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Medical care on the road


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Hello all-

My DH and I are planning to go FT in June 2016. We have some concerns about medical care. First, my husband has prostate cancer. He's had it for about 3 years and has been under surveillance since his diagnoses and does not require treatment at this time. He has an annual visit along with tests by his Urologist. Second, I was diagnosed with breast cancer May 2015. I had surgery and radiation therapy and have been fine for the last year. We chose the June 2016 time frame because I am required to see my Medical Oncologist every 3 months for the first 2 years, then every 6 months for the following 3 years. So, my quarterly visits will be finished next June. We want to get on the road and on with our lives. My husband is on Medicare. I have insurance through my employer which will continue to be provided by them after I retire. I will be retiring somewhere between December 2015 and June 2016. I currently have an HMO, and that will need to change. It's not a big deal to change, it will just be more expensive. We have not decided on our domicile, because we need to understand how medical care works on the road. If we wanted to keep our current doctors, we would have to figure out how to domicile in Illinois (maybe one of the kids homes-is that what others do?). I'm sure there are others out there who have to deal with regular doctor visits, and I don't take the Oncologist lightly, but how do you work these out? Do you have a doctor in the location you domicile and return there for your appointments each time, or do you find a doctor in the location you are visiting? Also, how do you handle prescriptions? My insurance requires I use Primemail for long term prescriptions (I have to be on this cancer drug for 4 more years). Short term I can have filled at any Walgreens, CVS...etc.,. Any of you doing the pharmacy by mail?

 

With all these decisions, getting rid of all of our stuff, planning the sale of our home, getting our rig, figuring out finances, it would be real easy to say we can't do it. I don't want to get to that point, and the medical stuff really worries me. Any advice you can offer would be greatly appreciated. We really want to be able to work this out and live the RV lifestyle.

 

Barbara

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Hi Barb & Dan:

Johnny and I are writing from Washington and we just started full timing in January. Where are you? What HMO do you have? We have Kaiser and no major health problems. My e mail is n.duke79@sbcglobal.net I would like to communicate with you about full timing and getting rid of your things, and moving on this or not.

Nancy & Johnny :):D

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Hi Nancy & Johnny-

My email is acting up, so I'll respond here. We are in Montgomery, IL. I have BCBS HMO Illinois. We both seriously want to do this, and we certainly realize how fragile life can be, I just need to make sure I've planned for as much as I can.

 

I know things happen, but I want as many answers as I can get.

 

Safe travels,

Barbara

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Our domicile was SD and we had doctors in NH, AZ and CO.

 

The second year we were full timing I injured my back moving a picnic table in a campground in NH. Got initial treatment there and headed for CO. It got worse and when we got to CO had more treatment and an operation (laminotomy) that fixed the problem.

 

Once I had the symptoms of a blood clot in my right leg (turned out to be a synovial cyst - same symptoms but not dangerous like a clot) while we were at Forrest City Iowa for work on the motor home. No sonogram machine available there so made a run to the Iowa University Medical center in Iowa City for diagnosis and treatment recommendations (as recommended by the clinic in Forrest City). Then went to a doctor in the Dartmouth Hitchcock Clinic in Concord NH for treatment. After 8 weeks ended up back in CO for final treatment (cortisone shot).

Five years later I had a hip replacement done in CO.

 

We had no doctor in AZ where we spent a lot of winters (Bouse near Quartzsite) so when I tore a rotator cuff I made an appointment with a surgeon that works two days a week in Parker - comes down from Lake Havasu City - he set me up for the operation in the La Paz County Hospital in Parker and I had the operation done there. Five years later I had a hip replacement done in CO.

 

The point of this is that we had no problems getting treatment wherever we were.

 

Also I found that recovery was actually easier in the motor home because everything is so close. Here in the house we bought in CO, the master bathroom is 100 feet round trip (35 steps) from our office. While in the motor home it was three steps from the bed and four steps from the couch.

 

A couple of years ago I had a blood clot (DVT) in my right leg while we were here in our house in CO and spent several weeks in a recliner with my leg elevated. Before it was resolved I was wishing I was back in the motor home where it was a lot easier to get around.

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I believe that you will find that most of us who have continuing medical needs do establish a primary care doctor in the location of our domicile but it could be anywhere that you will be visiting often enough to make the needed appointments. It is difficult to impossible to go to a new doctor for each visit since each one will want to run all/most of his own tests to establish just what your needs are and they may not use the same preferred medications for the condition. In addition, there is some health advantage for most of us in using the same doctor over time so that we have an established record with that practice. We carried a complete set of our health records with us for the 12 years that we were on the road and Pam did have continuing medical issues and over that time, when she did need to see a doctor along our travels for some short term problem, not one time was that doctor interested in seeing the records we carried with us. They might have been interested if we were establishing ourselves there to become long term patients, but for one time visits, no. I think that particularly for your husband it will be important to be established with a doctor long term and if it were me, I'd return to the current doctor or get his referral to one in the place that you are thinking of moving your domicile.

 

For prescriptions we also used a mail order pharmacy and just had the renewals sent to our mail forwarding service, or if we were sitting in one spot for an extended period, we sometimes had them sent to our location, but mostly to the mail service address. There are some controlled medications, mostly pain medications, that are controlled and which can't be mailed to you so make sure of that. You do want to also be sure that the medications are not refrigeration required if using a mail forwarding service.

 

I suggest that you explore the change of insurance ASAP as that will be your biggest problem as Medicare is accepted everywhere as long as you use the standard form of it and most supplemental policies are widely accepted, although they might have a preferred doctors listing. Health insurance can be the largest financial drain on those going on the road if it is not provided by a previous employer.

Hi Barb & Dan:

Johnny and I are writing from Washington and we just started full timing in January.

