Meh, bad day on the job at the doctor's office.

[Cleita]

I work part time for a doctor who specializes in pain management. Yesterday, we had a 78 year old woman come in, who has never been to a doctor. It turns out that she's suddenly coming up with a rash of symptoms, has cataracts, possible osteosporosis and a variety of other ailments that can only be diagnosed with a battery of tests. So she only has Medicare part A and payed in cash. I tried to explain to her what her options were under Medicare but that she would have to enroll in Part B and Part D, if beneficial, first. Since my doctor is a specialist, he referred her to a GP as we are not equipped to do general exams but he asked me to explain Medicare to her.

I told her that to enroll in Part B, it would cost approximately $90 a month that would be deducted from her Social Security payment and that Medicare only payed 80% of the approved amount. She gasped when I said it. I even told her that she could get privatized Medicare that promises a lot more coverage including drugs but that no physicians in the area would accept them because of their poor payment record. She could possible qualify for Medi-Cal that would cover the 20% but would have to be destitute almost to get it, otherwise she would have to get a Medigap private insurance policy that can cost between $125 and $250 a month depending on her problems and what the insurance company feels she needs to pay. I think she has too much to qualify for Medical but not enough to pay for an expensive insurance policy.

I tried to explain to her how expensive the tests are going to be to get a diagnosis and that since she and her deceased husband had worked all their lives and paid into it that they were entitled to it. But it turns out that the $90 a month and 20% co-pay are more than she can handle. She said that she would pay the doctor cash. I tried to tell her it wasn't going to be enough to get the tests she needed and that they were very expensive. I then suggested to her to go to the ER and to ask to talk to a social worker who can probably come up with a way to pay for her care. She hugged me and left.

Yet I'm bummed out. I don't think she will get what she needs. She knows apparently that she probably is dying and wants pain medication to die peacefully, yet no one will be able to give her this without the right documentation that she needs those pain medications and for that she needs a thorough physical exam, a battery of tests and no doubt referrals to other specialists who deal with her specific ailments. I really tried to impress on her that she won't be able to pay cash for everything she is going to be getting. What this elderly woman needs is to be able to present a health care card to every health care provider she might need. She shouldn't have to worry about how it will be paid. I think she will just die alone and in pain and I can't do anything for her.

Our health care system stinks. :cry:

[sandnsea]

1. Let me get this straight

The woman has Medicare that will pay for 80% of her treatment and lab work - and you don't have a doctor and lab in your area who will take her?

[Cleita]

6. She has Medicare Part A that everyone gets and it only pays for

hospitalization. She has to enroll for Medicare Part B to get 80% payment for doctors offices and tests. She doesn't have it and nearly had a heart attack when I told her it cost $90 a month to be deducted from her Social Security. That's why I sent her to the ER. Hopefully, the hospital will be able to sort out what Medicare will pay for and a social worker may be able to advise her of programs that I'm not aware of that could help her. I got the vibe though that she isn't going to do it. I mean someone who has never been to a doctor isn't going to start figuring out how the system works at this late stage.

I my perfect world, she should have been able to see my doctor with me swiping a health care card for her and then he would have been able to send her to another doctor and another swipe of the card, who would have ordered tests more card swiping and maybe referrals when needed. Then she could have come back to my doctor with diagnosis and another swipe of the card, a program of treatment and medication for pain management. No money need be mentioned to the patient.

[sandnsea]

9. Oh right

I missed that part somehow. It's all too complicated even if you have been going to the doctor. They're also unrealistic about what people can afford to pay, which is a real concern I have about making any program mandatory before we get the details worked out. What if they were just taking that $90 right out of her social security, which may well be her food budget. Too many people just don't understand how much money that is.

[wryter2000]

2. What a disgrace

The poor lady.

[Tammie]

3. Since she didn't enroll at age 65 she may have to pay even more than the $96.

Her premiums may be increased 10% for each twelve month period she could have selected Part B but did not.

[Cleita]

7. Oh goodie! Who thought that up? Penalize the patient who up until then

didn't cost you any money.

[Tammie]

8. Uncle Sam can be cruel ........

Shameful how this country treats the elderly.

[sinkingfeeling]

4. Yes it does. I've never been one to go to doctors except when absolutely necessary.

I went to one yesterday for the first time in 8 years. I'm 60 and a huge, very firm swelling develop on my neck in front of my right ear over the last month. I have employer paid insurance and met my deductible this year because of cataract surgery. I looked up the only endocrinologist in my insurance company's system and made an appointment, thinking it was probably my lymph node. He examined me and said, no he thought the swelling was in the parotid gland and referred me to an ENT in the same building. Cost to me for his 20 minutes of feeling my neck: $35, total bill $186.
Went downstairs to the ENT and he performed an FNA, but I won't have the results until 12/30. I don't know how much that cost, but I paid $35. He told me that I will have to have a CT scan and full blood workup and then surgery to remove the gland/tumor. Estimate cost over $15,000.

I remember the days went an office visit to the local GP was $10. The doctor took blood for testing and diagnosed problems and performed the surgery. Medicine in this country is too specialized and too costly.

[azurnoir]

5. Our current medical system literally puts a price on life

if you have money you live if not well.........

In my area one of the major clinical groups Park-Nicolette dumped its Medi-Care patients last spring because the returns were not high enough

[barbtries]

10. this is a travesty

in such a wealthy country, that an old woman cannot get the care she needs.

[Donnachaidh]

11. Considering her age, that 90 dollar payment for Medicare B might well be

25 or 30 PER CENT of her Social Security payment.

All the medigap insurances and the medicare part D programs are obscene. And it shows how much this country values it's seniors. :puke:

[Cleita]

12. This is why I get livid everytime some conservative ass comes up with

statements about giving free health care or pills to old people. They aren't free and we pay more for our health care on less income than younger employed people do.

[supernova]

13. Heartbreaking

:cry:

Thanks for your post.

[Sgent]

14. She needs to apply for Medicaid

or whatever its called in your state.

Even if she doesn't qualify for full blown Medicaid (which pays her 20%), and I get the feeling she may, she should qualify as a QMB.

The QMB is income only (they don't care about assets), and will pay for her Part B premiums.

[Cleita]

15. She won't do this on her own I feel.

I hope she goes to the ER like I told her and hopefully they will get a social worker to help her. Medi-Cal which is what we have in California could be her ticket to getting the tests and treatments that she needs. I don't think we will see her again at our office.

[supernova]

16. The social worker sounds like

her best option. They can help her navigate the system and fill out the paperwork for her.

I really hope she finds one.