I had talked to her once before and she seemed quite knowledgeable. If you'd like her name, send me a PM.

She takes Medicare (!) but has a surcharge, which I think is reasonable. Today's visit was probably close to 40 minutes and I was charged $75. I think an hour would be $150. They've made it affordable! Plus if I ever want to see their NP for routine things, it's a $45 surcharge.

So she basically asked me what I wanted from her and I explained the testing I'd like to get done and she was fine with everything, and suggested a few other things as well.

I don't seem to have dysautonomia issues, well, rarely on occasion but not as a regular matter, so I don't know how up she is on things like OI, etc.

She thinks I should try nutritional IVs - ozone/glutathione, NAD and an immune one. She said they're covered by Medicare! And is going to do a urine neurotransmitter test, again covered by Medicare, and Nutreval, the same. Her office is incredibly responsive. My appointment was over by 10:40 a.m. and maybe 90 minutes later her lab person was calling me to discuss tests.

She doesn't have an answer for ME/CFS but I think she's fairly knowledgeable, and willing to learn. I haven't had a decent doctor for probably 5 years. My prior one died - he couldn't solve ME/CFS either (no one can right now!) but he believed I was ill, was always willing to listen and support me if I wanted to try something new, and would come up with suggestions of things for me to try.

It feels like I have a partner in my corner, too good to be true! I was a bit nervous before the appointment - my last two experiences with new doctors did not go that well, one was very bad ("ME/CFS is not real, there is no research proving it's real, and there never will be, because it's not real") and the other was kindly and well-meaning but really knew nothing about ME/CFS and thought some exercise might make me feel better.

 

[Jyoti]

@Mary--what wonderful news. Finding a partner on the ME journey is almost as much longed for as the mythical life partner is for so many of us. Maybe even more so at times. I really hope this turns out to be a source of support and inspiration and above all, healing.

But no matter how it goes in terms of your health, the path will be a lot easier with someone who has your back. And an MD!

 

[lenora]

I had a tele-appointment with Dr. Anne Kuo of Oasis Family Medicine in Glendale -it's about 60 -90 minutes from me, depending on traffic but today's visit was by phone. She's a regular MD and also is trained in functional medicine. She's in her 30's I think, very smart and very nice. I had talked to her once before and she seemed quite knowledgeable.

She takes Medicare (!) but has a surcharge, which I think is reasonable. Today's visit was probably close to 40 minutes and I was charged $75. I think an hour would be $150. They've made it affordable! Plus if I ever want to see their NP for routine things, it's a $45 surcharge.

So she basically asked me what I wanted from her and I explained the testing I'd like to get done and she was fine with everything, and suggested a few other things as well.

I don't seem to have dysautonomia issues, well, rarely on occasion but not as a regular matter, so I don't know how up she is on things like OI, etc.

She thinks I should try nutritional IVs - ozone/glutathione, NAD and an immune one. She said they're covered by Medicare! And is going to do a urine neurotransmitter test, again covered by Medicare, and Nutreval, the same. Her office is incredibly responsive. My appointment was over by 10:40 a.m. and maybe 90 minutes later her lab person was calling me to discuss tests.

She doesn't have an answer for ME/CFS but I think she's fairly knowledgeable, and willing to learn. I haven't had a decent doctor for probably 5 years. My prior one died - he couldn't solve ME/CFS either (no one can right now!) but he believed I was ill, was always willing to listen and support me if I wanted to try something new, and would come up with suggestions of things for me to try.

It feels like I have a partner in my corner, too good to be true! I was a bit nervous before the appointment - my last two experiences with new doctors did not go that well, one was very bad ("ME/CFS is not real, there is no research proving it's real, and there never will be, because it's not real") and the other was kindly and well-meaning but really knew nothing about ME/CFS and thought some exercise might make me feel better.

Hi Mary.....I'm so glad that you finally found a Dr. that you can "connect" with, even though you didn't use that exact word. It makes all the difference in the world and that's why I encourage people to keep looking until they find a caring doctor. True, he/she may not cure you, perhaps that won't come along for awhile, but if they're trying, then we feel that we have someone in our corner. Someone who stays up to date on information, someone who take the job of physician seriously. What more can we ask?

