The sheer absurdity of the New world of medicine

I have worked n medical for 30+ and been a CPer for close to 20 yrs and the past week has literally floored me.

I have had the same PM for 6 yrs here and the one before that in my home state for 13. Background,I'm Medicare with Humana as a Medicare advantage plan and last year the primary they had assigned me lost his license for sexual misconduct(had seen him once) I was automatically assigned to a place called Island doctor's and they see no one but Medicare advantage patients and let me say here that the 8 times I have been there their names misleading because there's no doctor's in there only Nurse practitioners and physician assistants.

I went for initial visit to establish a relationship,several visits for flare ups of COPD and a few other piddly things because they have to make referrals to my PM Dr and their policies are for 3 month increments where my ther primarys were once a year.

At initial appointment they started giving me all these papers for labs,scans tests and prescreening stuff and I told them I would NOT do all that. I am 60 yrs old and I would opt not to treat vigorously the results of those tests. Having them is not necessary then but since the taxpayers pay my premiums and copays its wasting money,their money!!

Everytime I would have to go in they would start again with having all these done and again I said NO.

Then they started calling me two to three times a week and every time I said NO. First they prescribe nothing but a blood pressure pill I have been on years and zantac and a inhaler which again I have been on long before seeing these clowns.

Let me say here that they have huge and numerous signs all over the office lobby and every wall and hallway that states they DO NOT treat pain with narcotics unless your a cancer patient. Up until this month I have had no problems getting the referrals needed to my PM.

I saw the PM Dr last week and the record's manager whom I have a awesome relationship with came to the room before my PM Dr and said we have a problem and that after this month island doctors(NOT drs) would not reissue my referral and had told them I was a noncompliant patient and that was not going to go over well on DEA regulations on top of Humana not paying for the PM visits.

I was irate!! Those idiots who are not even doctors have no right to say I'm noncompliant simply because I refuse to do thousands of dollar's in tests that are not going to satisfy or benefit anyone but them? If I have a terminal illness I don't want to know so why do they have to know? So they can tell me and ruinwhat time I have left worrying about it? I already said NO treatment!!

Get to the pharmacy and they had been called as well and told the same thing and told they would not refill my primary meds. Really? Is this extortion and bribery? The pharmacy then says they could not fill the PM meds after this month because they don't fill PM meds only for patients. This is crazy.

If I have to take this to a lawyer I will but they had better have a MD somewhere behind this mess and he had better have a record of seeing me.

I Will not be coerced into having something done medically that I don't feels necessary and needed.

I'm convinced the ridiculous tests that docs order is a result of lawsuits. They see a hang nail & order a CT scan to rule out some obscure disease. Been there so many times I swear I'm gonna get more cancer from the radiation from unnecessary CT scans.

You have been treated horribly!

However, I must say it depends on the specific plan. I also have Medicare with Humana as a Medicare Advantage Plan. However, I've always insisted on choosing my own doctors, so I purchased the PFFS plan. (And in 8 years I've never run into a Dr that didn't take it.)

There are 4 types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNPs)

It sounds like you may have an HMO, where you can only get coverage with certain assigned Doctors.

But the bigger problem is with being unable to choose the level of treatment you want. If a person doesn't want treatment beyond a certain point, it's insane that insurance companies, Drs, pharmacies, etc can use the "non-complainant" label and refuse treatment.

I've had a similar issue, but not nearly as severe, with my dentist of 30 years -- they want to do X-rays every year instead of every 2 years, and when I refuse them (don't want the radiation or to spend the money) they get all huffy. Haven't yet refused treatment, but I won't be too surprised if it gets to that.

I'm really interested to see how your situation plays out, Vickie, please keep us updated.

Post Edited (Lynnwood) : 6/6/2016 9:51:00 AM (GMT-6)

Will you be ok if the pharmacy won't fill your Rx? You mentioned you have respiratory issues. Are they refusing to fill those? If so that's just plain dangerous.

I in fact have a HMO,I didn't pick this conglomerate of Drs they did when the previous one lost his license and I didn't like the fact they have numerous offices all over Florida and to me that says big profit and very little actual patient care. I imagine one or two doctors own the places and never see patients but hire NPs and PAs to staff them. I have a call into my humana rep.

Sherrine my Neuro office actually suggested looking into warp and United dual complete replacement plan or United health aarp.

I am so sorry you are having so many problems. Frankly, I think the docs are a bunch of creeps. Also these so-called nurses are for the birds. The insurance people also play dumb and are not advocating for the patients.

This has nothing to do with Obamacare either. All I can say is that you are not alone. They also would not renew my meds because they want another co-pay, insurance pay-out etc.

I am allergic to drugs so don't use controlled substances.

Doctors are flunkies for the government and all they care about is money. That is my assessment of the situation and I am no dumbie and that is FOR SURE.

