Diagnosing Knee Problems over the Phone - Medicare

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Erwin007
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Erwin007 » Sat Jan 12, 2019 3:23 pm

samsoes wrote:
Sat Jan 12, 2019 10:18 am
toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
In some food establishments, I oftentimes get a "senior discount," never having asked for one. And I'm 55, not 65.

Does your practice offer senior discounts?
Yes. It’s called Medicare. It pays me less than seeing a patient with private insurance.

likegarden
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by likegarden » Sat Jan 12, 2019 3:28 pm

Thank you all to participate in this discussion, it is very informant for me. I am on Medicare, paid many years of taxes for that. With age of 79 I get to understand that older age will bring some pain. Little pain of the small rip in the meniscus of my right knee is bearable, my severe arthritis in my right hip only creates pain when I start moving, Tylenol helps. There are days without pain. I continue to see my PCP, and do not like to hear about hip surgery, never talked to a specialist yet. I grew up in Europe, and getting healthcare was never a problem there.

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Sat Jan 12, 2019 5:16 pm

samsoes wrote:
Sat Jan 12, 2019 10:18 am
toofache32 wrote:
Fri Jan 11, 2019 9:55 am
vested1 wrote:
Thu Jan 10, 2019 5:44 pm
Without delving into politics, this laymen would be happy to see every doctor who wants to be licensed to practice in this country to be required to accept a certain percentage of Medicare patients, taking the burden off of others in their profession who carry the load, while perhaps shortening the waiting period for treatment. It is, or should be at least, about the patient.
And I think every grocery store owner should let customers over 65 buy food for below cost, and the grocery store has to just eat the loss, of course.
In some food establishments, I oftentimes get a "senior discount," never having asked for one. And I'm 55, not 65.

Does your practice offer senior discounts?
No, we are not a coffee shop. I sometimes charge seniors MORE because they require more time, have more health problems to manage, and are at higher risk of complications. Age has nothing to do with it. I do the same for younger patients who I anticipate will require more time and resources. This is one of the fundamental frustrations of Medicare....doctors are paid the least for the patients who require the most. You don't get a discount just because you survived for 65 years. And you've had your entire life to save for it.
Last edited by toofache32 on Sat Jan 12, 2019 5:55 pm, edited 2 times in total.

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Sat Jan 12, 2019 5:25 pm

samsoes wrote:
Sat Jan 12, 2019 12:41 pm
goodenyou wrote:
Sat Jan 12, 2019 12:14 pm
samsoes wrote:
Sat Jan 12, 2019 10:18 am
In some food establishments, I oftentimes get a "senior discount," never having asked for one. And I'm 55, not 65.

Does your practice offer senior discounts?
If a practice accepts Medicare, it gives seniors a discount. Does the restaurant have a cadre of people trying to collect money from patrons after they eat? Let them walk out and then give them a discount when you try to collect and see how willing you will be to be so “charitable “. Up front cash discounts are very common in medical practices.
Allow me to finish the first highlighted sentence:
If a practice accepts Medicare, it gives seniors a discount, otherwise the business will go elsewhere.
This is hysterical that someone thinks this is really a threat. Why would the practice think this is a bad thing for their charity cases to go elsewhere? If it was profitable, that would be one thing, but this is truly charity care since it barely covers costs and is certainly not profitable. Yeah I know Medicare patients "paid into it" their entire lives, but it doesn't change the fact that payments barely cover costs, if at all.
Why do you think Medicare and Medicaid are the first insurance plans to be dropped by private practices? This is why Medicare and Medicaid patients are being relegated to institutional settings that are eligible to charge facility fees to make up for losses. Private practices are not able to charge facility fees.

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samsoes
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by samsoes » Sat Jan 12, 2019 5:54 pm

toofache32 wrote:
Sat Jan 12, 2019 5:25 pm
samsoes wrote:
Sat Jan 12, 2019 12:41 pm
goodenyou wrote:
Sat Jan 12, 2019 12:14 pm
samsoes wrote:
Sat Jan 12, 2019 10:18 am
In some food establishments, I oftentimes get a "senior discount," never having asked for one. And I'm 55, not 65.

