Diagnosing Knee Problems over the Phone - Medicare

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Topic Author
vested1
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Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 12:27 pm

My wife is in need of an orthopedic surgeon to diagnose and treat her knee problems, which have been getting worse recently. We have few of these specialists who accept Medicare locally, so our choices are limited. She has Medicare parts A, B, D, and N. There is no need for a referral with her coverage, and I confirmed with her insurance carrier (UHC through AARP) that she can go directly to a specialist without a referral. They even suggested this doctor. My wife is 65.5 years old.

We looked at the ratings of the specialists in our area that are accepting new Medicare patients before calling. I was surprised at the offices reluctance to see my wife. A receptionist at the doctor's office called back and asked my wife what her symptoms were, basically asking her what she thought was wrong and asking her what she thought the diagnosis and treatment should be. They also asked if she was being referred by her PCP, which again is not necessary. My wife has a new PCP which she won't see for another 2 weeks as her previous doctor refuses to accept Medicare.

Since my wife isn't a medical professional she did the best she could to explain her pain while walking and climbing stairs, the occasional collapse of one or the other of her knees, and her trouble supporting herself while standing because of the pain, which is almost equal in both knees.

The receptionist wouldn't give my wife an appointment and told her that they would make a decision within the next 24 to 48 hours if they would see her in the future, then hung up on her. Most of the other orthopedic surgeons that accept Medicare in our area are in the same office as the one we called.

I suppose that any business has the right to refuse service to anyone, but I thought that if a doctor accepts Medicare and is accepting new patients that they should/would honor that commitment. Apparently I was wrong, but would like that confirmed by someone who knows.

livesoft
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by livesoft » Wed Jan 09, 2019 12:54 pm

Sounds like your spouse got a free consult.
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adam1712
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by adam1712 » Wed Jan 09, 2019 12:55 pm

I'm guessing the surgeon's thinking is they don't want to waste their time if your wife is not a candidate for surgery. And your wife likely isn't a candidate for surgery unless she's tried pain medications with management by a PCP and/or physical therapy.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 1:06 pm

livesoft wrote:
Wed Jan 09, 2019 12:54 pm
Sounds like your spouse got a free consult.
Great. I'll tell her to just ignore the pain and be thankful she still has legs. /s
Last edited by vested1 on Wed Jan 09, 2019 1:10 pm, edited 1 time in total.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 1:08 pm

adam1712 wrote:
Wed Jan 09, 2019 12:55 pm
I'm guessing the surgeon's thinking is they don't want to waste their time if your wife is not a candidate for surgery. And your wife likely isn't a candidate for surgery unless she's tried pain medications with management by a PCP and/or physical therapy.
How would they know until they see her and test her mobility at the very least? A receptionist is not a doctor. This condition has been getting worse for years and she does take over the counter medication when needed, as well as talking to her previous PCP about it.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 1:09 pm

deleted
Last edited by vested1 on Wed Jan 09, 2019 1:09 pm, edited 1 time in total.

RickBoglehead
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by RickBoglehead » Wed Jan 09, 2019 1:09 pm

Receptionists aren't medical professionals. Even if that was a doctor, I'd write off that practice totally. Find a doctor that wants to see patients.

Rupert
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Rupert » Wed Jan 09, 2019 1:10 pm

vested1 wrote:
Wed Jan 09, 2019 1:08 pm
adam1712 wrote:
Wed Jan 09, 2019 12:55 pm
I'm guessing the surgeon's thinking is they don't want to waste their time if your wife is not a candidate for surgery. And your wife likely isn't a candidate for surgery unless she's tried pain medications with management by a PCP and/or physical therapy.
How would they know until they see her and test her mobility at the very least? A receptionist is not a doctor. This condition has been getting worse for years and she does take over the counter medication when needed, as well as talking to her previous PCP about it.
Would the old PCP call and make an appointment for her? A referral may not be required for payment by your insurance but may be required by the specialist.

jayk238
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by jayk238 » Wed Jan 09, 2019 1:12 pm

vested1 wrote:
Wed Jan 09, 2019 1:06 pm
livesoft wrote:
Wed Jan 09, 2019 12:54 pm
Sounds like your spouse got a free consult.
Great. I'll tell her to just ignore the pain and be thankful she still has legs.
Dude. With all due respect there is a reason why we have pcps. She may have to wait till she sees one. Orthopedic surgeons do not want to do the work of a pcp. That means evaluting the knee, ordering imaging (which is necessary priro to the surgery anyway) and ordering physical therapy or doing knee injections. All of which I do. I understand your frustration w this system but only in america do we get to circumvent the primary care. In europe you usually have to go through them. Im sorry for your wifes pain but this may be her only option.

I empathize and sympathize for your wifes suffering and I wish her a speedy recovery and hope she gets care asap.
Last edited by jayk238 on Wed Jan 09, 2019 1:13 pm, edited 1 time in total.

jayk238
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by jayk238 » Wed Jan 09, 2019 1:12 pm

Rupert wrote:
Wed Jan 09, 2019 1:10 pm
vested1 wrote:
Wed Jan 09, 2019 1:08 pm
adam1712 wrote:
Wed Jan 09, 2019 12:55 pm
I'm guessing the surgeon's thinking is they don't want to waste their time if your wife is not a candidate for surgery. And your wife likely isn't a candidate for surgery unless she's tried pain medications with management by a PCP and/or physical therapy.
How would they know until they see her and test her mobility at the very least? A receptionist is not a doctor. This condition has been getting worse for years and she does take over the counter medication when needed, as well as talking to her previous PCP about it.
Would the old PCP call and make an appointment for her? A referral may not be required for payment by your insurance but may be required by the specialist.
Most orthopods in my area will reject a referral without a note showing an eval and appropriate imaging.

