Page 1 of 2 12 LastLast
Results 1 to 10 of 18

Thread: How is Medicare working where you live???

  1. #1
    New Community Member
    Join Date
    Oct 2006
    Location
    Texas
    Posts
    3

    Default How is Medicare working where you live???



    Hi everyone,

    It has been a long time since I have been here. Life just too complicated. I started here soon after my 1st surgery on 2000. Spinal fusion at L5S1. It was a very painful surgery- don't know how long it had been that bad since I had issues with my knees. It was after arthoscopic knee surgery, that the pain told me that I really had something wrong with my back - Ther doc gave me 2 choices: Have the surgery or get a wheelchair. (I alreasy had footdrop in my left foot.)

    Fast forward to 2012 well here I am with a long list of surgeries, the majority of then orthopaedic. See list beow. The most recent surgery was cervical fusion C4 to C5 (C5 to C7 was already fused.

    At the last visit we heard what Medicare was expecting the doctor and Patient to do. Even if there are obvious symptoms of a definate problem - such as MRI results, neuropathy in lower extremities and increased pain, Medicare may NOT agree to the surgery unless the patient is sent for epidural steroid injections and physicial therapy!!!!!!!!!!!!!!!! Then the Doc told us in addition, medicare is reviewing the patient's chart following a surgery and if their criteria is not met, they can take back from the doctors what they paid!!!!!!!!!!!!!!!!!!!!!!!! (They accomplish this by deducting the amount from the next check or checks from Medicare.

    Anyone else hear this??

    Leslie

  2. #2
    Distinguished Community Member Ging's Avatar
    Join Date
    Mar 2007
    Posts
    288

    Default

    Leslie, I just came back from PT and had to sign papers ,that stated, if I did not show improvement , they ( Medicare)would with hold payment to the Doctor.....guess who will then have to pay ? Yep the patient ! This is terrible ! What are they doing? It seems this is only for people on Medicare, Medicaid ...not the privately
    Insured ...money money money !!
    Last edited by Ging; 07-30-2012 at 11:48 AM.

  3. #3
    Distinguished Community Member
    Join Date
    Oct 2006
    Location
    Atlanta, Georgia
    Posts
    139

    Default

    Medicare doesn't.

    Linnie

  4. #4
    Distinguished Community Member
    Join Date
    Oct 2006
    Location
    S. Indiana
    Posts
    1,022

    Default

    This change with medicare came about as Obamacare goes in. The goal was a good goal of getting everyone covered through insurance but as we see what the results are people aren't going to be happy. This is not a political comment just the reality of the Bill, I read the majority of it, there are other major shocks coming if it isn't repealed and replaced by a more focused approach to help people. A lot isn't going to be working in a few years if we don't get real change started.

    Dr are dropping out of medicare because of these changes as they actually lose money if they have too many medicare patients. There are too many politicians that have no idea what they are passing into law, what people truly want, or they just demagogue their opponents instead of doing what is best for us, their representatives.
    1979 spinal issues, 1993 lumbar microdisectomy L3-4, 1996 360 3 level lumbar fusion L2-5, 1999 open thoractomy fusion T8-9,
    2002 C3-7 herniations and T4-7 herniations, 2004 total disability, a new limited life

  5. #5
    Community Member
    Join Date
    Oct 2006
    Location
    Indianapolis, Indiana
    Posts
    50

    Default

    I definitely agree with Mark.

    Leslie and Ging, I don't really know for certain. But I have Medicare A&B with my own private plan. So far, in the last few months I have had office visits and a couple of injections...no problem. But I did run into some bs with my elderly mother...long story. And she has the exact same insurance I do! It would be interesting if the both of you called Medicare and find out what is going on. But I THINK what the doc is saying is that conservative treatment has to be tried first before Medicare will pay. Again, I am not quite certain; just know what I went through with my mother. But what Mark said is spot on! However, none of my own Specialists have dropped out...not yet anyway.
    C3/C4 ACDF - 2004, C5/C6 ACDF - 2006
    L5/S1 - Facet Degeneration
    Lumbar Facet Rhizotomy L4, L5, S1 (left side) 2007
    Retired - DOD/Defense Finance & Acctg/IT - 2005

  6. #6
    Distinguished Community Member Ging's Avatar
    Join Date
    Mar 2007
    Posts
    288

    Default

    Kathi, , thanks for your reply, I thought I had medicare a & b and bought United Health care as a supplement , the PT office said no I don't have Medicare anymore, then they say after the 80%my part is 20% ...the 20% is why I have the supplement...this has happened twice ...concerning the same doctor as he has ownership in the surgical center, and in the PT facility. So I am wondering if they are getting their money up front anticipating the cuts ? This is crazy...