Still, I can't help but think some answers will be coming out much sooner than they did in my life with ME. You have so much more going for you today. You sound heartened...and you should. I wish you well with your new doctor. Yours, Lenora

 

[Mary]

Finding a partner on the ME journey is almost as much longed for as the mythical life partner is for so many of us

Yes! I never fully appreciated my prior doctor when he was still here, though I was glad to have him. I don't think I realized quite how rare he was! I've gotten gun shy now with doctors. And this new one, making it affordable to see a functional medicine MD - most want $500 - $600 to just walk in the door. As I said above, it feels too good to be true!

 

[Mary]

. Someone who stays up to date on information, someone who take the job of physician seriously. What more can we ask?

Hi @lenora , I think you're right! I couldn't ask for anything more

 

[Sushi]

had a tele-appointment with Dr. Anne Kuo of Oasis Family Medicine in Glendale

So glad that you had a good appointment and that she was happy to order tests and suggest treatments--this is so important for patients like us--having a partner in medicine.

Did you have any sense of what she might have recommended if you had already done all those tests and tried those treatments? I feel like I am up against a wall and just wondered "what else is out there?'

 

[Mary]

Did you have any sense of what she might have recommended if you had already done all those tests and tried those treatments? I feel like I am up against a wall and just wondered "what else is out there?'

Not really. I looked through the testing Dr. Kaufman did for me back in 2015 and picked out the ones where I had abnormal results (some of the immune stuff) and she's glad to run that, as well as NK cell function, and hormone testing. I've never had neurotransmitter testing done, that was new to me, which she will do. I did have Nutreval testing done before but that was 10 years ago so I'll be doing that too.

One thing their office does is something called "brain mapping" and this was covered by Medicare. I had this done maybe 3 months ago (right before COVID). It showed some abnormalities but also I'd taken an antihistamine for sleep the night before - I know it messed with the results. I told the technician because they had said no antihistamines before the test but I wouldn't have been able to sleep without it so they said to do it anyways, just as a baseline. And then I had a follow-up phone appt about the results with Dr. Kuo. She was thorough, and that phone appt - an hour - was included in the brain mapping fees which I didn't have to pay.

At that phone appt she recommended neurofeedback based on the brain mapping, only that's when lockdown started plus I didn't want to do the drive. And I didn't expect much from it anyways. But you might want to look into this. If it had been easier for me to do, I might have pursued it.

I did tell her about Cellfood and how it was helping me and said I'd probably want to try the ozone IV, just to see how I reacted to it. Also - this is unrelated - but my crashes are starting to seem lighter, and recovering more quickly than before, I think due to the Cellfood. I'm not positive, but my last 3 crashes have all been lighter than before, and I recovered more quickly. It's too soon to tell if this is going to last or was just a fluke -- I'm taking 10 drops 3 x a day.

 

[Wolfcub]

@Mary I am so glad to hear your consultation went very well!
The surcharges on top of medicare coverage are okay and manageable. And how refreshing to speak to a genuinely helpful doctor!
I wish I lived there now......(sad)

 

[Mary]

@Mary I am so glad to hear your consultation went very well!
The surcharges on top of medicare coverage are okay and manageable. And how refreshing to speak to a genuinely helpful doctor!
I wish I lived there now......(sad)

Thanks @Wolfcub ! It's taken me five years to find her . . . well, actually I did read about this office a couple of years ago but something put me off, I can't remember what, maybe the surcharge though it most definitely is reasonable! I could scrape together the money for say one $600 visit but for follow-ups? And I know we went over half an hour and she still only charged $75. It's too bad you don't have someone like this where you live! Yes, if you lived here, I'd take you to see her, only I don't think you would like our summer desert heat!

 

[Wolfcub]

Yes, if you lived here, I'd take you to see her, only I don't think you would like our summer desert heat!

Nope. Give me snow. Blue skies and the cold stuff. (brrrr....plus a wood burning stove when I've had enough.)

