topic Re: Why would some Drs not accept Medicare? in Wellness

Why would some Drs not accept Medicare?

Nataliesgramma — Thu, 25 Jun 2020 10:28:54 GMT

Our Dr of 40 years up and retired mid May. That left us with no Primary Care Physician.

I didn't think I would have a hard time finding a new one....but that wasn't the case.

All I wanted was one that was young enough that I wouldn't be going through this again in a couple years, one with good ratings and has an Office close.

About 3/4 of the Drs I inquired about either were NOT accepting new patients or do NOT accept Medicare. One Drs Office never even called me back!

I noticed one of my friends posted on FB that she was in the same boat as us and was looking for recommendations. She told me she found a DR (recommended By several of her friends). I called their Office. THEY WERE SO NICE and I got an appt for hubby for July 24th.

I never thought being on Medicare would be such a hassle.

Re: Why would some Drs not accept Medicare?

on the bay — Thu, 25 Jun 2020 10:33:33 GMT

I think it might have to do with they cannot charge as much with medicare?

they can charge as much but it won't be paid nor will the patient have to either. You know customary, acceptable charges.

I wouldn't want to go to a doctor who doesn't accept it.

Re: Why would some Drs not accept Medicare?

Witchy Woman — Thu, 25 Jun 2020 10:35:43 GMT

@Nataliesgramma

It never occurred to me that doctors might not accept Medicare, but I know from personal experience, that they don't always.

While I have decent health insurance, the GYN that I was going to will not accept Medicare. Thankfully, my supplemental health insurance covers most of the cost.

Their office visit and exam are high, so perhaps they cannot recover as much under Medicare.

Re: Why would some Drs not accept Medicare?

hopi — Thu, 25 Jun 2020 10:37:05 GMT

@Nataliesgramma

Medicare is actually excellent. Most Doctors know they will get their money. It does require proper paper work and coding which requires them to have a competent staff. Also @on the bay is correct they cannot overcharge and bogus up billing.

Re: Why would some Drs not accept Medicare?

meem120 — Thu, 25 Jun 2020 11:08:04 GMT

Doctors cant keep their offices open on medicare payments. Its as simple as that. Thats why many offices limit their new patients. The docs can charge whatever they want but medicare will pay only their rate, so Docs have to choose. I think its terrible that they dont take Medicare patients, but from a business standpoint you can see why. Medical offices are expensive to run. They need large, knowlegeable staff to deal with insurances, not to mention medical staff. Medical supplies are outrageous, not to mention office supplies. Then there's the malpractice insurance and general liability insurance and it goes on and on and on. For a large practice just the telephone bill alone can run several thousands dollard a month. Medicine is big business but not for doctors!!

Re: Why would some Drs not accept Medicare?

CalminHeart — Thu, 25 Jun 2020 11:11:33 GMT

@on the bay wrote:
I think it might have to do with they cannot charge as much with medicare?
Or
they can charge as much but it won't be paid nor will the patient have to either. You know customary, acceptable charges.
I wouldn't want to go to a doctor who doesn't accept it.

My doctors have all been paid in full by Medicare and my supplemental policy. I've never had Medicare decline to pay their full portion of any bill. My secondary insurance pays whatever is left after Medicare.

All insurance companies negotiate the going rate for each service so there are a lot of write-offs for people not on Medicare.

Hospitals get tax breaks for any supposed losses, benefit greatly from the 2017 tax plan to reduce corporate taxes, and always increase their prices to cover any supposed losses.

Re: Why would some Drs not accept Medicare?

gardenman — Thu, 25 Jun 2020 11:23:12 GMT

I had an old hematologist who charged everyone the Medicare rate. He explained that if one patient was paying him more than another he might find himself favoring the patient who paid more, so he eliminated that by charging everyone the Medicare rate. He had a center city Philly office (Tenth and Chestnut in the old Jefferson Building) but a minimal, one person staff in Monica his receptionist/do-it-all-gal. You had to file your own insurance regardless of what type of insurance you had. You'd get a receipt and the insurance was your problem. He'd draw your blood and do the labs himself. Other docs did not approve, but his patients loved him and he made a good living. He had a home in Philly and one at the Jersey shore, and put his two daughters through good universities. He even made house calls. Sadly he had a stroke in 1990 and had to retire. He always ran late, but he never rushed a patient. He'd spend an hour or more with you if necessary.

Re: Why would some Drs not accept Medicare?

catter70 — Thu, 25 Jun 2020 12:12:40 GMT

I'm worrying about maybe having to find a new PC physician. The hospital mine is affiliated with is being sold and everyone has to reapply for positions with the new owners.This will take place on July 1. My doctor who is of retirement age could either not now be accepted or may not want to bother with the hassle. I guess I'll find out soon. I have an appointment the end of next month.

Re: Why would some Drs not accept Medicare?

deeva — Thu, 25 Jun 2020 12:41:45 GMT

Because of the low reimbursement rate and having to hire additional staff to handle the paperwork.

Re: Why would some Drs not accept Medicare?

Jaspersmom — Thu, 25 Jun 2020 12:50:29 GMT

Google this article:

What to Do When Your Doctor Doesn't Take Medicare

Re: Why would some Drs not accept Medicare?

happycat — Thu, 25 Jun 2020 14:30:22 GMT

I have been told Medicare doesn't pay as well. I don't think it should be legal for drs to refuse folks, just because they are on medicare.

