Wellness

[151949]

I heard that one candidiate who shall go unnamed has a plan to help get medicare costs under control and it is to make ALL supplements be HMO or PPO type plans. I am all for this  as it has already proven to be very cost effective in the private sector for the PCP to have some control. It is unfortunate that when people are allowed to see any doctor they want as much as they want - how medicare is now - there is a segment of people who are very abusive of this. We read here on the board all the time that someone went to 6 different doctors for some problem because they weren't being told what they wanted to hear. Well, that behavior costs Medicare a ton of money. When someone wants to see 6 doctors - fine - but that person should have to pay for it then, not the taxpayer. Why should it be on the taxpayer to pay for people to doctor shop all over town?  I know the hypocondriacs won't like it but that is their problem - I find this to be a very viable solution to a lot of medicare's issues.

[Tinkrbl44]

Interesting comments @151949 ....

I have to mull this one over and will comment later.   

[gidgetgh]

Aren't all Medicare supplements now either HMO's or PPO's?

My husband's supplement (plan F through Blue Cross) is a PPO. His PCP doesn't have to coordinate any of his care. 

[151949]

@gidgetgh Very few medicare supplements are HMO/PPO - very very few. Are you sure your husband doesn't have an advantage plan? They are mostly HMO/PPO plans. Supplements and advantage plans are not the same thing.

When you have a PPO plan and go out of network it is usually a very high copay - that is how they keep you in the network.

[gidgetgh]

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@151949 wrote:

@gidgetgh Very few medicare supplements are HMO/PPO - very very few. Are you sure your husband doesn't have an advantage plan? They are mostly HMO/PPO plans. Supplements and advantage plans are not the same thing.

When you have a PPO plan and go out of network it is usually a very high copay - that is how they keep you in the network.

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@151949- I am absolutely positive he doesn't have an advantage plan. Traditional Medicare and Blue Cross Plan F supplement. He has no co-pay for any doctor or hospital, lab, etc. Plan F picks up everything Medicare doesn't cover and covers all the co-Pays. 

[Moonchilde]

IMO rather than mandatory filtering through a PCP, there needs to be a cap on the # of specialists one can go to through Medicare, i.e. a second, and perhaps a share-the-cost third opinion should remain an option, and after that it's out-of-pocket.

Many (many!) times people are in serious situations where they need a specialist appt without undue delay. Many PCP offices make even their acutely ill patients wait 3 weeks to be seen (just happened in my household, necessitating 2 separate visits to an urgent care center instead). That sure wasn't cost-saving :-(

We know the supply of doctors is shrinking. In certain areas they are spread very thinly indeed. I foresee more and more issues with the time it will take to get in to see a PCP in order to be referred, and in some cases this could be dangerous or needlessly uncomfortable for the patient.

I agree with the need for some sort of cap in letting the patient make the decisions and spending the govt's money, but I don't know that I think the overspending is endemic and widespread.

[151949]

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@gidgetgh wrote:

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@151949 wrote:

@gidgetgh Very few medicare supplements are HMO/PPO - very very few. Are you sure your husband doesn't have an advantage plan? They are mostly HMO/PPO plans. Supplements and advantage plans are not the same thing.

When you have a PPO plan and go out of network it is usually a very high copay - that is how they keep you in the network.

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@151949- I am absolutely positive he doesn't have an advantage plan. Traditional Medicare and Blue Cross Plan F supplement. He has no co-pay for any doctor or hospital, lab, etc. Plan F picks up everything Medicare doesn't cover and covers all the co-Pays. 

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OK I believe you. PPO stands for Perferred provider organization - in other words , a network. So if they pay everything for him no matter what doctor he goes to what would be an advantage to them to have a network? What is his incentive to stay in the network? It doesn't make sense.

[151949]

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@Moonchilde wrote:

IMO rather than mandatory filtering through a PCP, there needs to be a cap on the # of specialists one can go to through Medicare, i.e. a second, and perhaps a share-the-cost third opinion should remain an option, and after that it's out-of-pocket.

