SMOKINCHOICES (and other musings)

November 8, 2014

Got a M/C doctor ?

Insurers offer doctors who are unavailable

By Andrew M. Seaman Reuters

More than half of the dermatologists in Medicare Advantage plan directories were either dead, retired or not accepting new patients, or specialized in particular conditions, researchers found when they tried making appointments.
Inaccurate directories of doctors covered by an insurance plan might lead to people having few options and to the U.S. government approving plans that don’t meet standards regarding provider availability, the study team writes in JAMA Dermatology.
“I think it just identifies a big area that needs a lot of help to increase transparency to patients,” said Dr. Jack Resneck Jr. of the University of California-San Francisco, the study’s lead author.

The U.S. requires private insurance plans offered through Medicare (the government-run insurance program for the elderly and disabled) and through exchanges set up by the Affordable Care Act to offer plan participants a variety of doctors.

  • Even so, insurers have been increasingly “narrowing” their networks by eliminating contracts with physicians, the researchers write.
  • They add that there is increasing attention on the limited choices offered to patients through the private plans in Medicare — known as Medicare Advantage — and the Affordable Care Act.

For the new study, Resneck and his colleagues analyzed the accuracy of the lists of dermatologists that insurance companies said accepted Medicare Advantage plans.

The directories, from 12 U.S. metropolitan areas, included the names of 4,754 dermatologists. Forty-six percent of those doctors were listed twice, however.

The researchers attempted to make appointments with dermatologists for a fictional father who had an itch for months and was about to select a Medicare Advantage plan.

  • Of the remaining 2,590 dermatologists listed in the directories, 18 percent were not reachable, 9 percent had retired, died or moved and another 9 percent were not accepting new patients.

Overall, only 1,266 dermatologists — or fewer than half — were reachable, accepted the specific Medicare Advantage plan and offered an appointment.

  • For one of the plans, the researchers were unable to make an appointment with any of the listed dermatologists


My comment:
For more than a month I have been poring over brochures and plans and the Book from our government outlining all the relevant insurance companies available to me here  in Ohio in my county.  Its not an easy matter.  It deserves a great deal of consideration by each of us.   It is better to be thoughtful rather than take things for granted. . .for that is the source of so much needless painIt’s a pain in the gut to have to do this every year.  Have been with one company for 3 or maybe four years now.  Tho I plan never to be in a hospital again,  I have, nevertheless, learned that life sometimes has different plans for us than we might choose for ourselves.    So it pays to cover those bases as well as we can.  
Stuff changes,  my easy to ignore insurance company has  put a premium on my $0.00 premium plan.  I don’t take meds, so no cost factors there and I only saw a doc once this year for a mole removal and of course, a blood draw.  Don’t know how your budgets are doing, but mine is being squeezed.  My rent took a jump,   m y electric utility bill almost doubled. . .am spending near triple what I was  a year or two ago on groceries.  And like all other retired folks,  we pay more than $100 monthly for our medicare whether we use it or not from our Social Security.  So for those rare occasions I might need attention from the medical complex, I try to associate myself with the best I can get for the least amount of money.  While so much is going up, I shook my head at the paltry increase in our S.S. cola. . I think I read it was going to be 1.7%. .don’t take my word for it, check it out yourself.  
Well, anyway,  while all this decision-making is going on, I’m seeing this above article and now I’m spitting tacks!  Is this even possible?  I have to vent. . .so damned livid.  Call my son and relate to him. . .and he literally breaks up laughing. Guess he figured the old lady has really lost it now. . .just making stuff up.  No I assured him, this happened.  You know that old adage. . .the apple doesn’t fall far from the tree;  sometimes I wonder if my apple and I are even related.  But wait, I’m not done. . .         
. . .Thinking I’ve got my choice narrowed down to two, I related my thoughts on why I chose these two and the difficulty I was having opting for either.   My younger, modern and current son whose inner guide and smarts has always had my utmost trust and admiration,  casually recounted my dilemma and cleared a path for me to easily see my way and bingo. . there I was with a choice.   So I decided to call the only doctor I have now and see if their office accepts the new  (to me) insurance company.   Seems he is gone now to another location which is a good deal further for me to go.  Never got to speak to anyone as they were in transition to the new spectacular new shape of their practice.  But I could go online, check it out and even sign up and subscribe online if I so chose.  Well I went online  and couldn’t believe my eyes.  I’ve done an article some time ago within the last six months or so regarding concierge doctors.  There is an annual fee due up front and promising all the bells and whistles.    Too bad, since I liked him. . . a good man. I wish him well, but he has seen the last of me. 
Can’t believe I will also have to find a new doctor  to go along with my new insurance.   I put this story up not to mess with your head,  indeed, it’s just to alert you to check stuff out, take nothing for granted, do your due diligence before you sign anything.    .      .      ..   .  just sayin’. . .take care,  Jan


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