The sheer absurdity of the New world of medicine

If you are enrolled in a Medicare HMO plan, Medicare pays the plan administrators a fixed fee each year for each members' care.

It behooves Medicare HMO plans to keep member expenses at a minimum. These plans are not reimbursed at for each test, procedure, office stay, surgery, et. al. Medicare HMO plans are paid a fixed per diem rate for each member enrolled from Medicare.

Medicare HMO plans will tend to limit and contain unnecessary tests and procedures in order to keep within the per diem fees that the plan receives from Medicare.

I think that the problem expressed here has more to do with the participating clinic and its nurse practitioners/clinical providers. If I were you, I would change primary care providers.

It"s just as bad if you're on Medicaid, and live in Connecticut. They order a CT scan every time I turn around, or want bloodwork, then limit my medications. I have an ostomy due to
ulcerative colitis, spinal fractures and MAJOR pain from long term prednisone use to control the colitis, plus cataracts and kidney stones also related to the colitis. Connecticut has just banned doctors from prescribing the hydrocodone that actually gives some pain relief, and Obamacare is telling my doctor to treat me like I'm malingering unless they do all these tests, more ray exposure I don't want. We're on our way to enjoying third world medicine. Time to start looking for a witch doctor?
Rob ion Connecticut

Seashell,

I'm also beyond shocked at how much I'm apparently "worth".

I'm sooooo incredibly frustrated by insurance, but I'm sure after you guys saw what IS covered monthly, I'm also thankful.

docs want to maximize $ dermi forgot I was allergic can you dig it?

Vickie: More power to you. Carry on . . .

I have endured more in the last 5 years with my failing health then I can reasonably continue. Palliative Care eases the burden that comes with frail health but I have decided to forego any further medical interventions when I hit my next major health "speed bump."

I understand and support the choices that you are making.

I, too, have worked in the health care setting and have seen individuals with advanced dementia with placement of gastric feeding tubes when they could no longer swallow safely. I would not want this for myself nor for my loved one.

I decline all manner of "preventative" testing. Mammogram. Nope. Colonoscopy. Nope (I no longer have a large intestine but am still solicited by my insurance carrier for a colonoscopy. You would think that my insurance carrier would know this detail of my medical history as they paid for the entire hospital stay relating to the intestinal perforation that lead to the loss of my large intestine and ileostomy). Ultrasound study of the carotid artery bifurcation. Nope. Bone density/DEXA. Nope (I already have diagnosed severe osteoporosis).

I do not see how your declining of certain preventative care testing should have a bearing on your pain management? One does not correlate with the other, there is no direct association.

My body. My choices. It's as simple as that.

Your body. Your choices.

- Karen -

I am also tired of repetitive tests that can cause more problems than they help. I've had so many CT scans I'm really concerned about the radiation, not to mention the fact that I am now so allergic to the contrast dye I go into anaphylactic shock when it's injected...scary stuff.

Oh Vickie. I can't begin to understand what you went through with your daughter. But I do agree with your decision. That decision is yours and only yours to make. I watched my father waste away until he passed last year. Taking care of him at home was the hardest thing I ever had to bear; the suffering was beyond belief. Provided we are informed about our disease(s) & potential outcome, we should all have the right to decide what procedures to submit to or decline. I'm in the beginning stage of a disease that will ultimately take me. I should have the right to make an informed decision whether to go through treatment or just go...without the medical professionals throwing a tantrum and withholding comfort measures. What has happened to you is inhumane and counter to physicians' oath.

Post Edited (1 day at a time) : 6/16/2016 5:49:56 AM (GMT-6)

I've been on Medicare for about 10 years now, no supplemental insurance. I've never had a problem getting procedures approved. I have had my doctor recommend tests and have refused them. His comment..."I don't want some lawyer asking me why this test or that test wasn't done." I told him I would not have any problem signing a waiver that would hold up in court! The only issue I've had is when the doctor orders my vitamin D level to be tested, but Medicare won't pay for it, so when I get to the lab I have to tell them to leave it off.

I'm done having my boobs squished and there is NO WAY I'm having a tube put you know where. God made that EXIT ONLY and I will not go against HIS wisdom!

If that makes me non compliant, I'll claim religious persecution!

Joan:
You matter. Your life matters. The quality of your life matters.

I so sorry that you have had the unconscionable experience of a physician discrediting you.

Remove that physician from your life and toss the memories of experience over your shoulder like a surface of Teflon®.

Medical care is more and more an assembly line, of sorts. An increasing reliance on imaging scans - when many physical ailments lack a structural/anatomical cause amenable to imaging detection. Scant quality interaction between physician and patient. An absence of astute listening skills on the part of physicians.

I spent countless years being mis-diagnosed by a stream of inept physicians. Despite excellent medical insurance and residing in a large metropolitan area on the west coast.

My life's trajectory has been forever changed by poor medical care. I cannot recover what has been lost.

My large intestine suffered an extensive perforation at the hand of physician and pharmacist error. The dosage of prednisone was mistaken due to lack of attention to the medication's concentration. What was prescribed to be 15 ml a day/dose was in actuality 125 ml a day/dose.
My abdomen grew to the size of a football. I knew that I was going to "pop."

I called my MD the night before my intestine ruptured, imploring him as to my distress. He discounted my concerns and told me that I was "overreacting."

At around 2 am, my intestine ruptured - I knew immediately the source. I was able to call my next door neighbor before I lost consciousness. I spent the next 10 weeks in the hospital.

I now have a highly caring and attentive medical team. But I often wonder why my health had to reach a crisis point to galvanize physicians who actually care to come to my side.

Keep looking for a caring and knowledgeable physician. Keep turning over every stone. They are out there.

I have found nurse practitioners to be a source of true care. Their nursing backgrounds give nurse practitioners a more caring and patient-centered approach then I have found with most physicians. Adult nurse practitioners have licensing privileges almost identical to physicians - they can prescribe medications (even narcotics for those who hold DEA licenses), admit and oversee hospitalizations, order any/all tests/procedures.

Perhaps a nurse practitioner might be worth exploring?

I am sorry that the physician was as callous as he was toward you. I hope that karma comes his way.

A warm hug to you, because you deserve one.
- Karen -

for those with wrong answers from medicare i suggest taking it from the top down rather than bottom up.
the office of inspector general, us department of health and human services.
oig.hhs.gov/

Post Edited (greatunclebill) : 6/18/2016 9:48:12 PM (GMT-6)

UPDATE: Went to PM appointment today and alls well. They ordered the knee MRI that we have been trying to get for 6 months and my Humana PA's wouldn't authorize without using all the prescreening bs as a coercive. With the new insurance I don't have to have preauthorization or primary order. It was a awesome experience to have the Dr who knows and treats me be able to determine what I need. No more referrals every 3 months from a PA or np and no more bribes to force procedures I don't want or need.

I am glad Mercy & Grace got some accurate Connecticut information. Now they will not renew my scripts for high blood pressure unless I see them. I am an asthmatic and they don't care. Don't want to go out in this horrible weather. Very humid here and I will be 71 soon.