Does your practice offer senior discounts?
If a practice accepts Medicare, it gives seniors a discount. Does the restaurant have a cadre of people trying to collect money from patrons after they eat? Let them walk out and then give them a discount when you try to collect and see how willing you will be to be so “charitable “. Up front cash discounts are very common in medical practices.
Allow me to finish the first highlighted sentence:
If a practice accepts Medicare, it gives seniors a discount, otherwise the business will go elsewhere.
This is hysterical that someone thinks this is really a threat. Why would the practice think this is a bad thing for their charity cases to go elsewhere? If it was profitable, that would be one thing, but this is truly charity care since it barely covers costs and is certainly not profitable. Yeah I know Medicare patients "paid into it" their entire lives, but it doesn't change the fact that payments barely cover costs, if at all.
Why do you think Medicare and Medicaid are the first insurance plans to be dropped by private practices? This is why Medicare and Medicaid patients are being relegated to institutional settings that are eligible to charge facility fees to make up for losses. Private practices are not able to charge facility fees.
Your assessment as "hysterical," Doctor, is completely off-base. If the hospital chain I worked for lost the ability to collect through Medicare, they'd go under. This was repeatedly drilled-into our heads. Apparently, treating Medicare patients wasn't done at a loss. (Medicaid patients are treated at a loss, but not Medicare.)

Each year, every employee had to take many hours of training (in total took an entire day - staggered throughout the year) to review the bureaucratic Medicare rules the hospital had to follow. (Clinical and support staff, clerical/billing staff, and yes, IT staff.) Employees were disciplined for foul-ups. Medicare patients were vital to the hospital's bottom-line, according to our CEO who is also an MD. And our hospital was one of the profitable units in the nationwide network.

Hysterical? Hardly.
"Happiness Is Not My Companion" - Gen. Gouverneur K. Warren. | (Avatar is the statue of Gen. Warren atop Little Round Top @ Gettysburg National Military Park.)

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Sat Jan 12, 2019 5:57 pm

Go back and read my entire post where I separated institutional settings from private practices. Then get back to us once you are caught up. We are talking about different settings. These 2 settings are outlined in my post. I am talking about one and you are talking about the other.
[OT comment removed by admin LadyGeek] Medicare is shifting towards institutional settings and will soon not be an option for patients seeking a private practice physician. They will only be able to be seen in hospital/institutional clinics where the doctors are mere employees and most of the care will be rendered by nurses and low-level providers instead of doctors. While there is nothing wrong with this, my practice is thriving from patients who are trying to escape that inefficient, impersonal, and frustrating healthcare setting. I have said it here before, we are headed to a 2-tiered healthcare system, and there is nothing wrong with that. There will be slow assembly-line institutionalized care and there will be personalized and efficient private practice care.

Erwin007
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Erwin007 » Sat Jan 12, 2019 6:13 pm

toofache32 wrote:
Sat Jan 12, 2019 5:57 pm
Go back and read my entire post where I separated institutional settings from private practices. Then get back to us once you are caught up. We are talking about different settings. These 2 settings are outlined in my post. I am talking about one and you are talking about the other.
[OT comment removed by admin LadyGeek] Medicare is shifting towards institutional settings and will soon not be an option for patients seeking a private practice physician. They will only be able to be seen in hospital/institutional clinics where the doctors are mere employees and most of the care will be rendered by nurses and low-level providers instead of doctors. While there is nothing wrong with this, my practice is thriving from patients who are trying to escape that inefficient, impersonal, and frustrating healthcare setting. I have said it here before, we are headed to a 2-tiered healthcare system, and there is nothing wrong with that. There will be slow assembly-line institutionalized care and there will be personalized and efficient private practice care.
This is the problem with the great majority of these threads about healthcare on Bogleheads. Most posters don’t understand the difference between the doctor and the large hospital system they may or may not work for.

sambb
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by sambb » Sat Jan 12, 2019 6:16 pm

Erwin007 wrote:
Sat Jan 12, 2019 6:13 pm
toofache32 wrote:
Sat Jan 12, 2019 5:57 pm
Go back and read my entire post where I separated institutional settings from private practices. Then get back to us once you are caught up. We are talking about different settings. These 2 settings are outlined in my post. I am talking about one and you are talking about the other.
[OT comment removed by admin LadyGeek] Medicare is shifting towards institutional settings and will soon not be an option for patients seeking a private practice physician. They will only be able to be seen in hospital/institutional clinics where the doctors are mere employees and most of the care will be rendered by nurses and low-level providers instead of doctors. While there is nothing wrong with this, my practice is thriving from patients who are trying to escape that inefficient, impersonal, and frustrating healthcare setting. I have said it here before, we are headed to a 2-tiered healthcare system, and there is nothing wrong with that. There will be slow assembly-line institutionalized care and there will be personalized and efficient private practice care.
This is the problem with the great majority of these threads about healthcare on Bogleheads. Most posters don’t understand the difference between the doctor and the large hospital system they may or may not work for.
Agree.. bThe docs are mostly employees these days.

