Question:
Why are Medicade patients put on a different list then people who has Insurance?
I have Missouri Medicade. Medicade said they would pay for my surgery beause of all of my health problems I have and being overweight. The problem I am having Is not with Medicade but with the Dr. office. They have 2 different waiting lists for their patients.1 list Is for people with Insurance and the other list Is for people like myself who has to be on Medicade. People on the list for Medicade has a waiting list of about 4 or 5 years to wait. But If I had regular Insurance or If I get another type of Insurance then I can call back and be placed on the list and be seen so much faster. To me this isn't right. Medicade Is willing to pay for me to have this surgery because I have so many health issues and I need this surgery to help me stay alive. I may not have 4 or 5 years to wait and might not be able to wait this long. I know there are other people out there who has the same problem as I am having. Did anyone else find a way to have their surgery faster? To me this sounds like the Better off you are in having Insurance over Medicade the better off you are.This seems to be unfair. Good Luck to everyone who Is having the same problems as I am with their Dr's and the long waiting list for Medicade patient's. — Susan L. (posted on June 30, 2003)
June 29, 2003
I HAVE BCBS IN ILLINOIS, AND I ASKED THE OFFICE WHERE I AM PLANNING TO GO,
THAT IF I SHOULD GET LAID OFF AND HAVE TO GET MEDICAID WOULD IT MAKE A
DIFFERENCE ON MY CONSULT DATE (MIND YOU, I DIDN'T REALLY THINK THAT IT
WOULD BE A PROBLEM, BECAUSE INSURANCE IS INSURANCE) BUT YES, SHE DID
MENTION THAT I WOULD HAVE TO BE PUT ONTO A DIFFERENT LIST, WHICH I FOUND
RIDICULOUS. IT WAS EXPLAINED TO ME THAT ALTHOUGH MEDICAID DOES PAY FOR
YOUR PROCEDURE, THEY ARE MUCH SLOWER TO PAY THE HOSPITAL FOR THE EXPENSE OF
THE PROCEDURE, WHILE PRIVATE INSURANCES (BCBS, UNITED, OTHER.,) PAY
UPFRONT.
— Tanya F.
June 29, 2003
No, it isn't fair but it is all about money. I don't have medicaid but I
do have medicare and what they pay is riducously low. About 1/3 or less of
the actual bill. I can understand the hospital and doctors position. They
practically have to give this surgury for free to people with medicaid and
medicare. Most docs won't even accept these patients for that very reason
or they limit themselves to such a few in a certain time span that they do
have long waiting lists.
— Delores S.
June 29, 2003
ANOTHER SUGGESTION, MAYBE TRY TO FIND HOSPITALS IN SURROUNDING STATES.
BECAUSE ALTHOUGH MY DOCTOR SAID THAT I WOULD BE PUT ON ANOTHER LIST, MY
WAIT LIST WAS NOT AS LONG AS THE ONE YOU SAID. MY WAIT LIST WAS PROBABLY
TO MARCH-APRIL, WHICH ISN'T AS BAD AT 4-5 YEARS.
FYI, THE HOSPITAL IS RUSH PRESBYTERIAN IN ILLINOIS, SHOULD YOU DECIDE TO
FOLLOW UP ON MY SUGGESTION.
— Tanya F.
June 29, 2003
I dont have medicaid myself. BUT one thing I would find out if I were you
is 1) Did the doctor 'sign' up to be a medicaid doctor??? I know with
medicare the doctor doesnt have to be a 'medicare' doctor.. so if he
'signed' up to accept medicaid - what are the governing 'rules'??? Your
doctor may be treating you different but he may also be 'breaking' medicaid
rules in doing this.... cant hurt to find out! good luck....
— star .
June 29, 2003
I live in New Jersey. and I also have Medicade, But I didn't have any
problems with get things going with my doctor, the process went fairly
fast. No waiting list that I knew of. The way he did it was first come
first served. There was no waiting for nothing. Everything was within a
month or so.
— Naes Wls J.
June 29, 2003
One thing my Dr. mentioned (I don't have medicade) in the seminar was that
medicade didn't pay the full amounts etc... so more than likely they are
splitting them up to make way for cost etc... he does still have bills to
pay and medicade is slow to pay, and I know it isn't fair, but I don't know
if there is anything that can be done... my auntie had to drive from
Sedalia to Columbia (Missouri) to see a medicade dentist... that stinks...
