Advanced Primary Care Management- PCP Medicare

[Anonymous]

Anyone else here get sucked unwittingly into some program with your PCP whereby there's some extra "management" regarding comprehensive care and billed monthly to Medicare?

This was a boiler plate form at the doctor's office which looked like some basic understanding that the office would be the basic point of care as I now a Medicare subscriber. Nothing about fees, anything.

I feel like I don't want to deal with this practice anymore- very sketchy. Yes, I got out of it but not before Medicare was billed for months for absolutely nothjng.

Check your EOBs.

[Anonymous]

Agree to be careful-/ someone else posted about this recently.

[Anonymous]

Never heard of this and I am on Medicare. Curious what this “extra management care” is supposed to be?

[Anonymous]

Anonymous wrote:Never heard of this and I am on Medicare. Curious what this “extra management care” is supposed to be?

A lot of vague stuff that sounds like what you assume you would be getting anyway- the ability to make appts, referrals to specislists. It's ridiculous.

[Anonymous]

I'm familiar with it, and I don't think it is sketchy.

Medicare reimbursements for doctors are so low. This program is basically a way for them to get a little more money from Medicare every month, per patient with a slightly complex medical condition. (I think they need to have two or more health problems.) Even if you don't see them every month, they can bill Medicare for like, $48.00. That's not a lot, but if enough patients opt in, it adds some extra revenue to help them cover the things they are already doing like helping fight for prior authorization.

[Anonymous]

It’s not sketchy, it’s a way for your doctor’s office to get reimbursed for non face to face care that they provide and Medicare is willing to finally pay for.

Why not allow the office to collect these fees so they can continue to offer things that take time, staffing, EMR, etc?

[Anonymous]

Anonymous wrote:It’s not sketchy, it’s a way for your doctor’s office to get reimbursed for non face to face care that they provide and Medicare is willing to finally pay for.

Why not allow the office to collect these fees so they can continue to offer things that take time, staffing, EMR, etc?

Because the doctor isn't managing any of my conditions. I see specialists that he has nothing to do with. He does not prescribe any meds, he does not communicate with my drs and he barely understands my meds.
I show up one time a year for a wellness visit.
If my spouse or I need an appointment beyond that like for a virus or sprain, we see PAs there as that is who we are assigned to in an appt. And what time for visits? 10 minutes.
The doctor now billing Medicare is a doctor I have not seen..ever,,as my usual one left.
Medicare pays a fraction for the bill, then my secondary refuses to pay the rest and then I am billed 50 bucks- every month. What? On top of Medicare payments and secondary insurance payments?
Lastly this form I signed said none of what was happening, , listed Medicare services that are services everyone gets when going to the dr, and no mention of extra costs to us. Yes, that is sketchy. If you want more money, then bill the actual amount for the visit, period. Let's not pretend that the doctor is coordinating our total care.

[Anonymous]

Anonymous wrote:I'm familiar with it, and I don't think it is sketchy.

Medicare reimbursements for doctors are so low. This program is basically a way for them to get a little more money from Medicare every month, per patient with a slightly complex medical condition. (I think they need to have two or more health problems.) Even if you don't see them every month, they can bill Medicare for like, $48.00. That's not a lot, but if enough patients opt in, it adds some extra revenue to help them cover the things they are already doing like helping fight for prior authorization.

I don't need prior authorization. For what? The bill is twice what you listed and I am being billed the rest that Medicare doesn't pay.

[Anonymous]

Why not just bill higher for an appointment? The fact that Medicare doesn't pay much is not the patient's problem. Why are they billing for nothing that has transpired? How is this not concerning, and yes, sketchy?
I have a specialist who gives out his phone # (hopefully it's not abused, but I'm sure it is,) calls to check in frequently, orders tests from his living room if he has to. Medicare pays a fraction of his bill and yet he isn't finding hidden workarounds to get paid more.And yet my primary care dr, who is managing none of this, is asking for more money for managing this? He's not managing this.

What?

I guess they all can refuse Medicare, but I'm not sure why the patient will fill the gap here considering there's Medicare and Supplemental policy. If the supplemental policy refuses, how is that the patient's problem?