It really is great and I am pleased for you. I am sure this doctor will be helpful.

 

[geraldt52]

...She takes Medicare (!) but has a surcharge, which I think is reasonable.

Not that it is on you, but I'm pretty sure that what the doctor is doing is illegal. As I understand it, when a doctor "accepts" Medicare they agree to accept as payment whatever Medicare allows...which is the reason why so many doctors no longer take Medicare, as they don't believe that the Medicare reimbursements are adequate. If it was as simple as the doctors just charging the patient a "surcharge", beyond what Medicare allows, there would be no reason that every doctor wouldn't do that, and continue seeing Medicare patients and charging them whatever they want, by way of a surcharge. They don't do that because I'm pretty sure that Medicare prohibits it. I'm not a lawyer, but you might want to take advantage of a free opinion from one of the legal services as to how it might impact you.

 

[Mary]

Hi @geraldt52 - you make a good point, worth looking into. I'm going to send you a PM about this.

 

[YippeeKi YOW !!]

As I understand it, when a doctor "accepts" Medicare they agree to accept as payment whatever Medicare allows...which is the reason why so many doctors no longer take Medicare,

I think that there are multiple ways to legally justify the additional charges, and since COVID, almost every medical and dental practice is adding additional surcharges for various 'sanitizing' costs, which weakens the whole 'no additional charges' thing .....

Nonetheless, it might be a good idea to look into that, just in case.

@Mary , I can;t tell you how happy I am to read that, after all this time since your really good Dr died, you've finally found someone who seems willing to fight in your behalf, and listen to what you want or think might help, including various lab tests, without dismissing you or putting you down with comments about their expertise vs. your amateur status !!!!

Selfishly, it gives all of us hope, so thank you so much for sharing that !!!!

 

[Sushi]

As I understand it, when a doctor "accepts" Medicare they agree to accept as payment whatever Medicare allows...which is the reason why so many doctors no longer take Medicare, as they don't believe that the Medicare reimbursements are adequate.

Very good question. This was also my understanding of Medicare too, but getting a legal clarification posted here would be helpful for all of us. The sanitizing fee would be valid for dentists who aren't part of government Medicare anyway, but I'd like to know more about how a surcharge can be added for a phone or video call. I have not had any in-office doc visits yet--only video--but it would be good to understand this.

 

[Mary]

I think that there are multiple ways to legally justify the additional charges,

I think there are ways to do this, but I will look into it.

I can;t tell you how happy I am to read that, after all this time since your really good Dr died, you've finally found someone who seems willing to fight in your behalf, and listen to what you want or think might help, including various lab tests, without dismissing you or putting you down with comments about their expertise vs. your amateur status !!!!

Thanks @YippeeKi YOW !! ! Yeah, she was really easy to talk to, just what you hope a doctor would be like. She told me she was impressed with everything I've done (e.g., my phosphorous discovery, potassium, to name a couple). And she had some good suggestions too! She knew what I was talking about and there was no whiff of condescension or judgment because I dare to use the internet!

Selfishly, it gives all of us hope

You know, in thinking about this, the fact that it's a major event to find a decent doctor - it is so telling about the horrific dearth of good doctors for all of us! It's probably like an AIDS patient in the early 1980's trying to find a good doctor, only it's 40 years on for us . . .

 

[Mary]

Very good question. This was also my understanding of Medicare too, but getting a legal clarification posted here would be helpful for all of us. The sanitizing fee would be valid for dentists who aren't part of government Medicare anyway, but I'd like to know more about how a surcharge can be added for a phone or video call. I have not had any in-office doc visits yet--only video--but it would be good to understand this.

I will look into this and let y'all know what I find. It is very hard for me to believe they don't know what they're doing billing-wise, but I'll find out.

