Reply
Esteemed Contributor
Posts: 6,687
Registered: ‎03-10-2010

@pieman wrote:

@spent2much  That's where we are from and leaving Florida soon to head back/

Medical down here is a nightmare!

I fell, broke my pelvis in 3 places, plus broke my femur..

Got to the hospital, had a cat-scan and was told the great news from a Doogie Hauser, floor walker intern.

 

No surgery to fix anything, told no PT needed either,

Take Tylenol for pain as needed

I am still unable to walk without the walker and that will be almost 3 years ago,

Then Covid hit and no one wanted to know anything about private PT.

 

Its what you've said you get up there in years and they don't want to know anything, its very sad.

I hope when its their time, they will get doctors who treat them as bad ,if not worse than they've treated us down here.

 

Have all ready made arrangements for care back in Ct, so when I get home, I may get my life back, that sounds good to me.


@pieman 

That sounds terrible, but I have to ask if those were hairline fractures.  That makes a difference.  My bedbound son had a fall and fractured several vertabrae in his back.  They were hairline fractures so they were left to heal on their own and they did. He was seen by an orthopedic specialist and that was the standard treatment.

 

I can't imagine a total break (not hairline fracture) in the femur that would not get a cast.  It would need the cast to heal straight.  But again, not if it's just hairline. 

 

When I was in my late 30s my pelvis was fractured in 7 places in an auto accident.  There was no surgery, but I was in bed with a sling around my hips for many weeks.  Thankfully it all healed well and I'm still very active in my 70s. 

 

Given the bad experience you had, would you please share with us whether you had regular Medicare with a supplement, or an Advantage plan? 

"Breathe in, breathe out, move on." Jimmy Buffett
Esteemed Contributor
Posts: 7,776
Registered: ‎02-13-2021

Medicare reimbursement is a lot less than what private pay or other medical insurance types pay.  The reimbursement rate is so much lower.  This is not a new theory, and it is factual. 

 

I remember when I first started with Medicare and was going into Manhattan to see a specialist they sent me to their Clinic instead of the actual doctor I wanted to see.  No problem with the Clinic, but I knew it was because of my Medicare.  I was seen by the physicans who were doing residency and then the regular doctor would come in and go over the visit and then I'd leave.

 

All one need do is google to know we are on the lower rung of reimbursement for services rendered.  Some doctors/practices will take on Medicare patients (perhaps not as many as other types of insured) but they will take some.  Medicare has a standard payment schedule and when these doctors agree to accept Medicare that means they are willing to be reimbursed for the Medicare established rate.

 

Ever taken a look at one of your bills when Medicare sends you your statement of service provided?  Well I do, I make it my business.  There is the amount the Doctor/hospital charges (which is enormous always) then the Medicare amount of that charge that they will send for the service.  It's a pittance compared to what the doctors actually want to charge.  Then my 20% I pay later once the doc sends me the bill for my portion. 

 

If doctors had their way with no insurances (they don't pay for the exhorbitant rates either ~ but they do pay MORE THAN MEDICARE) they would get $500 an hour.  It's about the money.  Doesn't matter whether the physician has his/her own practice or if they work out of a hospital.  All doctors are affilliated with some hospital somewhere for "admitting purposes."  This is actually how I try to find my doctors and specialists.  Based on what hospitals in NYC they are given rights at.  The better the hospital afilliation, the better the chance I'd want this doc to be my doc.

 

I prefer more mature physicians because I figure they are not trying to pay back student loans.  In any event you have to advocate for yourself.  Then some docs and offices shouldn't even be allowed to practice so do your due dilligence and watch out for yourselves.





A Negative Mind ~ Will give you a Negative Life
Honored Contributor
Posts: 10,888
Registered: ‎03-10-2010

@Kalli   I don't think it's Medicare, I think it is the health care crisis they are having. At least in California. Not enough specialists.  Here you have to waits months to get appt with GI doctors or Rheumatologists and other specialty care.  No Internist will see you if you have cold symptoms, you have to go to urgent care   The ER is horrible. They put wrong medications, diagnosis etc on chart.   They are in a rush and tend  only to the obvious medical.  Here in California doctors left during Covid. They left all private practices, and medical groups just heard you in and out. I have good doctors, but the system only gives them enough time to  to ask a few basic questions.  It's horrible

Esteemed Contributor
Posts: 7,776
Registered: ‎02-13-2021

Wonder why some doctors grumble when a Medicare patient walks in the door? It's likely because the government program typically pays only 80% of what private insurers do.