[Anonymous]

Anonymous wrote:Why not just bill higher for an appointment? The fact that Medicare doesn't pay much is not the patient's problem. Why are they billing for nothing that has transpired? How is this not concerning, and yes, sketchy?
I have a specialist who gives out his phone # (hopefully it's not abused, but I'm sure it is,) calls to check in frequently, orders tests from his living room if he has to. Medicare pays a fraction of his bill and yet he isn't finding hidden workarounds to get paid more.And yet my primary care dr, who is managing none of this, is asking for more money for managing this? He's not managing this.

What?

I guess they all can refuse Medicare, but I'm not sure why the patient will fill the gap here considering there's Medicare and Supplemental policy. If the supplemental policy refuses, how is that the patient's problem?

Because the cost of appointments isn't the issue. Mountainous administrative hassle (preauthorizations, script refills, fighting insurance companies, etc) and communication with patients outside of appointments (a million portal messages about side effects, do-I-need-to-be-seen-for-this, etc) is the issue, and this tends to be related to managing people with chronic issues. Could you bill more for appointments to offset that? Maybe in theory; but Medicare isn't going to allow for that. No one is "finding hidden workarounds" here; doctors are just trying to get paid for the labor that has gone unpaid for a very long time and had finally hit completely unsustainable.

That said, it sounds like you pcp doesn't have to manage anything for you. Fine. Just opt out of this fee or whatever.

[Anonymous]

Anonymous wrote:I'm familiar with it, and I don't think it is sketchy.

Medicare reimbursements for doctors are so low. This program is basically a way for them to get a little more money from Medicare every month, per patient with a slightly complex medical condition. (I think they need to have two or more health problems.) Even if you don't see them every month, they can bill Medicare for like, $48.00. That's not a lot, but if enough patients opt in, it adds some extra revenue to help them cover the things they are already doing like helping fight for prior authorization.

That seems like the definition of sketchy to me. Trying to extract money for doing nothing. Especially if they are actually billing the patient.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Why not just bill higher for an appointment? The fact that Medicare doesn't pay much is not the patient's problem. Why are they billing for nothing that has transpired? How is this not concerning, and yes, sketchy?
I have a specialist who gives out his phone # (hopefully it's not abused, but I'm sure it is,) calls to check in frequently, orders tests from his living room if he has to. Medicare pays a fraction of his bill and yet he isn't finding hidden workarounds to get paid more.And yet my primary care dr, who is managing none of this, is asking for more money for managing this? He's not managing this.

What?

I guess they all can refuse Medicare, but I'm not sure why the patient will fill the gap here considering there's Medicare and Supplemental policy. If the supplemental policy refuses, how is that the patient's problem?

Because the cost of appointments isn't the issue. Mountainous administrative hassle (preauthorizations, script refills, fighting insurance companies, etc) and communication with patients outside of appointments (a million portal messages about side effects, do-I-need-to-be-seen-for-this, etc) is the issue, and this tends to be related to managing people with chronic issues. Could you bill more for appointments to offset that? Maybe in theory; but Medicare isn't going to allow for that. No one is "finding hidden workarounds" here; doctors are just trying to get paid for the labor that has gone unpaid for a very long time and had finally hit completely unsustainable.

That said, it sounds like you pcp doesn't have to manage anything for you. Fine. Just opt out of this fee or whatever.

I don't think it would be unreasonable to charge a small fee for portal messages and RX refills and the like, but to charge a monthly fee when there has been no contact is not ethical IMO.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Why not just bill higher for an appointment? The fact that Medicare doesn't pay much is not the patient's problem. Why are they billing for nothing that has transpired? How is this not concerning, and yes, sketchy?
I have a specialist who gives out his phone # (hopefully it's not abused, but I'm sure it is,) calls to check in frequently, orders tests from his living room if he has to. Medicare pays a fraction of his bill and yet he isn't finding hidden workarounds to get paid more.And yet my primary care dr, who is managing none of this, is asking for more money for managing this? He's not managing this.

What?

I guess they all can refuse Medicare, but I'm not sure why the patient will fill the gap here considering there's Medicare and Supplemental policy. If the supplemental policy refuses, how is that the patient's problem?

Because the cost of appointments isn't the issue. Mountainous administrative hassle (preauthorizations, script refills, fighting insurance companies, etc) and communication with patients outside of appointments (a million portal messages about side effects, do-I-need-to-be-seen-for-this, etc) is the issue, and this tends to be related to managing people with chronic issues. Could you bill more for appointments to offset that? Maybe in theory; but Medicare isn't going to allow for that. No one is "finding hidden workarounds" here; doctors are just trying to get paid for the labor that has gone unpaid for a very long time and had finally hit completely unsustainable.