TN_Boy
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by TN_Boy » Wed Jan 09, 2019 1:13 pm

vested1 wrote:
Wed Jan 09, 2019 1:08 pm
adam1712 wrote:
Wed Jan 09, 2019 12:55 pm
I'm guessing the surgeon's thinking is they don't want to waste their time if your wife is not a candidate for surgery. And your wife likely isn't a candidate for surgery unless she's tried pain medications with management by a PCP and/or physical therapy.
How would they know until they see her and test her mobility at the very least? A receptionist is not a doctor. This condition has been getting worse for years and she does take over the counter medication when needed, as well as talking to her previous PCP about it.
She needs a physical exam, ideally with an orthopedic group, but an exam by a good general practitioner might be a good enough start. Has she had X-rays or an MRI? Has she been aggressive about stating to her doctor "my ability to do X is curtailed by my knee pain, how can we fix that?"

There are a lot of knee issues you can't fully diagnose without an MRI. A lot of things can cause knee pain (ask me how I know this ...)

btenny
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by btenny » Wed Jan 09, 2019 1:20 pm

I have found good orthopedic doctors are very busy and have tons of work. So their staff screens patients and limit new patients to referrals from other Docs they know and other hospitals etc.. So cold call requests to get an appointment may not work. Plus Docs in general are not happy with the low fees they receive from Medicare so they also try to limit the number of those patients. So I suggest you may not get to see the doctor you selected without going through your PCP if at all.

I broke my back last year in a fall. I went to the ER and got treated. They gave me some meds and a brace and told me to go see a specialist orthopedic guy in the next week. I called the guys office for an appointment and got told he could not see anyone for 2 months. Sound familiar? I did not understand so I called the hospital and complained. That got me a call back and a appointment in 4 days. When I visited the doctor he said I "bet up" his staff over the phone to get my appointment. He was nice about the comment but I was again bothered. Later I found out he does not see anyone unless referred and since he was not "consulted during my ER visit" it was not exactly a referral. He ended up seeing me that week but I did not need any treatments beyond a MRI. And now 12 months later I am almost 100% well. So his last treatment plan rings true. "When your back quits hurting you are well."

So I suggest your wife see her PCP and see what they recommend.

Good Luck.

Rupert
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Rupert » Wed Jan 09, 2019 1:22 pm

jayk238 wrote:
Wed Jan 09, 2019 1:12 pm
Rupert wrote:
Wed Jan 09, 2019 1:10 pm
vested1 wrote:
Wed Jan 09, 2019 1:08 pm
adam1712 wrote:
Wed Jan 09, 2019 12:55 pm
I'm guessing the surgeon's thinking is they don't want to waste their time if your wife is not a candidate for surgery. And your wife likely isn't a candidate for surgery unless she's tried pain medications with management by a PCP and/or physical therapy.
How would they know until they see her and test her mobility at the very least? A receptionist is not a doctor. This condition has been getting worse for years and she does take over the counter medication when needed, as well as talking to her previous PCP about it.
Would the old PCP call and make an appointment for her? A referral may not be required for payment by your insurance but may be required by the specialist.
Most orthopods in my area will reject a referral without a note showing an eval and appropriate imaging.
It's weird how practices vary across the country. In my city, most orthopedists reserve a few appointments a day for accident cases. So you can almost always get in to see an orthopod within a day or two. On the other hand, it takes about a month to get an appointment with my PCP. Some specialists though (e.g., rheumatologists, cardiologists and pulmonologists, all of which I have personal experience with so speak with some authority on with respect to the practice in my city), will not take new patients without a referral, regardless of what the insurance company permits or requires.

Kennedy
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Kennedy » Wed Jan 09, 2019 1:30 pm

I am not at all surprised that the ortho wouldn't see her without a workup. There are lots of things that cause knee pain, not all of which have a surgical treatment. Specialists are generally busy with many having a waiting list.

If it was me, I would wait the two weeks to see the primary care (or ask to be put on a cancellation waiting list). The PCP can evaluate the knee properly and order any physical therapy or imaging. I don't know medicare requirements, but some private insurance companies will not even pay for MRIs unless certain criteria is met (PT, passage of time, etc.).

Please don't be offended, but one of the reasons health care costs in the US are sky-high is because too many people jump right to a specialist (including the emergency dept.) rather than start with the lower cost PCP who can take care of many issues. It may turn out that she needs to see an ortho, but it is a waste of money to have the ortho do a workup that should be done by a PCP.

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bottlecap
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by bottlecap » Wed Jan 09, 2019 1:32 pm

My wife is in the healthcare field.

The problem I think your wife is experiencing is that Medicare "don't pay enough" for many services "to pay the bills."

So the office is trying to figure out on the front end whether a) Medicare will pay at all and b) your wife is likely to require services that will justify signing her up as a Medicare patient and seeing her.

Here is the problem my wife has seen with her employer: Medicare doesn’t pay enough for some services to justify agreeing to treat a patient, unless the other services the provider is likely to provide can make up for the loss.

So many prices Medicare will pay are incorrect.

A bureaucracy can’t set a fair price for one service, let alone tens of thousands of services. Heck, it can't even keep up with classifying all of the services. So some prices will be too low and some will be too high. Some may not even be billable unless the office is creative with codes.

And my guess is once that office accepts the Medicare patient, it is stuck with that Medicare patient.

Maybe tell them she will self pay for the initial consult?

Good luck,

JT

WillRetire
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by WillRetire » Wed Jan 09, 2019 1:38 pm

vested1:

Though your wife should not in theory have to do this, the path of least resistance may be for her to have her knee examined by her PCP, then get a referral from him/her. The process and bureaucracy can be maddening, but if she has medigap, she is likely well covered for PCP visits as well as specialist visits. It's a good idea anyway to keep the PCP in the loop.

She can also request a consultation with world-renowned clinics like Mayo and Cleveland, but honestly, those too will likely require tons of medical history and paperwork, not to mention travel.

She should ask her PCP for multiple referrals. Be prepared to travel if she wants to avoid that one office where she was rudely treated.

Once her PCP agrees she needs orthopedic care, things should go smoothly.