Many (many!) times people are in serious situations where they need a specialist appt without undue delay. Many PCP offices make even their acutely ill patients wait 3 weeks to be seen (just happened in my household, necessitating 2 separate visits to an urgent care center instead). That sure wasn't cost-saving :-(

We know the supply of doctors is shrinking. In certain areas they are spread very thinly indeed. I foresee more and more issues with the time it will take to get in to see a PCP in order to be referred, and in some cases this could be dangerous or needlessly uncomfortable for the patient.

I agree with the need for some sort of cap in letting the patient make the decisions and spending the govt's money, but I don't know that I think the overspending is endemic and widespread.

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Private insurance found they saved a ton of money when they went with the  HMO /PPO options, and that is why they have all stayed with them.

As for limiting how many specialists a person can see - what if a person has multiple diseases and needs several different specialists? Many patients have more than one or two medical issues. What if you were seeing all the specialists you were allowed and then suddenly needed a surgeon? I don't see that as a solution.

[gidgetgh]

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@151949 wrote:

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@gidgetgh wrote:

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@151949 wrote:

@gidgetgh Very few medicare supplements are HMO/PPO - very very few. Are you sure your husband doesn't have an advantage plan? They are mostly HMO/PPO plans. Supplements and advantage plans are not the same thing.

When you have a PPO plan and go out of network it is usually a very high copay - that is how they keep you in the network.

---

@151949- I am absolutely positive he doesn't have an advantage plan. Traditional Medicare and Blue Cross Plan F supplement. He has no co-pay for any doctor or hospital, lab, etc. Plan F picks up everything Medicare doesn't cover and covers all the co-Pays. 

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OK I believe you. PPO stands for Perferred provider organization - in other words , a network. So if they pay everything for him no matter what doctor he goes to what would be an advantage to them to have a network? What is his incentive to stay in the network? It doesn't make sense.

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@151949- yeah, I agree with you.  Maybe we just haven't run into anyone out of network yet.  His PCP and Neurologist both take both and last year when he was hospitalized and had surgery, Medicare and Blue Cross covered everything, including the two ambulance trips.  In or out of network never came up and it didn't occur to me to ask as each physician, etc. came in his room.

[Moonchilde]

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@151949 wrote:

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@Moonchilde wrote:

IMO rather than mandatory filtering through a PCP, there needs to be a cap on the # of specialists one can go to through Medicare, i.e. a second, and perhaps a share-the-cost third opinion should remain an option, and after that it's out-of-pocket.

Many (many!) times people are in serious situations where they need a specialist appt without undue delay. Many PCP offices make even their acutely ill patients wait 3 weeks to be seen (just happened in my household, necessitating 2 separate visits to an urgent care center instead). That sure wasn't cost-saving :-(

We know the supply of doctors is shrinking. In certain areas they are spread very thinly indeed. I foresee more and more issues with the time it will take to get in to see a PCP in order to be referred, and in some cases this could be dangerous or needlessly uncomfortable for the patient.

I agree with the need for some sort of cap in letting the patient make the decisions and spending the govt's money, but I don't know that I think the overspending is endemic and widespread.

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Private insurance found they saved a ton of money when they went with the  HMO /PPO options, and that is why they have all stayed with them.

As for limiting how many specialists a person can see - what if a person has multiple diseases and needs several different specialists? Many patients have more than one or two medical issues. What if you were seeing all the specialists you were allowed and then suddenly needed a surgeon? I don't see that as a solution.

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Multiple diseases requiring specialists = for each specialist needed, not cumulative.

It's always good to save $$ and cut down on costs, but not at the expense of quality of care/neglect, i.e. waiting an inordinate amount of time to see a PCP and then further delay in getting an appt with a specialist. What if we're talking eyes here, for example. With the best judgment and best intentions, office staff might still cost a person their eyesight, in a worst case scenario. We'd all like to believe that wouldn't happen, but not every doctor, or practice, is what it should be.  And who wants to be the test case?

I'm not disagreeing with you entirely - I rarely see things in black and white, i.e. all wrong or all right, good/bad, etc. There should be room for discussion and compromise in most things, IMO, especially on a discussion forum.