 

 

Medicare has the bad rap of being a big, bloated government program, but it's not because it's overpaying doctors.

 

 

CNNMoney analyzed the "allowed charges" for five common procedures, using data provided the Centers for Medicare and Medicaid Services and Truven Health Analytics, a research firm.

 

 

The differences can be stark. Private insurers allow an average of $1,226 for low-back disc surgery, while Medicare will only permit $654, for instance.

And the gap can grow wider depending on where the patient is. In New York, insurers allow $1,352 for a gall bladder removal, compared to $580 for Medicare.

 

Some services are more comparable. For office visits by established patients, for instance, Medicare will allow 92% of what insurers do.

Overall, Medicare's allowed charges are roughly 80% of the charges allowed by private insurers - about the same as they have been since 1999.

 

Sometimes, however, the government does reimburse health care providers more. In Florida, for instance, a doctor doing a colonoscopy in his office will receive $395 for a Medicare patient, but only $342 for one covered by private insurance.

 

 

How does Medicare get away with paying less?

"Medicare doesn't negotiate rates. It sets them," said Stuart Guterman, vice president at The Commonwealth Fund, an independent health policy research group.

 

And doctors might be okay getting less per procedure because Medicare patients tend to need a lot of care. As a result, the total bill can add up. Nearly 4,000 doctors were paid more than $1 million from Medicare, according to data released this month.

 

 

Private insurers, meanwhile, can't cut rates that deeply or they risk a revolt by doctors, who may opt to leave the carrier.

 

 

https://money.cnn.com/2014/04/21/news/economy/medicare-doctors/index.html

 

 

How Does Medicare Estalish its Payment Rates?

 

Private payers usually establish provider prices through contract negotiations. If providers and payers are unable to agree on contracted prices, the provider is typically excluded from the insurer’s network. Medicare, on the other hand, is a price setter and uses a variety of approaches to determine the prices it will pay, depending on whether it is paying a hospital, doctor, drug or device. Through its rate setting process, Medicare aims to cover the costs that “reasonably efficient providers would incur in furnishing high-quality care.”3

 

 

"Traditional"4 Medicare typically determines a base rate for a specified unit of service and then makes adjustments based on patient clinical severity, geographic market differences and other factors.5 Further, Medicare considers factors such as: beneficiaries’ access to care, quality of care, and providers’ access to capital. If reimbursement rates are too low, facilities may selectively discourage patients covered by Medicare—limiting beneficiaries’ access to care. These considerations result in a balancing act for Medicare pricing.

 

 

Industry Claims

 

There is a debate as to whether Medicare underpays hospitals. The American Hospital Association (AHA) has long claimed that Medicare payment rates reimburse below the cost of care for many services. The payment-to-cost ratio represents average payment relative to average cost, with costs including both patient-specific clinical costs and fixed costs such as equipment, buildings and administrators’ salaries. A 2019 AHA survey found that Medicare reimbursement was $53.9 billion lower than actual costs.9 According to the AHA, private insurance payments average 144.8 percent of cost, while payments from Medicare average 86.8 percent of cost.10 The study also revealed that two-thirds of hospitals received payments from Medicare that were less than cost.11

 

 

The industry’s claims are supported by Medicare’s own data showing that hospital aggregate (inpatient and outpatient) Medicare profit margins (the difference between total net revenue and total expenses divided by total net revenue) were -9.9 percent in 2017. As a result, MedPAC recommended raising inpatient and outpatient payment rates for 2020.12

 

https://www.healthcarevaluehub.org/advocate-resources/publications/medicare-rates-benchmark-too-much...





A Negative Mind ~ Will give you a Negative Life
Esteemed Contributor
Posts: 7,776
Registered: ‎02-13-2021

@shoekitty wrote:

@Kalli   I don't think it's Medicare, I think it is the health care crisis they are having. At least in California. Not enough specialists.  Here you have to waits months to get appt with GI doctors or Rheumatologists and other specialty care.  No Internist will see you if you have cold symptoms, you have to go to urgent care   The ER is horrible. They put wrong medications, diagnosis etc on chart.   They are in a rush and tend  only to the obvious medical.  Here in California doctors left during Covid. They left all private practices, and medical groups just heard you in and out. I have good doctors, but the system only gives them enough time to  to ask a few basic questions.  It's horrible


@shoekittyI don't think the Health Care Crisis has anything to do with it.  This has been going on for quite some time.  It's akin to people snubbing their noses down at people who need other kinds of public assistance.  Only 40% of the U.S. population has Medicare.  The rest have private insurance or no insurance at all.