If she needs orthopedic surgery, consider traveling to a facility that is highly rated in that field.
https://health.usnews.com/best-hospital ... rthopedics

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 1:40 pm

Rupert wrote:
Wed Jan 09, 2019 1:10 pm
vested1 wrote:
Wed Jan 09, 2019 1:08 pm
adam1712 wrote:
Wed Jan 09, 2019 12:55 pm
I'm guessing the surgeon's thinking is they don't want to waste their time if your wife is not a candidate for surgery. And your wife likely isn't a candidate for surgery unless she's tried pain medications with management by a PCP and/or physical therapy.
How would they know until they see her and test her mobility at the very least? A receptionist is not a doctor. This condition has been getting worse for years and she does take over the counter medication when needed, as well as talking to her previous PCP about it.
Would the old PCP call and make an appointment for her? A referral may not be required for payment by your insurance but may be required by the specialist.
Not possible. My wife transitioned to Medicare in July 2018 when her retiree insurance transitioned to secondary. She had an appointment with the previous PCP in October and informed them of the transition, providing all the cards and information. They failed to tell her that they don't take Medicare. They also refused to bill Medicare and the secondary wouldn't pay anything because Medicare wasn't billed. I successfully disputed the $400 bill because they were given all the information but didn't warn my wife. I was willing to negotiate but they immediately said "fine" and hung up. I think I see a local pattern forming.

Now her previous PCP refuses to renew her prescriptions even though UHC called and asked him to do a short term renewal until she could see her new PCP. Luckily she has barely enough to last until then. He used to be my PCP as well until he kicked me off, mailing me a 2 page handwritten letter insulting my company provided insurance. He was just out of school at the time.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 1:51 pm

Kennedy wrote:
Wed Jan 09, 2019 1:30 pm
I am not at all surprised that the ortho wouldn't see her without a workup. There are lots of things that cause knee pain, not all of which have a surgical treatment. Specialists are generally busy with many having a waiting list.

If it was me, I would wait the two weeks to see the primary care (or ask to be put on a cancellation waiting list). The PCP can evaluate the knee properly and order any physical therapy or imaging. I don't know medicare requirements, but some private insurance companies will not even pay for MRIs unless certain criteria is met (PT, passage of time, etc.).

Please don't be offended, but one of the reasons health care costs in the US are sky-high is because too many people jump right to a specialist (including the emergency dept.) rather than start with the lower cost PCP who can take care of many issues. It may turn out that she needs to see an ortho, but it is a waste of money to have the ortho do a workup that should be done by a PCP.
This seems to be the consensus, and is a reasonable solution. After all, she's waited this long. She has been patient however, at my urging.

Our retiree insurance through her previous employer was cancelled as of 12/31/18, and we were forced onto Medicare supplemental and Part D. We were only informed about about this 6 months ago. We talked about her knees and decided to wait until the new insurance kicked in on 1/1/19 to avoid unforeseen issues with changing coverage. Our OOP went from about $1,300 to about $11,500 per year, excluding co-pays for office visits and hospital stays. Luckily we have HRA's from our previous employers that cover most of it after we submit proof of payment. We can only hope the HRA's continue.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 1:56 pm

Thanks to all for your suggestions. It seems that one of the advertised benefits of our Medicare supplemental of "Not needing a referral" is simply a marketing tool that doesn't stand up to reality. I will stop being penny wise and pound foolish in trying to avoid what I perceived was an unnecessary step in obtaining a referral.

fru-gal
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by fru-gal » Wed Jan 09, 2019 2:02 pm

Out of curiosity, what area of the country are you in?

I have the same insurance you do except plan F instead of N (I forget the difference.)

I live in Rhode Island, and I see specialists in RI and Mass. including ones at the excellent Mass teaching hospitals. If you are near a teaching hospital, that may be your best bet.

As I recall, in all my ortho issues, my primary has done imaging first. I have never had to supply a reference to a specialist, although I usually say when calling in that my internist has said I should see Dr. SoandSo about my (insert body part here.)

The only reason I can see about your former primary not renewing a prescription is that there is some Medicare gotcha that limits fees if a doctor treats any Medicare aged patient and maybe the renewal counts as that.

I would ask your wife to hang in there for the two weeks it takes her to see her new primary care doctor. Hopefully he or she can get this started and should know specialists to refer her to.

There does seem to be a wide variation geographically as to how doctors deal with Medicare patients. In my area, we seem to be lucky.

Update: I will say that it never occurred to me, except for ER type stuff, to not go to my internist first.

Shallowpockets
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Shallowpockets » Wed Jan 09, 2019 2:19 pm

Well thank goodness I have a Medicare Advantage plan. I thought that one of the things people consider the greatest advantage when going on Medicare supplemental is, I want to pick my own doctors, and I want to go see a specialist if I want. I guess in reality it does not quite work that way.
Your wife's knees should be seen by a PCP first. XRs, and the usual gamet of treatments or lifestyle changes. It is pretty straight forward. Why waste the time on the phone or in person or here on BH concerning an orthopedist when you could be moving forward with the PCP right now.
And, if you have to wait a few weeks for an apt, what's the big deal on that? The knees have been bad for a while and you may have to wait a while longer. Or have pursued this sooner.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 2:22 pm

fru-gal wrote:
Wed Jan 09, 2019 2:02 pm
Out of curiosity, what area of the country are you in?

I have the same insurance you do except plan F instead of N (I forget the difference.)

I live in Rhode Island, and I see specialists in RI and Mass. including ones at the excellent Mass teaching hospitals. If you are near a teaching hospital, that may be your best bet.

As I recall, in all my ortho issues, my primary has done imaging first. I have never had to supply a reference to a specialist, although I usually say when calling in that my internist has said I should see Dr. SoandSo about my (insert body part here.)

The only reason I can see about your former primary not renewing a prescription is that there is some Medicare gotcha that limits fees if a doctor treats any Medicare aged patient and maybe the renewal counts as that.

I would ask your wife to hang in there for the two weeks it takes her to see her new primary care doctor. Hopefully he or she can get this started and should know specialists to refer her to.