This came up once before about changing outside the enrollment period and if I recall there's a way for me to do so because I'm SNP or rather Medicare with Medicaid which is limited to only paying my premiums and copays. ExtraCare in the state of Florida and some states called QMB. I will check on that later today.

My reason for saying that to have all those tests done is wasting taxpayer's money,its them that are funding all those outrageous copays for some of those expensive tests. Yet twice my Neuro has attempted to get primary to order a new knee mri since the last one 8 years ago showed broken hardware and they have denied both times. So they want to order a slew of stuff I don't need but won't order something I should have already had done.

My first visit to that primary Dr or PA Humana was billed $983? Lol for a office visit? Yea they checked 02sat, they did a series of breathing exercises and a history and physical but nothing I could see was anywhere close to a grand in cost.

Vickie, I have had calls from my primary drs office wanting me to have certain tests too which I declined. I simply said if I feel at some point I need these I will let you know. No problem. None of my care has been in jeopardy as a result of my refusal nor has Medicare forced me into having these tests, it does not work that way with Medicare.

I have regular Medicare with a supplemental plan thru AARP (United Healthcare) that is expensive as hell. We pay over $400 a month for the plan that pays the 20% Medicare doesn't. I plan to shop around for a new plan for the next enrollment. Because of not being 65 I am limited to a certain supplemental plan. I stayed with regular Medicare because none of my drs would accept any of the other plans out there. The costs varies from state to state too. We are paying over $500 a month between Medicare & the supplemental. I do not have drug coverage was too expensive. Between the premium costs monthly & the cost of medications, its cheaper for me to pay cash & use GoodRx coupons.

I hope you can either find a different dr on your plan or get some help with this mess. I would call Medicare about Humana.

Yes, the plans do vary based on age. My husband is 71 & we are almost paying double with me being younger & I am limited to certain plans only because of the age thing. I also assumed that a supplemental could be bought in any state & found out that is not true. I strongly disagree with that one, it forces people to go with an HMO. I refused an HMO even when we had private insurance, The coverage was very limited & we had crappy drs to pick from. We stayed with a PPO simply because the drs selection was so much better & were not as limited as we would have been with an HMO. Believe it or not insurance is our largest expense, home owners, health, auto, boat, & motorcycles, we are truly insurance poor, it just makes me sick the money we spend a month on it.

I've been paying a fortune for insurance since I was awarded disability years ago. I talked with the case worker at Duke and multiple supplemental insurance plans, in addition to Medicare, and nothing could be found that would cover the meds and the manner in which they were to be used except for the current employer plan. I've been paying $650(cobra) a month for supplemental insurance, but I wouldn't be able to afford the meds otherwise.

We calculated that insurance was covering $99,000 a MONTH of meds. Plus, many many of the meds were used off label. By the time the battle of copays were figured out monthly, I would be paying $1100 a month, and that's without additional clinic costs.

This Oct I'm going to try again and see what we can come up with. The social worker/case worker for the main dept that I'm treated in is working with my Drs. It's the Duke crew that runs up the $$$$. Treatments that could be done locally are the more traditional route and would be covered.

I totally agreed-it's absurd!!!

Hi there everyone! I am not only new to this group, Healing Well, but also to any kind of forum or chat........so I am just jumping in here. I saw the word absurd and that pretty much sums up my situation as well. I have been through six surgeries in the past five years and when the doctors have now recommended this last one the insurance company has deemed it 'investigative' and won't pay for it. I am in pain constantly and am loosing my strength. I'm at the end of my rope and loosing hope...

There is assistance available for lots of meds, and quite often I was approved. The problems started when meds were used off label, so I didn't always meet the requirements, even with a Drs appeal. Ex:I could get assistance for Cytoxan OR Rituxan, but not the way I'm using them now. I get BOTH of them at the same time-very very long infusion-like 12+hrs long. I did not meet enough requirements for IVIG assistance.

I'm not on a traditional treatment plan, for really any disease. It's a cornucopia of fun:)

I have a love/hate relationship with insurance companies. I know that I've cost them an incredibly large sum of money. But, I also know that there are waaaaaay to many hoops to jump thru. I have an awesome team of med folks to work through the process, but they can only do so much.

The whole system is absurd, but I'm at a loss as to how to fix it. I know for a fact that regimes I've followed here, would not be available in other countries.

Vickie, I think it's asinine that you are being treated this way. Just another fun horse on the merry-go-round of healthcare.

Vickie, I think it's more the HMO and doctors you are with. I've been on Medicare for over 18 years due to disabilities and have had only good experiences. I've never been denied, been hospitalized with no hassles afterwards, plus my doctors don't force anything on me. But I have excellent doctors and that makes a big difference. Plus, these HMO's I think do things like you are experiencing to earn more money for themselves. Medicare pays them for all of that stuff so it's a bigger profit for them. It's not Medicare's fault.

I do check my Medicare statements to make sure there are no overcharges, double charges, or charges for things I never had done, and all have been fine. If I ever found any, I'd be reporting it to Medicare.

Sherrine