A Negative Mind ~ Will give you a Negative Life
Honored Contributor
Posts: 10,888
Registered: ‎03-10-2010

@gertrudecloset wrote:

@shoekitty wrote:

@Kalli   I don't think it's Medicare, I think it is the health care crisis they are having. At least in California. Not enough specialists.  Here you have to waits months to get appt with GI doctors or Rheumatologists and other specialty care.  No Internist will see you if you have cold symptoms, you have to go to urgent care   The ER is horrible. They put wrong medications, diagnosis etc on chart.   They are in a rush and tend  only to the obvious medical.  Here in California doctors left during Covid. They left all private practices, and medical groups just heard you in and out. I have good doctors, but the system only gives them enough time to  to ask a few basic questions.  It's horrible


@shoekittyI don't think the Health Care Crisis has anything to do with it.  This has been going on for quite some time.  It's akin to people snubbing their noses down at people who need other kinds of public assistance.  Only 40% of the U.S. population has Medicare.  The rest have private insurance or no insurance at all.


@gertrudecloset  I was saying in an around about way that I feel there isn't any difference between Medicare and private.  I had private and now Medicare last 3 years. At least near SILICON valley in California where I live. This did start years ago , but intensified during and after the Covid lockdowns.  I have a couple Dr friends and a nurse in family and this is what I hear. The work load is more.  More paper work, less patient care. That means less patients than 6 years ago in a day. They are retiring early, leaving for other jobs. And yes Medicare is bilked to the max and rife with fraud. I read the other day in NYT it is billions that Medicare supplement insurers falsely bill Medicare.  United Health care led the list. I have aarp united healthcare supplement lol and I love it. But how they work was a huge eye opener.  But as I said. All areas are different. I live in a populous state, and Santa Clara county with millions of residents.  

 

Esteemed Contributor
Posts: 7,776
Registered: ‎02-13-2021

@shoekitty wrote:

@gertrudecloset wrote:

@shoekitty wrote:

@Kalli   I don't think it's Medicare, I think it is the health care crisis they are having. At least in California. Not enough specialists.  Here you have to waits months to get appt with GI doctors or Rheumatologists and other specialty care.  No Internist will see you if you have cold symptoms, you have to go to urgent care   The ER is horrible. They put wrong medications, diagnosis etc on chart.   They are in a rush and tend  only to the obvious medical.  Here in California doctors left during Covid. They left all private practices, and medical groups just heard you in and out. I have good doctors, but the system only gives them enough time to  to ask a few basic questions.  It's horrible


@shoekittyI don't think the Health Care Crisis has anything to do with it.  This has been going on for quite some time.  It's akin to people snubbing their noses down at people who need other kinds of public assistance.  Only 40% of the U.S. population has Medicare.  The rest have private insurance or no insurance at all.


@gertrudecloset  I was saying in an around about way that I feel there isn't any difference between Medicare and private.  I had private and now Medicare last 3 years. At least near SILICON valley in California where I live. This did start years ago , but intensified during and after the Covid lockdowns.  I have a couple Dr friends and a nurse in family and this is what I hear. The work load is more.  More paper work, less patient care. That means less patients than 6 years ago in a day. They are retiring early, leaving for other jobs. And yes Medicare is bilked to the max and rife with fraud. I read the other day in NYT it is billions that Medicare supplement insurers falsely bill Medicare.  United Health care led the list. I have aarp united healthcare supplement lol and I love it. But how they work was a huge eye opener.  But as I said. All areas are different. I live in a populous state, and Santa Clara county with millions of residents.  

 


@shoekittyI hear you.  However, I don't think the Covid 19 crisis was the beginning of all of the problems we're having.  It's been in the making for years.  Not as many people going into medicine.  Shortage of physicians in the U.S. has been an ongoing and longstanding problem.  Some areas of the country are even worse.  Covid 19 may have exascerbated our already tenuous problem, but it didn't cause it. 

 

There are some top hospitals in California.  There are some very well regarded hospitals in NYC and other parts of our country.  What good are they if there is no staff and no one wants to become a doctor now?