There does seem to be a wide variation geographically as to how doctors deal with Medicare patients. In my area, we seem to be lucky.
Central coast of California. We have a great number of doctors and specialists, but due to the level of wealth there are relatively few doctors who accept Medicare. When I complained to my previous employer some years back that there were few doctors who would accept their insurance I was told by them that was because we were so rural and didn't have many doctors to choose from. I sent them a list of over 300 doctors within a 5 mile radius.

adam1712
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by adam1712 » Wed Jan 09, 2019 2:24 pm

vested1 wrote:
Wed Jan 09, 2019 1:51 pm
Kennedy wrote:
Wed Jan 09, 2019 1:30 pm
I am not at all surprised that the ortho wouldn't see her without a workup. There are lots of things that cause knee pain, not all of which have a surgical treatment. Specialists are generally busy with many having a waiting list.

If it was me, I would wait the two weeks to see the primary care (or ask to be put on a cancellation waiting list). The PCP can evaluate the knee properly and order any physical therapy or imaging. I don't know medicare requirements, but some private insurance companies will not even pay for MRIs unless certain criteria is met (PT, passage of time, etc.).

Please don't be offended, but one of the reasons health care costs in the US are sky-high is because too many people jump right to a specialist (including the emergency dept.) rather than start with the lower cost PCP who can take care of many issues. It may turn out that she needs to see an ortho, but it is a waste of money to have the ortho do a workup that should be done by a PCP.
This seems to be the consensus, and is a reasonable solution. After all, she's waited this long. She has been patient however, at my urging.

Our retiree insurance through her previous employer was cancelled as of 12/31/18, and we were forced onto Medicare supplemental and Part D. We were only informed about about this 6 months ago. We talked about her knees and decided to wait until the new insurance kicked in on 1/1/19 to avoid unforeseen issues with changing coverage. Our OOP went from about $1,300 to about $11,500 per year, excluding co-pays for office visits and hospital stays. Luckily we have HRA's from our previous employers that cover most of it after we submit proof of payment. We can only hope the HRA's continue.
Sorry for your wife's increasing knee pain. I hope she can find treatment that helps. Make sure she communicates with her PCP and any future surgeon about the previous care she received from her PCP and the time-course of the pain. As important as many think a physical exam is for diagnosing and deciding to treat, the history and previous treatments have a big effect on what clinicians decide for many health problems.

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vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 2:29 pm

Shallowpockets wrote:
Wed Jan 09, 2019 2:19 pm
Well thank goodness I have a Medicare Advantage plan. I thought that one of the things people consider the greatest advantage when going on Medicare supplemental is, I want to pick my own doctors, and I want to go see a specialist if I want. I guess in reality it does not quite work that way.
Your wife's knees should be seen by a PCP first. XRs, and the usual gamet of treatments or lifestyle changes. It is pretty straight forward. Why waste the time on the phone or in person or here on BH concerning an orthopedist when you could be moving forward with the PCP right now.
And, if you have to wait a few weeks for an apt, what's the big deal on that? The knees have been bad for a while and you may have to wait a while longer. Or have pursued this sooner.
We don't have access to Medicare Advantage plans in our area according to Medicare.gov, and I posted this question after not being able to find an answer on the web, also knowing that many doctors who deal with this issue are members here. At least one of them replied to answer my question, which is more proof that this site is a great resource.

InMyDreams
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by InMyDreams » Wed Jan 09, 2019 3:16 pm

you might try looking for a sports medicine or physiatrist (physical medicine) doctor in your area. They might be quicker to get in to, and provide the first eval that the orthopod wants.

I was recently grateful that my father was not on a Med Advantage program. When I needed a fast second opinion for his eye problem, I didn't have to work within a single system to get it. And he did need that second opinion.

There are advantages and disadvantages to both.

There is a national shortage of Primary Care Physicians.

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dodecahedron
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by dodecahedron » Wed Jan 09, 2019 3:24 pm

At least one large (and very good) orthopedic practice in my area runs SPECIALIZED urgent-care walk-in clinics, no appointment necessary. It is staffed by physician assistants (PAs) who do initial exams, screening and triage. The PAs are specialist PAs with expertise specifically in orthopedics. Depending on how urgent they perceive the issue to be, they can get you to the doc right away or schedule an appointment for followup.

You could see if there is such a practice in your area.

WillRetire
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by WillRetire » Wed Jan 09, 2019 5:27 pm

vested1 wrote:
Wed Jan 09, 2019 1:51 pm

This seems to be the consensus, and is a reasonable solution. After all, she's waited this long. She has been patient however, at my urging.

Our retiree insurance through her previous employer was cancelled as of 12/31/18, and we were forced onto Medicare supplemental and Part D. We were only informed about about this 6 months ago. We talked about her knees and decided to wait until the new insurance kicked in on 1/1/19 to avoid unforeseen issues with changing coverage. Our OOP went from about $1,300 to about $11,500 per year, excluding co-pays for office visits and hospital stays. Luckily we have HRA's from our previous employers that cover most of it after we submit proof of payment. We can only hope the HRA's continue.
How is that possible? Medigap Plan N covers all but the deductible.

Yooper16
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Yooper16 » Wed Jan 09, 2019 5:40 pm

Over the years I have had similar questions/conversations with my SIL on medical systems/insurance. She has been a billing person in private practice and ultimately retired from the billing dept of a regional Hospital system.

"No referral needed" from Medicare is really only talking about payment authorization, same applies to supplements etc. The practice can still have an internal procedure that requires referral from another Dr. or even the ER. The likelihood is that this practice has such a procedure.

My Urologist, at previous residence, would not take anyone without a Physician referral or if he was on ER duty/call and was involved in your treatment. The later was my case, with a 10mm kidney stone. My PCP said I had a lucky stone that day. When my DH had a kidney issue, he got in without an issue because I was an established patient. Or it seemed that that was the key.

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by carolinaman » Wed Jan 09, 2019 5:45 pm

I have seen a number of orthopedic docs for all sorts of issues and I have never had problems getting an appointment, including the 9 years I have been on Medicare. I could see some sort of screening to determine how quickly you need to be seen but that diagnosis sounded really odd.

I would not trust a diagnosis by a PCP for knee issues. They may or may not do a decent job but at the end of the day will likely refer you to an orthopedic. OTOH, that may be your best option to get a referral to a specialist.

