How Medicare Really Works
Have you ever needed your Medical Insurance and it hasn’t been there for you? Without knowing how the rules work it hits you smack between the eyes when you actual try to move within the insurance system.
This is my recent story. When I became Medicare eligible eight years ago I picked my Medicare Insurance (HMO) Health Maintenance Organization plan and (PCP) Primary Care Physician. I decided to change my PCP recently without thought to the consequences. This is what happened. I did not change my HMO Plan it stayed the same, but my new PCP was in a different Medical Group. The insurance, on the whole, will run the same way or so I thought.
I recently had eye surgery and my eye had cleared up and was back to normal. I forgot about my eye and the special care it had required. After I had seen my new (PCP) I suddenly had eye pain, swelling and redness in the eye I had surgery in. Since it was late at night I went to the Emergency Room and found out it was a Cornea Abrasion. The ER Doctor flushed my eye and gave me antibiotic drops and drops of the pain. I was told to make an appointment with my eye surgeon ASAP.
The next morning I called my eye surgeon and found this out. He was not on the Medical Group I was now on. He was still on the HMO Plan but not the Medical Group and did not plan to become a provider for this Medical Group. If I wanted to see the eye specialist I would have to pay for my visit since it did not have anything to do with my recent eye surgery even though it was the same eye.
I was told to call my new (PCP). I did I immediately called my new Primary Care Doctor and because I had recently been in to see him I was told, Susan, would start working on a referral for me to see a new eye specialist it would take at least a week.
Note: Even if I would have paid for the visit to the eye specialist who had performed my eye surgery he could not have given me a prescription or performed any kind of procedure. I was out of luck since I was not on the medical group that he was registered with.
This ladies and gentlemen is how our Medical System Works. Would you call this a broken system?
Let me hear from you. Let me hear your horror stories.