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MD Anderson Refuses Insurance!

11 years 2 months ago #20160 by sara.anne
The irony of this situation is that the Advantage plans and other HMO-Medicare deals are paid MORE than the average physician gets from Medicare. Here in Oregon we have a real problem with Medicare reimbursement. Most physicians in primary care are NOT accepting new Medicare patients. This makes it a real problem if your doctor retires or you feel the need to change.

My internist (who is also a personal friend) told his Medicare patients last winter that as of January 1, 2008, he could no longer accept Medicare assignment. Medicare was cutting primary care reimbursement by 10%. Fortunately, Congress put a stop to that last month. Oregon is already on the very low end for Medicare fee reimbursement...many rural locations so they feel that physicians do not "need" to earn as much as they do in other geographic areas.

Fortunately, this has not been an issue with my urologist. However, I was turned down by two orthopedic surgeons before I found a third (who was acceptable to me) for rotator cuff surgery last November.

Bottom line? Health care in this country is a real mess. And I am one of the lucky ones who IS insured.

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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11 years 2 months ago #20064 by Cynthia
Unless I am missunderstanding the situation it is Medicare that is causing the problems with thier rules.
I wonder why you could not pay cash for the consultation and then ask your plan for rembursment. Do they have a cluase for payment out of network? Every plan has its own ploicies of course.

Cynthia Kinsella
T2 g3 CIS 8/04
Clinical Trial
Chemotherapy & Radiation 10/04-12/04
Chemotherapy 3/05-5/05
BCG 9/05-1-06
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11 years 2 months ago #20043 by Julie
I think this mess is because your Dad selected one of the "Advantage" plans when he became eligible for Medicare. These are HMO's who will provide all the insurance coverage. The problem with HMO's as you found out is you are restricted in where you can have treatment paid for.

Two other options would be to appeal to the HMO to pay Anderson the rate that Medicare does or ask where your Dad can go to get a second opinion with a recognized expert in your Dad's problems that the HMO will cover.

There has been a lot in the press about how the Advantage plans are not as beneficial as Congress makes them out to be. However the majority of our Congressmen continue to support Advantage plans for Medicare recipients.

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11 years 2 months ago - 11 years 2 months ago #20039 by Cynthia
I would talk to your Senitors office as I suggested in another post. That your father should be denied the best care avalible due to a Medicare rule is not the intent and should be looked at. If you would like we can make contact and I will make the call for you. At the very least this should be brought to the goverments attention as being wrong. I have in the past had some success with this sort of thing.

Cynthia Kinsella
T2 g3 CIS 8/04
Clinical Trial
Chemotherapy & Radiation 10/04-12/04
Chemotherapy 3/05-5/05
BCG 9/05-1-06
RC w/umbilical Indiana pouch 5/06
Left Nephrectomy 1/09
President American Bladder Cancer Society

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11 years 2 months ago #20036 by harleygirl
I just got a call from a woman in the Managed Care department at MD Anderson. She went through this whole long explanation about why they don't accept my Dad's insurance.

Apparently, Medicare pays MD Anderson MORE than most insurance plans do. So, if the insurance company won't agree to pay at least as much as Medicare, they don't accept that plan.

My Dad went with his current plan because it was less costly than Medicare and had more benefits. When he made this choice, cancer was not even a remote consideration.

She said my Dad could change to a plan they do accept (which are very few and may not even be accepted next year!) or go back to Medicare. If they decide to no longer accept your plan in the middle of your treatment, they are "kind" enough to not terminate your treatment, but when you are done, you are out and can't come back for follow-up.

When I asked why Dad could not pay out-of-pocket for the second opinion, she told me Medicare doesn't allow Medicare patients to do this as some doctors would then decide Medicare does not pay them enough and require the patient to make up the difference. So, Medicare mandates no out-of-pocket payment allowed.

Bottom line, if Dad does not want to change insurance providers or go back to Medicare, he can't go to MD Anderson. And, if he DID choose to go back to Medicare, it would take at least a month for the changeover and a month is a long time when you are dealing with an aggressive cancer.

He likes his doctor at UT Southwestern so I guess that is where he will stay. Bottom line, MD Anderson is a business and must be operated as such. The woman I talked to said that they were held accountable by the Texas taxpayers. Well, my Dad and my whole family are Texas taxpayers, but that really doesn't mean anything.

Needless to say, I am disappointed that one of the best cancer centers in the world is not available to my Dad and a little angry at how the system works (or doesn't work as the case may be.)

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11 years 2 months ago #20017 by Patricia
But Cynthia..he did not sign up for Medicare...he has no rights according to them.
Pat

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