When I was in my 30s, I tore 2 ligaments in my right knee playing soccer. I did not know what was wrong and could not put any weight on it and could only hop on my good leg. One of my teammates took me to ER. The resident doctor told me I had a bruised knee. I hobbled around for 10 days before finally seeing an orthopedic. He did major knee reconstruction surgery the next day. It took the orthopedic a minute to diagnose my problem. He did x-rays and other things, but he knew immediately what the problem was. See a specialist.

Broken Man 1999
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Broken Man 1999 » Wed Jan 09, 2019 6:04 pm

InMyDreams wrote:
Wed Jan 09, 2019 3:16 pm
you might try looking for a sports medicine or physiatrist (physical medicine) doctor in your area. They might be quicker to get in to, and provide the first eval that the orthopod wants.

I was recently grateful that my father was not on a Med Advantage program. When I needed a fast second opinion for his eye problem, I didn't have to work within a single system to get it. And he did need that second opinion.

There are advantages and disadvantages to both.

There is a national shortage of Primary Care Physicians.
My DW's knees are a mess as well. We have a Humana Medicare Advantage PPO plan, so no referrals necessary, but she asked her PCP for a suggestion of an Orthopedic doctor. He suggested the doctor that is the orthopedic doctor for the Tampa Bay Lightening NHL team. There are steps that are appropriate (perhaps required, for all I know) prior to surgery. First came PT. That has been done. Check. Next came an expensive series of three injections in each knee ($550 copay for the injections). Check. Next, at some time in the future will come knee replacements. It is only a matter of time, so she is resigned to her fate in the future, when is unclear. I am pretty confidant she is in good hands, but I wish PT and the injections could have kept her out of the realm of knee replacements.

Because we live in a two-story home, I'll be investigating the possibility of a chair lift, as our staircase is straight, and will easily accommodate a chair lift.

One thing I have found is even with no "official" referral, our PCPs can get us in to see good specialists quickly even if they have a long wait for appointments. I told my PCP he had a great clique, and he said, No, YOU have a great clique. I agree. All I've had to do is say Dr XX suggested I see you, and the appointments open up.

So, your PCP can open doors for you even if a referral isn't needed, in some cases.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

likegarden
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by likegarden » Wed Jan 09, 2019 6:19 pm

I would not use any diagnosis over the phone. I am on Medicare and have additional insurance at $120 per month. My PCP (have him for 25 years) ordered Xray, ultra sound, CT scan tests which showed that my right knee's meniscus had a slight rip, and I now have severe arthritis in my right hip, probably due to the knee problem walking differently. He suggested possibly getting a hip joint replacement. I think all this is due to advancing age, I take one Tylenol, and do not want to see any surgeon.

staythecourse
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by staythecourse » Wed Jan 09, 2019 6:47 pm

Just because an office agrees to see medicare doesn't mean they have to see all medicare. Most offices limit the amount of medicare or medicaid (if they are willing at all) based on being profitable. Why would anyone running a for profit see more of a less profitable segment of the population then another unless they have to?

I don't do the above for several reasons, but don't blame any medical office for doing it. The common man somehow thinks running a medical office is somehow different then running any other business. It isn't like a dry cleaner would be willing to be paid 0.50cents for a shirt vs. $1.50 per shirt that another customer would be willing to pay.

My advice, is establish your PCP first. The BIGGEST advantage of having a good PCP is it is their responsibility to get you to the right referrals not only in specialty, but based on your insurance. I have always said you don't notice having a good PCP when you have one, but realize it when you don't have one. Your PCP will work the system as you advocate.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

SlowMovingInvestor
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by SlowMovingInvestor » Wed Jan 09, 2019 7:37 pm

staythecourse wrote:
Wed Jan 09, 2019 6:47 pm
Just because an office agrees to see medicare doesn't mean they have to see all medicare. Most offices limit the amount of medicare or medicaid (if they are willing at all) based on being profitable. Why would anyone running a for profit see more of a less profitable segment of the population then another unless they have to?

I don't do the above for several reasons, but don't blame any medical office for doing it. The common man somehow thinks running a medical office is somehow different then running any other business. It isn't like a dry cleaner would be willing to be paid 0.50cents for a shirt vs. $1.50 per shirt that another customer would be willing to pay.
If an office says it does not take Medicare or Medicaid that's one thing, but for an office to say it takes Medicare (or any other insurance for that matter), and then to limit or discourage patients with Medicare (or a particular plan), that's another matter altogether.

If any other business were to agree to provide a menu of services to people in a group and then not actually provide some of the services, then I would not consider it acceptable either.

Topic Author
vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 7:52 pm

WillRetire wrote:
Wed Jan 09, 2019 5:27 pm
vested1 wrote:
Wed Jan 09, 2019 1:51 pm

This seems to be the consensus, and is a reasonable solution. After all, she's waited this long. She has been patient however, at my urging.

Our retiree insurance through her previous employer was cancelled as of 12/31/18, and we were forced onto Medicare supplemental and Part D. We were only informed about about this 6 months ago. We talked about her knees and decided to wait until the new insurance kicked in on 1/1/19 to avoid unforeseen issues with changing coverage. Our OOP went from about $1,300 to about $11,500 per year, excluding co-pays for office visits and hospital stays. Luckily we have HRA's from our previous employers that cover most of it after we submit proof of payment. We can only hope the HRA's continue.
How is that possible? Medigap Plan N covers all but the deductible.
Yes, but Plan D does not if you have an expensive prescription, which my wife does. We paid $10 every 90 days up until the end of 2018. The same medication, which has been on the market for over 20 years and was granted a patent extension recently for another 14 years has a copay of about $5,300 a year on her plan. The Part D through my previous employer had the lowest co-pay we could find for her medication. My prescription co-pays on a different Part D plan are $224 a year.

Her single medication was eligible for a "discount" card for patients, regardless of income prior to age 65, which accounted for the $10/90 day co-pay. The manufacturer was sued by a competitor a few years back and was forced to negate eligibility for the card for anyone using Part D.

