Reply to Advanced Primary Care Management- PCP Medicare

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][b]Why not just bill higher for an appointment? [/b]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?[/quote]

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

There is a lot you don't understand here. There is no "ethics" problem. And I don't know what you mean by "fronting ... extra costs." Managing patients with chronic conditions comes with a high administrative cost, whether the doctor provided direct care to you in the billed-for-month that you are enraged over or not. Which is why they can still bill for it even if they did not see you.

At any rate, they do need your consent to bill for this, so just don't give it if you are going to act this enraged over it. But there is no ethics issue here, just a failure on your part to understand APCMS.  And if you are so ready to slam your doctor as having poor ethics, maybe you should find another one? Something tells me they won't mind if you move on. 
[/quote]
1. They won't even know. I have seen a doctor or a PA once a year only to authorize yearly bloodwork. Period. I really don't know anyone there. I had to show up 3 years ago after an ER visit for really nothing, and that was my only other visit. That's literally it. I see specialists out of this office that do not communicate with this office. I am dependent on this office for really nothing, 
2. Spouse has been seen 2 times this year and met with 2 different PAs. No doctor.t
3. What do you not understand about the fronting of extra costs? This is a PCP practice. They see thousands of patients of all ages. Why is my Medicare being charged monthly for quite a bit of money, outside of the regular insurance cost and any copays, for a separate fee to Medicare,  because of the overall patient burden when all these non Medicare patients are not? Is there an assumption that they do not have 2 or more chronic conditions? They pretty much do. The kid next door has asthma and allergies, got Covid 3 times. He's 14. He's in there all the time, while someone like myself is not. I see my own specialists. So why is my Medicare and secondary insurance being charged each month with this surcharge? This is all I am asking.  Of course, secondary did not pay it- so now they want the monthly cost from me. I have yet to figure out why. 
3. Let me explain how they got my permission. A bunch of forms on a clipboard with this one tucked in at the end the title being " Advanced Primary Care, Medicare." I was new to Medicare and this looked like the form indicating that Medicare is my primary- that is all. It said to the effect that I would be able to get same day appts (never happened to my spouse in these last months) that I could get referrals to their choice of doctors out of the practice for specialty issues( I can make my own, but even so, don't all doctors refer when that is necessary?)
4. Fee? Yeah, the form indicated that my bills are going to Medicare as primary. I think we all understand that if we are on Medicare that is where the bill goes. Any mention that this will be an extra cost? No. Any mention of the cost? No. Yes, it was all pretty vague.  And yes, I opted out this month after a bill for $150 appeared in my portal for 3 months, and I checked my EOBs.

So yes, it looks like they are using Medicare and Medicare patients to cover the costs for all that are burdening the practice. Medicare is struggling as it is, how is that helping?  I am willing to pay more for appts, I actually have 2 insurances (!)I understand this is a problem, in fact I pay for someone else's health insurance currently because of the rising costs- this is someone without a job and cannot afford ACA prices. 
 So, this looks like back door antics to me, sorry. Of course I am leaving the practice. It appears they took on too many patients, perhaps. I would have been easy as I barely go and require nothing really from them. Oh well.

I suggest you reconsider this if you are a practitioner, or at least be up front about it. Or= just be concierge as it seems that is the trend. [/quote]

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