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Sat Jan 12, 2019 6:31 pm

Erwin007 wrote:
Sat Jan 12, 2019 6:13 pm
toofache32 wrote:
Sat Jan 12, 2019 5:57 pm
Go back and read my entire post where I separated institutional settings from private practices. Then get back to us once you are caught up. We are talking about different settings. These 2 settings are outlined in my post. I am talking about one and you are talking about the other.
[OT comment removed by admin LadyGeek] Medicare is shifting towards institutional settings and will soon not be an option for patients seeking a private practice physician. They will only be able to be seen in hospital/institutional clinics where the doctors are mere employees and most of the care will be rendered by nurses and low-level providers instead of doctors. While there is nothing wrong with this, my practice is thriving from patients who are trying to escape that inefficient, impersonal, and frustrating healthcare setting. I have said it here before, we are headed to a 2-tiered healthcare system, and there is nothing wrong with that. There will be slow assembly-line institutionalized care and there will be personalized and efficient private practice care.
This is the problem with the great majority of these threads about healthcare on Bogleheads. Most posters don’t understand the difference between the doctor and the large hospital system they may or may not work for.
Yes, he still doesn't get it. His institution is allowed to charge facility fees (multiples of the doctors fees), which is how he is paid. A private practice doc, however, is not eligible to charge facility fees and therefore has to pay for their IT services out of the fees paid from CPT codes for direct medical care.

Erwin007
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Erwin007 » Sat Jan 12, 2019 6:44 pm

toofache32 wrote:
Sat Jan 12, 2019 6:31 pm
Erwin007 wrote:
Sat Jan 12, 2019 6:13 pm
toofache32 wrote:
Sat Jan 12, 2019 5:57 pm
Go back and read my entire post where I separated institutional settings from private practices. Then get back to us once you are caught up. We are talking about different settings. These 2 settings are outlined in my post. I am talking about one and you are talking about the other.
[OT comment removed by admin LadyGeek] Medicare is shifting towards institutional settings and will soon not be an option for patients seeking a private practice physician. They will only be able to be seen in hospital/institutional clinics where the doctors are mere employees and most of the care will be rendered by nurses and low-level providers instead of doctors. While there is nothing wrong with this, my practice is thriving from patients who are trying to escape that inefficient, impersonal, and frustrating healthcare setting. I have said it here before, we are headed to a 2-tiered healthcare system, and there is nothing wrong with that. There will be slow assembly-line institutionalized care and there will be personalized and efficient private practice care.
This is the problem with the great majority of these threads about healthcare on Bogleheads. Most posters don’t understand the difference between the doctor and the large hospital system they may or may not work for.
Yes, he still doesn't get it. His institution is allowed to charge facility fees (multiples of the doctors fees), which is how he is paid. A private practice doc, however, is not eligible to charge facility fees and therefore has to pay for their IT services out of the fees paid from CPT codes for direct medical care.
Yep, which is how large institutions are able to absorb the Medicare rates. Charges for E/M and CPT codes are low, but facility fees make it up. But practitioners can’t charge facility fees, which samsoes (and quite a few others on this thread) doesnt understand.

staythecourse
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by staythecourse » Sat Jan 12, 2019 6:55 pm

toofache32 wrote:
Sat Jan 12, 2019 6:31 pm
Yes, he still doesn't get it. His institution is allowed to charge facility fees (multiples of the doctors fees), which is how he is paid. A private practice doc, however, is not eligible to charge facility fees and therefore has to pay for their IT services out of the fees paid from CPT codes for direct medical care.
Don't mean to derail this thread further (apologize to OP), but think this is one aspect that is VERY misunderstood. With medical billing there are 2 fees if done at a hospital or surgery center or hospital outpatient department. There is the facilty fee. First is paying the facility for the electricity, time usage of the facility, drugs, equipment, syringes, nursing salaries, employee salaries, etc... As one can imagine that is the BIGGEST cost. The second is the professional fee. That is the charge to the provider to perform x which is either to see the patient and talk/ examine them (E/M codes) or to do the procedure. If the same is done in an office (like a doctor's office) there is only a GLOBAL charge which is a combined facility+ professional fee (almost always reduced vs. the facility+ professional fee if done in the other setting).