My wife's previous insurance through her previous employer covered us both for medical, prescriptions, dental and vision for $100 a month, even past Medicare until they decided to end it at the end of 2018. Since she didn't have Part D until 1/1/19 she still qualified for the subsidy from the manufacturer until then. The drug without insurance costs over $74,000 a year per Medicare.gov

Topic Author
vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 8:03 pm

Thanks again to everyone for their helpful advice, as always. I certainly learned some things. This issue is now resolved as I just got a call from the orthopedist's office that they will accept my wife as a patient. We set up two appointments, one for xrays and another for the initial consultation.

I was just a bit surprised over the initial calls to and from the office concerning their over-the-phone self-diagnosis and their delay/possible refusal to even see her. We're fortunate that they didn't require a referral, which is apparently their right.

staythecourse
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by staythecourse » Wed Jan 09, 2019 8:11 pm

SlowMovingInvestor wrote:
Wed Jan 09, 2019 7:37 pm
staythecourse wrote:
Wed Jan 09, 2019 6:47 pm
Just because an office agrees to see medicare doesn't mean they have to see all medicare. Most offices limit the amount of medicare or medicaid (if they are willing at all) based on being profitable. Why would anyone running a for profit see more of a less profitable segment of the population then another unless they have to?

I don't do the above for several reasons, but don't blame any medical office for doing it. The common man somehow thinks running a medical office is somehow different then running any other business. It isn't like a dry cleaner would be willing to be paid 0.50cents for a shirt vs. $1.50 per shirt that another customer would be willing to pay.
If an office says it does not take Medicare or Medicaid that's one thing, but for an office to say it takes Medicare (or any other insurance for that matter), and then to limit or discourage patients with Medicare (or a particular plan), that's another matter altogether.

If any other business were to agree to provide a menu of services to people in a group and then not actually provide some of the services, then I would not consider it acceptable either.
Willing to take is not the same as HAVING to take every patient with x insurance. Like it or not that is EVERY private owners right of running their own company. They can refuse to accept anyone they want as long as they are not discriminating on one of the protected categories.

I don't like it as a customer as well, but do love it as a business owner (run my own practice). If you run your own business you would love it as well.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

meebers
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by meebers » Wed Jan 09, 2019 8:15 pm

It was a 2 year "grind" for me. X-ray's MRI's, shots, partial clean out and finally the fix, total knee replacement. :(

SlowMovingInvestor
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by SlowMovingInvestor » Wed Jan 09, 2019 8:17 pm

staythecourse wrote:
Wed Jan 09, 2019 8:11 pm
SlowMovingInvestor wrote:
Wed Jan 09, 2019 7:37 pm
staythecourse wrote:
Wed Jan 09, 2019 6:47 pm
Just because an office agrees to see medicare doesn't mean they have to see all medicare. Most offices limit the amount of medicare or medicaid (if they are willing at all) based on being profitable. Why would anyone running a for profit see more of a less profitable segment of the population then another unless they have to?

I don't do the above for several reasons, but don't blame any medical office for doing it. The common man somehow thinks running a medical office is somehow different then running any other business. It isn't like a dry cleaner would be willing to be paid 0.50cents for a shirt vs. $1.50 per shirt that another customer would be willing to pay.
If an office says it does not take Medicare or Medicaid that's one thing, but for an office to say it takes Medicare (or any other insurance for that matter), and then to limit or discourage patients with Medicare (or a particular plan), that's another matter altogether.

If any other business were to agree to provide a menu of services to people in a group and then not actually provide some of the services, then I would not consider it acceptable either.
Willing to take is not the same as HAVING to take every patient with x insurance. Like it or not that is EVERY private owners right of running their own company. They can refuse to accept anyone they want as long as they are not discriminating on one of the protected categories.

I don't like it as a customer as well, but do love it as a business owner (run my own practice). If you run your own business you would love it as well.
To me, that seems akin to false advertising. Like a restaurant saying (for instance) that it would offer a discount for customers with a particular dining card and then not take some such customers to avoid having to offer the discount. That's totally different from not taking or claiming to honor the card at all (which strikes me as perfectly fine).

And I have run my own business in the past, and I would not do that.
Last edited by SlowMovingInvestor on Wed Jan 09, 2019 8:27 pm, edited 2 times in total.

Topic Author
vested1
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by vested1 » Wed Jan 09, 2019 8:22 pm

staythecourse wrote:
Wed Jan 09, 2019 8:11 pm
SlowMovingInvestor wrote:
Wed Jan 09, 2019 7:37 pm
staythecourse wrote:
Wed Jan 09, 2019 6:47 pm
Just because an office agrees to see medicare doesn't mean they have to see all medicare. Most offices limit the amount of medicare or medicaid (if they are willing at all) based on being profitable. Why would anyone running a for profit see more of a less profitable segment of the population then another unless they have to?

I don't do the above for several reasons, but don't blame any medical office for doing it. The common man somehow thinks running a medical office is somehow different then running any other business. It isn't like a dry cleaner would be willing to be paid 0.50cents for a shirt vs. $1.50 per shirt that another customer would be willing to pay.
If an office says it does not take Medicare or Medicaid that's one thing, but for an office to say it takes Medicare (or any other insurance for that matter), and then to limit or discourage patients with Medicare (or a particular plan), that's another matter altogether.

If any other business were to agree to provide a menu of services to people in a group and then not actually provide some of the services, then I would not consider it acceptable either.
Willing to take is not the same as HAVING to take every patient with x insurance. Like it or not that is EVERY private owners right of running their own company. They can refuse to accept anyone they want as long as they are not discriminating on one of the protected categories.

I don't like it as a customer as well, but do love it as a business owner (run my own practice). If you run your own business you would love it as well.