A Negative Mind ~ Will give you a Negative Life
Honored Contributor
Posts: 10,888
Registered: ‎03-10-2010

@gertrudecloset wrote:

@shoekitty wrote:

@gertrudecloset wrote:

@shoekitty wrote:

@Kalli   I don't think it's Medicare, I think it is the health care crisis they are having. At least in California. Not enough specialists.  Here you have to waits months to get appt with GI doctors or Rheumatologists and other specialty care.  No Internist will see you if you have cold symptoms, you have to go to urgent care   The ER is horrible. They put wrong medications, diagnosis etc on chart.   They are in a rush and tend  only to the obvious medical.  Here in California doctors left during Covid. They left all private practices, and medical groups just heard you in and out. I have good doctors, but the system only gives them enough time to  to ask a few basic questions.  It's horrible


@shoekittyI don't think the Health Care Crisis has anything to do with it.  This has been going on for quite some time.  It's akin to people snubbing their noses down at people who need other kinds of public assistance.  Only 40% of the U.S. population has Medicare.  The rest have private insurance or no insurance at all.


@gertrudecloset  I was saying in an around about way that I feel there isn't any difference between Medicare and private.  I had private and now Medicare last 3 years. At least near SILICON valley in California where I live. This did start years ago , but intensified during and after the Covid lockdowns.  I have a couple Dr friends and a nurse in family and this is what I hear. The work load is more.  More paper work, less patient care. That means less patients than 6 years ago in a day. They are retiring early, leaving for other jobs. And yes Medicare is bilked to the max and rife with fraud. I read the other day in NYT it is billions that Medicare supplement insurers falsely bill Medicare.  United Health care led the list. I have aarp united healthcare supplement lol and I love it. But how they work was a huge eye opener.  But as I said. All areas are different. I live in a populous state, and Santa Clara county with millions of residents.  

 


@shoekittyI hear you.  However, I don't think the Covid 19 crisis was the beginning of all of the problems we're having.  It's been in the making for years.  Not as many people going into medicine.  Shortage of physicians in the U.S. has been an ongoing and longstanding problem.  Some areas of the country are even worse.  Covid 19 may have exascerbated our already tenuous problem, but it didn't cause it. 

 

There are some top hospitals in California.  There are some very well regarded hospitals in NYC and other parts of our country.  What good are they if there is no staff and no one wants to become a doctor now?


@gertrudecloset    Yes yes and yes.  I did say it has been going for years, but increased with Covid. When I was in hospital a few months ago, I was surprised at the care at one of the top hospitals. Things were broken, call buttons cannot be answered quickly, nurses are run ragged.  I was surprised how many nurses where I was were contracted from out of state. They came from all over, Michigan, Louisiana,,Nevada,   They sign for a year. I guess the money is good . Also, there were so many nurses that were on call or substitutes because they don't have regular staff. In the hospital one day I had nurse changing beds, and everything. What a mess the nurses and staff were excellent , it is just what can you do with no staff. ?  Hold your breath and do the best you can do
Esteemed Contributor
Posts: 5,739
Registered: ‎03-10-2010

@FranandZoe 


@FranandZoe wrote:

@millieshops wrote:

@qvcaddition    Your gastro gave you a different message than mine gave me when he scheduled me for my last colonoscopy. His strong recommendation to me was that because the anesthesia becomes more dangerous  and there's increased chances of a puncture wound in an old intestine, he would not chose another ROUTINE screening colonoscopy.   

 

He left it open for my having another one if I developed symptoms.  I was 78 when we did the consulting appointment, but 79 for the actual procedure.    When he came to the recovery room as I was waking, he immediately assured me I was free of any signs of disease, but he repeated his belief that I shouldn't undergo another unless my body functions changed.

 

I was insulted and didn't feel he put me out to pasture to eat my way into oblivion.


Why were you insulted?  Sounds like he was really looking out for you.  


My Dr. is a female.  She didn't insult me, she was telling me the facts.  I was 80 at my last colon. I am now 86. I didn't have a problem, but the Male Dr. that did it said it would be my last one.  I did have to fight or speak up for three times to get my b12 shots once a month.  The b12 vits. are not doing the job.

I have an HMO.

Esteemed Contributor
Posts: 5,291
Registered: ‎06-15-2015

@shoesnbags 

 

Most of the post by @pieman made little medical sense to me. You fracture a Femur, and and they tell you to take Tylenol?  No surgery to fix anything? To me a bunch of who shot john, not buying it for a minute.

 

Were I treated that way there would be some legal action in store for these doctors(?), or whomever these characters talked about in that post. Had too many injuries and health issues, and most of that post passed my smell test. Sounds like a bash the doctors to me.

 

hckynut  🇺🇸

hckynut(john)