That said, it sounds like you pcp doesn't have to manage anything for you. Fine. Just opt out of this fee or whatever.

I don't think it would be unreasonable to charge a small fee for portal messages and RX refills and the like, but to charge a monthly fee when there has been no contact is not ethical IMO.

Ok, given all of your replies in this thread, it's clear you are in a rage about this and can't see reason. Just go to a different doctor if you think this one has an ethics problem.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Why not just bill higher for an appointment? The fact that Medicare doesn't pay much is not the patient's problem. Why are they billing for nothing that has transpired? How is this not concerning, and yes, sketchy?
I have a specialist who gives out his phone # (hopefully it's not abused, but I'm sure it is,) calls to check in frequently, orders tests from his living room if he has to. Medicare pays a fraction of his bill and yet he isn't finding hidden workarounds to get paid more.And yet my primary care dr, who is managing none of this, is asking for more money for managing this? He's not managing this.

What?

I guess they all can refuse Medicare, but I'm not sure why the patient will fill the gap here considering there's Medicare and Supplemental policy. If the supplemental policy refuses, how is that the patient's problem?

Because the cost of appointments isn't the issue. Mountainous administrative hassle (preauthorizations, script refills, fighting insurance companies, etc) and communication with patients outside of appointments (a million portal messages about side effects, do-I-need-to-be-seen-for-this, etc) is the issue, and this tends to be related to managing people with chronic issues. Could you bill more for appointments to offset that? Maybe in theory; but Medicare isn't going to allow for that. No one is "finding hidden workarounds" here; doctors are just trying to get paid for the labor that has gone unpaid for a very long time and had finally hit completely unsustainable.

That said, it sounds like you pcp doesn't have to manage anything for you. Fine. Just opt out of this fee or whatever.

I don't think it would be unreasonable to charge a small fee for portal messages and RX refills and the like, but to charge a monthly fee when there has been no contact is not ethical IMO.

I think I was clear- this practice does not prescribe anything for me. The only portal message in the last year was a referral for a second call back for radiology appt that they didn't send me to to begin with, it's just a yearly thing that I did need a referral for to do a second look- and it took a 10 days to get it with 3 different messages.
If you think all those things you listed above are a problem for a practice, and they need more $$, then why is my secondary not paying, and all other patients not on Medicare not being charged? Yes, it seems really suspect. I am "not in a rage." I am asking to see if this was ubiquitous, and,according to my friends, it is not.

What this means is that we all will now be paying for concierge services which, way more that this surcharge, and, in my view, will only compound the overwhelming disconnect problem in healthcare. I say charge more to everyone for the appt or whatever, and deal with insurance, but this makes little sense.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Why not just bill higher for an appointment? The fact that Medicare doesn't pay much is not the patient's problem. Why are they billing for nothing that has transpired? How is this not concerning, and yes, sketchy?
I have a specialist who gives out his phone # (hopefully it's not abused, but I'm sure it is,) calls to check in frequently, orders tests from his living room if he has to. Medicare pays a fraction of his bill and yet he isn't finding hidden workarounds to get paid more.And yet my primary care dr, who is managing none of this, is asking for more money for managing this? He's not managing this.

What?

I guess they all can refuse Medicare, but I'm not sure why the patient will fill the gap here considering there's Medicare and Supplemental policy. If the supplemental policy refuses, how is that the patient's problem?

Because the cost of appointments isn't the issue. Mountainous administrative hassle (preauthorizations, script refills, fighting insurance companies, etc) and communication with patients outside of appointments (a million portal messages about side effects, do-I-need-to-be-seen-for-this, etc) is the issue, and this tends to be related to managing people with chronic issues. Could you bill more for appointments to offset that? Maybe in theory; but Medicare isn't going to allow for that. No one is "finding hidden workarounds" here; doctors are just trying to get paid for the labor that has gone unpaid for a very long time and had finally hit completely unsustainable.

That said, it sounds like you pcp doesn't have to manage anything for you. Fine. Just opt out of this fee or whatever.

Again, it's about the ethics behind it. Medicare and I, along with other Medicare patients, fronting the extra costs? What?