Good luck.
I agree with this completely. A medical practice is a business with the need to be profitable, and dealing with insurance must be a nightmare. That being said, my wife's previous PCP (young and arrogant) was remiss in refusing to renew her prescriptions before she was able to see a new PCP, nor to get so personal with me about poorly paying insurance by writing me that ridiculous two page insulting letter. I was working at the time and had no control over what my employer offered for health insurance. A simple, "I can no longer have you as a patient due to your insurance coverage" would have been sufficient.

dknightd
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by dknightd » Wed Jan 09, 2019 8:27 pm

I'm confused. A history of knee problems. No they can not diagnose those over the phone!
My last stop would be a surgical solution!

JPM
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by JPM » Wed Jan 09, 2019 8:33 pm

From the professional side, orthopedic practices have clinic hours largely for preoperative and postoperative visits. Some enjoy the clinic and the personal relationships developed in clinic but others regard their job as primarily one of being a highly effective technical surgeon and have little interest in seeing clinic patients for visits unrelated to a surgical procedure. From the PCP's point of view, having a great technical surgeon to refer to is very important. Any competent surgeon can do a routine case in his repertoire, but for a tough case you want the best technical surgeon available.

On the commercial side, the orthopedic practice makes most of its money in the OR, not in the clinic. Maximizing surgical production is an important business consideration. Many, by no means all, consider doing the PCP's work as a waste of their valuable time.

One large orthopedic group in my area has a daily walk-in clinic to which patients established in its practice can simply walk in or call ahead for an urgent problem or if not established can obtain a same-day appointment on referral from a PCP. Each doctor in the six man practice takes one or two half-days per week in this duty. The other group of four will provide same day service only if the PCP calls and persuades the ortho clinic of the need for a same day appointment for the patient.

The specialists in some areas expect to do most of the diagnostic work themselves, but this is an inefficient method of organizing a system. It requires a PCP visit to make the referral, a first visit to the specialist for initial evaluation, the specialist then orders a number of tests, then the patient returns to discuss the test results, receive the diagnosis if one is established by the initial testing, and then either a treatment plan or further diagnostic testing is proposed at the second visit. I am familiar with some large groups in which the PCPs do little other than direct traffic to the specialists. More efficient organizations have the PCP do the initial evaluation and order the tests that the specialist is likely to require and so more can be accomplished by the specialist in the initial visit with the diagnostics in hand.

stlutz
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by stlutz » Wed Jan 09, 2019 8:34 pm

vested1 wrote:
Wed Jan 09, 2019 8:03 pm
Thanks again to everyone for their helpful advice, as always. I certainly learned some things. This issue is now resolved as I just got a call from the orthopedist's office that they will accept my wife as a patient. We set up two appointments, one for xrays and another for the initial consultation.

I was just a bit surprised over the initial calls to and from the office concerning their over-the-phone self-diagnosis and their delay/possible refusal to even see her. We're fortunate that they didn't require a referral, which is apparently their right.
Good news! Glad the appointment piece got worked out.

Without a diagnosis this can be hard, but I'd write down your list of questions that you'll have before you go in for the appointment. The standard ones are easy to think of if you spend a little time beforehand ("What are the alternatives to surgery", "How long will it before I know the PT isn't helping", "Is that definitely the problem or could it be something else?").

As has been noted, orthopedic offices are extremely busy between the regular patients and trauma patients, so it can be had to get an answer to a question you don't think of the next morning.

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Wed Jan 09, 2019 10:09 pm

vested1 wrote:
Wed Jan 09, 2019 1:56 pm
Thanks to all for your suggestions. It seems that one of the advertised benefits of our Medicare supplemental of "Not needing a referral" is simply a marketing tool that doesn't stand up to reality. I will stop being penny wise and pound foolish in trying to avoid what I perceived was an unnecessary step in obtaining a referral.
I think you're completely misunderstanding what a "referral" is. This has nothing to do with a "referral". A "referral" is simply a request from one doctor asking another to see a patient. It is used simply when some insurance companies require patients to see their (less expensive) PCP prior to going to a (more expensive) specialist. Medicare should absolutely require referrals and it irritates me that they do not. The issue you are missing is that no workup has been done at all. No physical exam, no xrays. The orthopedic surgeon wants to see patients who need surgery. They don't need a "referral". They need documentation that your wife is a candidate for surgery.

StoopieHippo
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by StoopieHippo » Wed Jan 09, 2019 10:22 pm

I think you should also keep in mind that sometimes a knee problem could be something that surgery wouldn't help, so a orthopedic surgeon really wouldn't be necessary for treatment. It could be something like arthritis which, while painful, wouldn't necessarily be helped by surgery. Best to get diagnosed by a PCP versus just going for a surgical consult.

I skipped a referral for an orthopedic, but that was because I broke 3 bones in my ankle and needed surgery the next morning. I wouldn't exactly suggest going that route. ;)

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goodenyou
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by goodenyou » Wed Jan 09, 2019 10:26 pm

toofache32 wrote:
Wed Jan 09, 2019 10:09 pm
vested1 wrote:
Wed Jan 09, 2019 1:56 pm
Thanks to all for your suggestions. It seems that one of the advertised benefits of our Medicare supplemental of "Not needing a referral" is simply a marketing tool that doesn't stand up to reality. I will stop being penny wise and pound foolish in trying to avoid what I perceived was an unnecessary step in obtaining a referral.
I think you're completely misunderstanding what a "referral" is. This has nothing to do with a "referral". A "referral" is simply a request from one doctor asking another to see a patient. It is used simply when some insurance companies require patients to see their (less expensive) PCP prior to going to a (more expensive) specialist. Medicare should absolutely require referrals and it irritates me that they do not. The issue you are missing is that no workup has been done at all. No physical exam, no xrays. The orthopedic surgeon wants to see patients who need surgery. They don't need a "referral". They need documentation that your wife is a candidate for surgery.
Not only that, but Medicare stopped paying for consultation E&M CPT codes (9924-x) years ago and only recognizes New Patient codes (9920-x) further LOWERING reimbursements. Patients prefer the efficiency of having the specialist do the work-up and expedite surgery, if necessary, but it is a poor use of time for the surgeons. That’s why more surgeons’ offices hire Mid-Levels to take care of this.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Wed Jan 09, 2019 10:39 pm