Here is an example. One of the simple procedures I do reimburses from medicare about $80 to me as a professional fee if done in a facility. If done in a surgery center they get $300 for the facility fee, but if done at a hospital outpatient the hospital get $600. If done in an office I would get a global fee of about $240. So now one can see why hospitals were more then happy to jump on the healthcare reform bandwagon. It was NOT because it improved care, but they made an agreement with President Obama early on that their charges would ALWAYS be higher if done at one of their facilities in exchange for supporting the reform bill. As you can see in a very quick way there is NO way health care costs can go down. Driving business to the hospital HAS to increase the price tag by the example I gave above.

This is why hospitals are trying to buy up all the physicians as they can do the EXACT same procedure with the same physician and same patient and same disease process and make more money from the insurance companies. It all about business. The mistake patients make is thinking it is the doctors making more money. Driving healthcare to the private office of the doctor DECREASES healthcare costs in most instances or even to a surgery center, but this is where politics and healthcare get conflicting goals.

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

toofache32
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by toofache32 » Sat Jan 12, 2019 7:01 pm

staythecourse wrote:
Sat Jan 12, 2019 6:55 pm
toofache32 wrote:
Sat Jan 12, 2019 6:31 pm
Yes, he still doesn't get it. His institution is allowed to charge facility fees (multiples of the doctors fees), which is how he is paid. A private practice doc, however, is not eligible to charge facility fees and therefore has to pay for their IT services out of the fees paid from CPT codes for direct medical care.
This is why hospitals are trying to buy up all the physicians as they can do the EXACT same procedure with the same physician and same patient and same disease process and make more money from the insurance companies. It all about business. The mistake patients make is thinking it is the doctors making more money. Driving healthcare to the private office of the doctor DECREASES healthcare costs in most instances or even to a surgery center, but this is where politics and healthcare get conflicting goals.
And this is why the public and anyone paying into Medicare throughout their lives should be livid. This is increasing costs for no reason.
It's hospital administrators that are winning here.

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Teague
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Teague » Sat Jan 12, 2019 7:09 pm

toofache32 wrote:
Sat Jan 12, 2019 7:01 pm
Image
Another way to interpret that chart is that the supply of U.S. physicians has been kept artificially low.
Semper Augustus

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ram
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by ram » Sat Jan 12, 2019 7:57 pm

I am a physician that sees Medicare patients. Some prior posts have suggested that because of that I stand on a higher moral ground than other physicians that have elected not to see Medicare patients. This is not true.

I am actually an employed physician that sees whatever patients my employer sends my way. The decision about accepting any particular insurance is made by my employer. My employer pays me a salary. If my employer is unable to pay me a satisfactory salary I have the option of leaving and finding another employment.

Physicians in private practice have the additional responsibility of making sure that they can keep their doors open. Forcing them to accept work that leads to a loss is not reasonable. If that were to happen then all private practices would have to eventually close their doors. That would not be a beneficial thing for our society.

Toofache and others have correctly pointed out that large heath care facilities get paid a higher amount for the same work from Medicare. Discussing reasons for the same would be a breach of the policies of this forum. But the interested reader can google for it.

Some non physician members on the board have mentioned that they have donated to charity to the best of their ability. Suffice it to say that physician members of this board (and other physicians) are also doing the same. To have rules that demand additional charity from one section of the society is not reasonable in my opinion.

Those that think that heath care should be available more widely with less out of pocket costs should look at the heath care options in Canada and western Europe. There are pros and cons to each system.
Ram

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cheese_breath
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by cheese_breath » Sat Jan 12, 2019 9:24 pm

goodenyou wrote:
Sat Jan 12, 2019 11:48 am
cheese_breath wrote:
Sat Jan 12, 2019 11:36 am
goodenyou wrote:
Sat Jan 12, 2019 9:47 am
fru-gal wrote:
Sat Jan 12, 2019 7:51 am
toofache32 wrote:
Fri Jan 11, 2019 11:02 pm
This is why Medicare is called an "entitlement".
Only certain people call Medicare an entitlement, the ones who like to ignore the fact that people have been taxed for it all their working lives.
Not every taxpayer pays enough to cover their healthcare consumption....
That's the same with any type of insurance. But with private insurance pools some use less than they pay for to cover those who use more.