  7. #7
    Community Member
    Join Date
    Dec 2006
    Location
    Pacific Northwest
    Posts
    70

    Default

    I can't speak about Medicare but private insurance can decide not to cover visits, too. I've got 1st hand experience as I've been stuck with some bills that the insurance decided (6 months after the first visit) that it wouldn't cover. My insurance pegs every single physical therapy visit as "under medical review, additional documentation has been requested from the provider". I contact the provider and all they see is that the visit "under medical review". So, the "medical review" doesn't start until they receive all documentation requested and can take 30 to 60 days from that point on. All told, this process can stretch out for 4+ months. So I end up dropping out of PT over fear of racking up a huge bill that the insurance won't cover.

  8. #8
    Distinguished Community Member
    Join Date
    Oct 2006
    Location
    S. Indiana
    Posts
    1,022

    Default

    Newcervie, there is no perfect system but what I like about having insurance companies run policies is I have been able to go to my state insurance commission board and have them override insurance's decisions. When gov't runs it there is no one else to turn to. Lets face it, unless you are wealthy enough to pay your own medical bills we are at the mercy of who helps pay the bills. I do know that medicare will be more regimented on how they do things as they now have standards they require treatments to follow. It would be nice if they could adjust to individual situations but like most bureaucracies we have to fit them they don't fit what we need.
    1979 spinal issues, 1993 lumbar microdisectomy L3-4, 1996 360 3 level lumbar fusion L2-5, 1999 open thoractomy fusion T8-9,
    2002 C3-7 herniations and T4-7 herniations, 2004 total disability, a new limited life

  9. #9
    Distinguished Community Member Ging's Avatar
    Join Date
    Mar 2007
    Posts
    288

    Default

    Newcervie, exactly! I told them I could not afford a $40.00 copayment five days in a row, plus a $40.00 to follow up next week with the Dr. They are all paying less.I remember back in the Dinasour days when you had a procedure and your follow up was included in the initial charge ....ah for the good old days :(

  10. #10
    Community Member
    Join Date
    Oct 2006
    Location
    Indianapolis, Indiana
    Posts
    50

    Default

    Ging, you are welcome. I am a little confused though. How is that you don't have Medicare A&B anymore? If you don't mind my asking.

    Mark, I had to laugh because we (myself and husband) are at the mercy of Medicare, FEHBP (OPM) and Tricare. But I agree. I like having my own private plan...all OPM does is to administer it. And my husband brought up a good point this morning. We all have seen the "Law" but we have yet to see the REAL regulations. We both know for a FACT that OPM and CMS have been writing these regulations for some time now (before the Supreme Court ruling). So, yep, be prepared for more shock waves!
    C3/C4 ACDF - 2004, C5/C6 ACDF - 2006
    L5/S1 - Facet Degeneration
    Lumbar Facet Rhizotomy L4, L5, S1 (left side) 2007
    Retired - DOD/Defense Finance & Acctg/IT - 2005

Page 1 of 2 12 LastLast

Similar Threads

  1. THANKS Not Working
    By Beader in forum BrainTalk's feedback forum
    Replies: 7
    Last Post: 03-28-2014, 12:10 PM
  2. Tell David you want live chit chat
    By lor in forum Chit-Chat
    Replies: 1
    Last Post: 03-22-2012, 07:49 AM
  3. To Those That Live In USA
    By Abby2006 in forum Multiple Sclerosis
    Replies: 3
    Last Post: 11-27-2011, 07:27 PM
  4. Live Radio Show about TN Nov. 12, 2011
    By JeanC in forum Trigeminal Neuralgia
    Replies: 1
    Last Post: 11-12-2011, 01:25 AM
  5. PT says working out is bad?
    By funnylegs4 in forum Child Neurology
    Replies: 0
    Last Post: 08-20-2011, 06:41 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  


BTC Inc's Disclaimer and Privacy Policy

The material on this site is for information & support purposes only, and is not a substitute for medical advice provided by a licensed health care provider. Always consult your doctor before trying anything that you find online.