Re: Why would some Drs not accept Medicare?

Still Raining — Thu, 25 Jun 2020 14:49:25 GMT

Medicare has always only been an option. Seems to be more common with physician who do not do services in a hospital, when the hospital will require it.

Check to see what your state does with balance billing.

Re: Why would some Drs not accept Medicare?

Carmie — Thu, 25 Jun 2020 15:02:34 GMT

Medicare has a low reimbursement rate. Some services only pay pennies on a dollar. They also do not pay anything for some services like drawing blood, or for some lab fees.

If the doctor accepts Medicare, these low payments and non-covered fees cannot be billed to the patient.

HIPPA, in addition to the privacy concerns, also requires doctors to submit claims electronically, and use certain coding methods. These changes have caused my doctors to retire early and many others to form a large group, so that they can afford the staff and equiptment needed for standard operating and billing.

This equiptment is super expensive. Insurance companies also had to spend millions of dollars for this. It made insurance costs go up and many some small companies went out of business.

In some states, like PA where I live, all doctors must accept Medicare allowances and cannot charge the difference between what Medicare allows and the provider's charge. This is good for me and bad for them.

It is very difficult for doctors to stay in business if they have all Medicare patients. In order to do so, they must see many, many patients in a day. Quantity over quality.. that's the reason doctors rush their patents through. They get paid so little,thatthey need to make up for it by seeing more patients.

If the US goes to socialized medicine, it will get worse. In our Country, doctors are self employed. They also pay for their own education.

In most countries with socialized medicine, doctors are employees of the government. They also get their education paid for. They get paid a salary and usually it' not going to make them wealthy.

I have worked in the health insurance industry a long time. I am scared for what I know is going to happen with our health care. If you think it is bad now....just wait.

Re: Why would some Drs not accept Medicare?

Scooby Doo — Thu, 25 Jun 2020 15:11:29 GMT

Try to find a doctor that is in a clinic attached to a hospital. They have to take Medicare. All hospitals are required to take Medicare. That way the doctor is being paid a salary by the hospital corporation and it won't matter to the doctor if you have Medicare.

Re: Why would some Drs not accept Medicare?

dulwich — Thu, 25 Jun 2020 15:19:00 GMT

I worked in medical field in CA for quite a few years, The message from all the Drs/Clinics was do not take Medicare new patients.

Coming from U.K. I did not understand this but was told paperwork involved, amount of reimbursement and the length of time taken not worth it. All about money.

So many people were turned away. When we moved to AZ totally different Medicare accepted everywhere, new patients welcome.

When we came back CA same problem as we had Medicare and our additional carrier did not operate here - luckily we found a new carrier so that plus Medicare works - but here in CA it seems to me nothing has changed re Medicare - not a good scenario.

Re: Why would some Drs not accept Medicare?

ID2 — Thu, 25 Jun 2020 15:21:50 GMT

Wow OP your doctor of that long didn't even sit down with his patients and recommend doctors for them? Really? My PCP I had for almost 40 years and for months before he retired he did his homework with all of his patients and recommeded doctors for them. Me included.

Re: Why would some Drs not accept Medicare?

shoesnbags — Thu, 25 Jun 2020 18:04:20 GMT

Around here many doctors do not accept patients with Medicare Advantage plans. They do accept patients who have traditional Medicare with a supplement. That's what we have, and we haven't encountered any problems seeing any doctor we wanted.

Re: Why would some Drs not accept Medicare?

germanshepherdlove — Thu, 25 Jun 2020 18:09:25 GMT

A lot of large clinics that have all the specialities within a 10 or 20 mi radius don't take Medicare because they are offering their own Part C Advantage Plan which they always claim is superior to Medicare.

Problem for us, because we don't live in Ca where doctors have a much better reputation for their skill and expertise, is that particular clinic that we went to for years under my husband's health plan through his employer....has awful doctors, rigid in their thinking who get angry if you ask about other types of therapies that are not approved by their superiors and which we had no prior knowledge until they got angry. Had enough of that and were fortunate to find an excellent doctor in private practise who does take Medicare.

But I still believe that health care is more advanced in Ca and NYC and one's survival is much better...obviously at Johns Hopkins and other medical centers too in Ohio and in AZ and forgive me if I haven't mentioned your fine city too.....

Boo for us since we don't live in any of those cities/states.

Re: Why would some Drs not accept Medicare?

Lali1 — Thu, 25 Jun 2020 18:14:16 GMT

For the same reason they don't accept other health insurance. Because the insurance does not pay as much as some others do. So the doctors and hospitals work at a discounted rate when they take the insurance.
I dealt with the situation when I broke my arm in several places Jan 2019. I went to three different preops before I had surgery because the hospital would call me the night before the surgery and inform me they did not take my insurance. I waited 3 weeks to have surgery. My husband was livid.

Re: Why would some Drs not accept Medicare?

Witchy Woman — Thu, 25 Jun 2020 19:34:44 GMT

@shoesnbags

That has been my experience.

I'm a retired Fed and my "supplemental" is a top notch plan offered to me as an employee, and taken into retirement.

My understanding is, Medicare is the primary, and my Federal health plan is secondary. I've assumed they get paid one way or another.

My GYN (as I mentioned), mentioned outright they didn't do Medicare, but they billed the full amount to my secondary plan. I didn't pay any portion of the bill.