But I'm surprised nobody has mentioned ponzi scheme yet. (Or maybe I missed it.) Medicare and social security are both ponzi schemes. My parents collected both because my generation paid for it. I'm collecting both now because the next generation's paying for it. I don't blame the people in my generation who thought paid for healthcare when they got old. And I don't blame the physicians whose Medicare reimbursements don't cover their expenses. Like any ponzi scheme both Medicare and SS are reaching the point where there's not enough new money coming in to pay the earlier subscribers.
The pool is different. If commercial insurance companies were insuring a vast majority of extremely high utilizers, like Medicare, it would be as insolvent as Medicare. The insurance companies don’t have the advantage of having a printing press to cover their losses.
As far as your other comments, it would be crossing the line of interesting but verboten discussion. Unfortunately, it’s probably gone there already.
I don't think so. They were simply a statement of the economic reality.
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by LadyGeek » Sun Jan 13, 2019 9:19 am

I removed an off-topic post containing details of a medical treatment. The reasons medical advice is not permitted in this forum:

1. This is an anonymous internet forum. It is not possible to verify anyone's identity (nor do we want to). Credentials also imply accurate advice, which may not always be the case.
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5. Readers will misinterpret the given advice.

Since real harm can be done, we do not permit medical advice and is the reason for the first sentence in: Medical Issues
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by Darwin » Sun Jan 13, 2019 10:51 am

LadyGeek wrote:
Sun Jan 13, 2019 9:19 am
I removed an off-topic post containing details of a medical treatment. The reasons medical advice is not permitted in this forum:
:oops: My bad, that makes sense.
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AlbertEinstein
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by AlbertEinstein » Sun Jan 13, 2019 4:27 pm

1. Is your wife on TRADITIONAL Medicare or a Medicare ADVANTAGE plan?
2. What state are you in?
3. I will not give you medical advice, but I will tell you how to resolve your problem.

newstreetnj
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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by newstreetnj » Sun Jan 13, 2019 4:49 pm

Sorry to hear about your wife's pain.
I'm a physician and have loads of experience with orthopods after having a bad femur fracture about 5 yrs ago.
Physical therapists(PTs) made all the difference for me and still do. A good one will teach her how to strengthen the muscles around the knee etc. PTs will also steer her to the best orthos. She will need a referral for a PT from her PCP.
Hope this helps. Bob

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Re: Diagnosing Knee Problems over the Phone - Medicare

Post by AlbertEinstein » Sun Jan 13, 2019 4:55 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.
As far as needing or not needing a referral to a specialist (assuming your policy doesn't require it), this is more often dictated by local custom and the supply of specialists. In an area with many orthopedic surgeons, the ortho docs are often eager to see patients directly. Countering that, PCPs may be loathe to refer to specialists who don't let them see the patient first (so that they can generate an extra office visit). Yep, I know that sounds a bit unethical (they justify it on the grounds that they can look for other causes, maintain continuity of care, etc. - anything but admitting that it's about $). At the end of the day, you've got to make the best of the way things operate in your area.

As far as your Medicare plan, you need to see if you have traditional medicare or a medicare advantage plan (that would typically be a Medicare Part C plan). If you have a medicare advantage plan, don't blame the docs (particularly the specialists) for not taking medicare as they probably do take regular/traditional medicare. Orthopedic docs, to a large extent, do most of their big surgeries (hips and knees) on medicare patients. Does it make much sense to cut off half (or more) of your patient base? Does it make much sense for an ortho doc to tell the PCPs that refer to him to send their referrals elsewhere? If one ortho doc in your area takes medicare, they (almost) all will.

OK. For whatever reason - you're on part C or nobody takes real medicare - you can't get seen by ortho. Good news and bad news. Virtually every university hospital in USA takes medicare (including part C and medicaid) and they have quality orthopedic surgeons - in many cases, the best. Bad news - you may have to travel.

PS: Now that you've been warned, don't automatically sign up for Part C next year (even if your PCP tells you to as it's a scam they use to get more $ like an HMO). If you have a Part C PCP, run away....fast!

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