 

[lenora]

Not that it is on you, but I'm pretty sure that what the doctor is doing is illegal. As I understand it, when a doctor "accepts" Medicare they agree to accept as payment whatever Medicare allows...which is the reason why so many doctors no longer take Medicare, as they don't believe that the Medicare reimbursements are adequate. If it was as simple as the doctors just charging the patient a "surcharge", beyond what Medicare allows, there would be no reason that every doctor wouldn't do that, and continue seeing Medicare patients and charging them whatever they want, by way of a surcharge. They don't do that because I'm pretty sure that Medicare prohibits it. I'm not a lawyer, but you might want to take advantage of a free opinion from one of the legal services as to how it might impact you.

Hi Gerald,

I've found (and I'm no young chick...age 73), that the younger doctors who take Medicare are often very open to discussions in their early years. They're still learning about how to talk to patients, have very good knowledge and are quite willing to share it and basically, talk things over. Every single physician that I've been to over the past 10 years (if they're new) has stuck with Medicare, even after their practices are established. Friends tell me the same thing. It's true that as time passes they don't have the same amount of time to spend with us, are often later in their appointments....the usual doctor thing. Going back 34 years or so ago, I was also starting with young doctors establishing their practices. Once they've made a commitment to people, it's lasting and we've stayed in each other's lives.

I'll wait and see what the legal minds have to say tomorrow, but I hope that things work out well for Mary and her new doctor. (And I know you do, too.) Yours, Lenora.

 

[YippeeKi YOW !!]

It is very hard for me to believe they don't know what they're doing billing-wise, but I'll find out.

I tend to agree, but I'm prejudiced in favor of ANY Dr. who knows their stuff, and doesn't mind if you know yours regarding an illness that you've battled for a couple of decades. But ya' never know ....

 

[YippeeKi YOW !!]

I'd like to know more about how a surcharge can be added for a phone or video call. I have not had any in-office doc visits yet--only video--but it would be good to understand this.

Even if it's a Skype call, wouldn't the Dr have to do basic disinfecting of the area and the computer he/she used for the call? I mean, unless it's a single-physician practice with no nurses. Otherwise, considering their possibility of multiple exposures during any given day, anyone in that office could pass it along to anyone else, including the patients.

That's my story and I'm stickin' to it ....

 

[valentinelynx]

Not that it is on you, but I'm pretty sure that what the doctor is doing is illegal. As I understand it, when a doctor "accepts" Medicare they agree to accept as payment whatever Medicare allows..

Medicare billing is a tricky business. They can change the rules and come after doctors for violating them retroactively! I once angered someone on this forum for bringing up a similar issue regarding a doctor that was waiving a fee for a patient not on Medicare—the law being that you cannot charge any patients less than what Medicare pays or you will be charged with Medicare fraud. The reasoning being that if you charge one patient less, then you are overcharging Medicare for the rest of the patients. Of course, that's ridiculous. Anyway, someone said that by warning of this, I was somehow possibly bringing it to the attention of the authorities! So, I was afraid to bring this up; glad someone did. However, it's more complicated when the doctor charge more than Medicare, as opposed to less.

Here's a breakdown of how it works:

First there's the concept of "accepting Medicare assignment". This means that a doctor who accepts assignment has agreed to accept the Medicare-approved amount as full payment for any covered service provided to a Medicare patient. If the doctor does not accept assignment they can charge more, but there are limits (see the second dot below).

The rules on charging are as follows: (from Medicare.gov's page on Concierge Care)

• Doctors who accept assignment can’t charge you extra for Medicare-covered services. This means the membership fee can’t include additional charges for items or services that Medicare usually covers unless Medicare won’t pay for the item or service. In this situation, your doctor must give you a written notice called an "Advance Beneficiary Notice of Noncoverage” (ABN) listing the services and reasons why Medicare may not pay.
• Doctors who don’t accept assignment can charge you more than the Medicare-approved amount for Medicare-covered services, but there’s a 15% limit called the " limiting charge ."
• All Medicare doctors (regardless of whether or not they accept assignment) can charge you for items and services that Medicare doesn’t cover.

So, perhaps @Mary 's doctor is charging the fee for non-Medicare covered services, or she doesn't "accept assignment" from Medicare and is therefore able to change up to 15% more for Medicare-covered services.