I just don't get it other than the fact that Dr's just don't want to deal
with all the red tape... MF
— MF
June 30, 2003
Susan, you don't mention what doctor(s) you have tried getting scheduled
with. Have you contacted Dr. Ali at Truman Medical Center in Kansas City?
I know he takes Medicaid, and was under the impression he did not have
*that* long of a wait. If self-pay is even the slightest option (I mention
this only because of another post I saw from you), Dr. Sifers in Shawnee
Mission has a self-pay option of around $15,000. I know for me that may
as well be 15 million, but just thought I would throw the info out there
for you. Good luck! I sure hope you find what you need.
— Lynne S.
June 30, 2003
I heard the secretary at my wl surgeons office telling someone on the phone
that they only do a certain number of medicaid patients per year, that is
why the list is so long. It is stupid and not fair. One possibility is
finding a surgeon that does this surgery but isnt listed on this site. I
know of a general surgeon who is very good, he does several kinds of
surgery and wls is one of them. He does the surgery at St. L U hospital.
If you want his name email me. Im sure there wont be a waiting list...
— cherokey55
June 30, 2003
It isn't just with Medicare patients there is a surgeon here who does the
same thing for patients who have Tricare(insurance that the military
uses)he only does one Tricare patient a month, because Tricare pays a lower
allowable charge but the surgeon's have agreed to this charge so I don't
understand why it would be any different than any other insurance. I am
sure that there is nothing to do but look for another surgeon. My surgeon
has no waiting list at all.
— S C.
June 30, 2003
As Lynne suggested, Dr. Ali in Kansas City does NOT have a waiting list
that long. I am also Missouri Medicaid. I went to my first appointment
with him in December, and was offered a date sometime in March. I had my
surgery in June due to MY scheduling necessities. Right now I think he's
scheduling into November. The list is getting longer, but he accepts
Medicaid patients EVERY DAY. He does have 2 different clinics, and one is
for Medicare/Medicaid, the other is for self-pay and regular insurance.
But he has never treated me any less than respectfully, and I'm very happy
with his staff. Just thought I'd chime in. :)
— ladyphy
June 30, 2003
As a surgeon's office manager for many years, I can tell you that managing
patient's ELECTIVE surgeries who are on medicaid is not uncommon. I once
worked for an opthamologist who did 15 cataract surgeries a day, twice a
week. He allowed 3-4 a day of a certain welfare HMO program. If it got
close to the surgery date and there were openings, we could fill up the
rest of the day with the welfare HMO patients. The wait was an extra 4-6
weeks, not years. It was not about taking longer to get paid, it was being
able to minimize his losses. Using fake numbers (its been a long time,
can't remember exact figures) the charge for the doc was $1200 (not
hospital, anesthesia, or anything else, just the surgeon). Medicare
allowed about $800, private insurance anywhere from the whole $1200 to
$1000. Welfare direct and this HMO paid $350. Now he had enough patients
that he could see no welfare patients at all, but he chose to treat the
patients that needed him, even if he got paid less than half of his usual
amount, and only a quarter of his charge. If he didn't use this
"rationing" of time system, he would get paid $5250 instead of
$18000, which is a loss of $25500 a week. Now that is still a lot of
money, and doctors do make good money, but they also work very hard, spend
a decade learning and training along with all that extra expense, have
malpractice coverage, secretaries, nurses, taxes, health insurance to pay
for the employees, PTO, accountant to oversee the company's books,
bookkeeper to bill insurance and patients and argue when they don't get
their money, patient balances that go to collection, overhead, and plenty
of other things people don't think about them having to pay - dues to each
hospital they are on, licensing fees, computers & software, ongoing
education & travel expensess for himself and his staff members (nurse,
insurance biller) transcriptionist, a staff member to do nothing but
authorizations, answering service, etc.
I think it is completely fair for a surgeon to ration out his losses for
ELECTIVE surgeries. If the one you want is that far booked out, get on the
list and keep looking for others.
URGENT MEDICAL PROCEDURES are something entirely different, and I have
never seen a doctor waver for a minute about attending to someone who
needed care based on their insurance.
— bethybb
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