staythecourse wrote:
Wed Jan 09, 2019 6:47 pm
Just because an office agrees to see medicare doesn't mean they have to see all medicare. Most offices limit the amount of medicare or medicaid (if they are willing at all) based on being profitable. Why would anyone running a for profit see more of a less profitable segment of the population then another unless they have to?
When I was a Medicare provider, I scheduled Medicare and Medicaid appointments to Monday mornings at 8am. These were the least desirable slots and hardest to fill by the younger crowd who would often no-show the appointments, and it seemed Medicare patients were OK with those time slots. Medicaid we triple-booked because only 1 out of 3 Medicaid patients show up for their appointments.
SlowMovingInvestor wrote:
Wed Jan 09, 2019 7:37 pm
If an office says it does not take Medicare or Medicaid that's one thing, but for an office to say it takes Medicare (or any other insurance for that matter), and then to limit or discourage patients with Medicare (or a particular plan), that's another matter altogether.

If any other business were to agree to provide a menu of services to people in a group and then not actually provide some of the services, then I would not consider it acceptable either.
If a business was required to give a 50% discount to certain customers who required more time and expense to take care of, don't you think that business would look for ways to minimize those losses?
Last edited by toofache32 on Wed Jan 09, 2019 10:52 pm, edited 2 times in total.

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Wed Jan 09, 2019 10:39 pm

fru-gal wrote:
Wed Jan 09, 2019 2:02 pm


The only reason I can see about your former primary not renewing a prescription is that there is some Medicare gotcha that limits fees if a doctor treats any Medicare aged patient and maybe the renewal counts as that.
The reason that doctor is no longer refilling medications is because the OP's wife is no longer a patient there. The doctor-patient relationship was terminated when the patient refused to pay for services provided.
vested1 wrote:
Wed Jan 09, 2019 2:22 pm

Central coast of California. We have a great number of doctors and specialists, but due to the level of wealth there are relatively few doctors who accept Medicare. When I complained to my previous employer some years back that there were few doctors who would accept their insurance I was told by them that was because we were so rural and didn't have many doctors to choose from. I sent them a list of over 300 doctors within a 5 mile radius.
Few doctors accepted your employer's plan because your employer cheaped out and bought a crappy plan that paid low rates. As far as Medicare.....it's Medicare. It pays barely more than Medicaid. When a doctor's practice gets busy enough it's the first one they drop. It pays less than half of commercial insurance on average. Why would they continue taking Medicare unless they are a salaried hospital employee? As I have said before, this is why Medicare and Medicaid are being relegated to institutional settings instead of private practices. Institutional settings like hospitals and universities can bill facility fees while a private office cannot.

TN_Boy
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by TN_Boy » Wed Jan 09, 2019 10:58 pm

StoopieHippo wrote:
Wed Jan 09, 2019 10:22 pm
I think you should also keep in mind that sometimes a knee problem could be something that surgery wouldn't help, so a orthopedic surgeon really wouldn't be necessary for treatment. It could be something like arthritis which, while painful, wouldn't necessarily be helped by surgery. Best to get diagnosed by a PCP versus just going for a surgical consult.

I skipped a referral for an orthopedic, but that was because I broke 3 bones in my ankle and needed surgery the next morning. I wouldn't exactly suggest going that route. ;)
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.

StoopieHippo
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by StoopieHippo » Wed Jan 09, 2019 11:03 pm

TN_Boy wrote:
Wed Jan 09, 2019 10:58 pm
StoopieHippo wrote:
Wed Jan 09, 2019 10:22 pm
I think you should also keep in mind that sometimes a knee problem could be something that surgery wouldn't help, so a orthopedic surgeon really wouldn't be necessary for treatment. It could be something like arthritis which, while painful, wouldn't necessarily be helped by surgery. Best to get diagnosed by a PCP versus just going for a surgical consult.

I skipped a referral for an orthopedic, but that was because I broke 3 bones in my ankle and needed surgery the next morning. I wouldn't exactly suggest going that route. ;)
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.
Arthritis is pretty common for PCPs to diagnose, I believe. The idea is usually to try the meds if the symptoms fit arthritis prior to going to MRIs, etc anyway.

Teague
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Teague » Wed Jan 09, 2019 11:30 pm

TN_Boy wrote:
Wed Jan 09, 2019 10:58 pm
StoopieHippo wrote:
Wed Jan 09, 2019 10:22 pm
I think you should also keep in mind that sometimes a knee problem could be something that surgery wouldn't help, so a orthopedic surgeon really wouldn't be necessary for treatment. It could be something like arthritis which, while painful, wouldn't necessarily be helped by surgery. Best to get diagnosed by a PCP versus just going for a surgical consult.

I skipped a referral for an orthopedic, but that was because I broke 3 bones in my ankle and needed surgery the next morning. I wouldn't exactly suggest going that route. ;)
I believe (based on personal experience and talking with orthopedic doctors and PAs) that many knee problems are going to require an MRI for proper diagnosis. I don't know how common it is for a PCP to order knee MRIs, interpret them, and recommend surgery.
You bring up an interesting point about PCP's interpreting imaging. In my experience, the PCP will read the radiologist's findings and impressions and take those as the result of the imaging study. The radiologist is not usually specialized in whatever body part was studied. Qualified yes, but specialized, not usually. And the poor PCP doesn't stand a chance of interpreting any but the most basic imaging studies without that radiology report.

Give the same imaging study and radiology report to a specialist, an orthopedist in this case, and the radiologist's report may not get more than a cursory glance, if that. The orthopedist or other specialist is likely to pull up the actual images and interpret those images with the eye of an expert in the diagnosis and treatment of that body part. They are less likely to completely rely on the opinion of some locum radiologist they've never heard of before.

And this presents a bit of a bind for the patient. The person best qualified to interpret the study doesn't want to see the patient until that study has already been interpreted by a generalist to suggest a need for surgery. The generalist may misinterpret the findings to some degree, and therefore never refer the patient to the person - the specialist - who could best formulate the diagnosis and treatment plan.

A bit of a Catch-22, no?
Semper Augustus

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