Let me add a quick welcome to the Escapee forums for you on to this response. We are always happy to have new folks join us here so feel free to post, ask questions, or just join the conversations at any time! Welcome!

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Thank you, Clay and Kirk. This is great information. So it all sounds "doable". While I'm not crazy about having to return to the same spot every 6 months for 3 years, it could be worse. I'll be doing a lot more exploring with my insurance during our annual enrollment, which comes up in September. I'll be 58 in November, so I have a while before I'm eligible for Medicare. My employer will reimburse me $2700 each year after I go on Medicare, for whatever medical expenses I have,

even if it's just the $104.90 to Medicare and whatever supplemental insurance I need....so that helps. In the meantime, I will have around $100 a month in a premium and I'll have to find out about the changes with deductibles and co-pays when I switch from the HMO.

 

Anyway, clearly, we won't be the first people to attempt medical care while seeing the country. Hopefully, God willing, this will be the worst we have to deal with.

 

Safe travels, everyone.

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We moved our domicile to South Dakota but kept our primary doctors in Minnesota under our retiree medical insurance there. When we needed care while on the road we checked our insurance providers list to find someone local. When I needed regular blood tests done my doctor wrote the orders for me to take with me dating each one three months apart then we found labs that would draw the blood and send the results or my doctor. It all went much smoother than I expected it to do.

 

Linda Sand

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Do you envision spending some winter months in the same 'warm' area? Summer months - a visit to Illinois? If so, then I would keep your present doctors for the summer visit and establish new doctors for your winter digs. At least consider doing this during your 3-year checkups. You'll be amazed at how fast three years passes! You can carry your tests results with you or nowadays medical facilities can communicate via their medical computer program.

 

We have dealt with cancer, joint replacements and other surgeries and medical issues during our winter stops. Cancer was detected while in Michigan and surgery was in Arizona where I wanted to recoup. By the way, recouping from surgery in a RV is very easy - not much walking and everything is within easy reach. Physical therapists will also come to your RV. Also, you can have the surgery at the best facilities in the country.

 

When traveling and blood tests or other lab tests were required, it was easily done at any hospital or lab while traveling and the results sent to our doctor. Other times we needed medical while traveling - either an Urgent Care or the ER room. It's not been a problem. Even during a trip through Canada we had excellent care for a gall bladder attack and the cost to us was $65!!! The doctor called every couple days as we traveled to see how I was doing. Awesome!

 

Changing from a HMO to a PPO is advised for easier appointments.

 

Quite often, full-timers use a prescription mail service and have their meds sent to their mail forwarding service who in turn sends it on to you. It's easily done. Ourselves, we've always utilized WalMart pharmacies which are found everywhere and it's very easy to transfer from one WalMart to another by a phone call.

 

You definitely don't have to do your medical appts. in your state of domicile. Many full-timers never return to their state of domicile except for perhaps an update driver's license, etc.

 

Finally, we used Escapees RV Club for our mail forwarding and state of domicile.

 

Relax. It CAN be done. Best of luck in your new lifestyle!

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About returning to the doctor every 6 months.... Is there a reason the doctor need to have your physical presents every 6 months, or is it that there are some tests which need to done and evaluated? If it is tests & evaluation hopefully you could arrange to have the tests done wherever you happen to be and have the results send back to the doctor. You may still want to go back once a year to have a face to fact visit.

 

Here is a link to a couple who has a blog about their travels and I believe in 2014 they took an 4-6 month trip and had some tests done and sent back to their doctor. You will have to read through their blog to find the details about how they handled the tests.

 

They are active on this forum if you want to PM them: http://www.rvnetwork.com/index.php?showuser=6894

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BarbDan, We are former Illinois residents. We changed our domicile to SD mainly because of the need to meet vehicle exhaust requirements and not wanting to impose on DD to deal with our mail. We still have our Doctor in DuPage Co who understands our lifestyle and we return there a couple times a year for family visits so it works for us. That said, both Sandi and I had minor surgery while in Texas last winter. We just checked out local Doctors in the specialties needed and chose those we felt comfortable with. I'm on medicare and Sandi is on my retirement PPO coverage. We have had blood work done in different areas while traveling just get the Doctor to fax a local lab for the tests. Sandi gets 90 day supplies of meds through insurance mail plan for BP. They're sent to our mail forwarding address and then sent to our preferred location.

If you have a son or daughter willing to handle your mail and your primary Doctor will work with you I see no reason not to maintain your Illinois domicile.

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Anyway, clearly, we won't be the first people to attempt medical care while seeing the country. Hopefully, God willing, this will be the worst we have to deal with..

I believe that you have the proper attitude! A positive attitude and determination to find a way are the primary tools to succeed. While Pam's medical needs did in time push us off of the fulltime life, we believe those 12 years to have been some of the best of our lives and our only regret is that they didn't continue for longer. You can find a way to do this, just stay flexible and adjust as you must. Please do return and join into conversations or start new threads to share your progress with us. You have many friends here who are happy to help as much as we are able!

 

Enjoy your travels now while you are both able to share. Never forget that the only thing that we have which once gone can never be recovered or replaced is our time. Do not waste this precious commodity!

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Though I am sure your children would be happy to assist we have experience dealing with 4 parents thru illness, dementia and their passing. One parent was a month their spouse was 5 years and other parents were 4 years and their spouse 2 years. We were fortunate one set opted for assisted living the other could not make the move. Their mindset was to be independent and not burden family or friends, though commendable not realist and definitely not safe. Upon her passing we had to move the dad to assisted living as we could not personally provide the challenging 24 hour care his dementia required. It is a very draining experience and we have no problem admitting we are not care givers but managed the last parent in assisted living very well. Dad was not happy in the beginning but after a couple of months he thanked us and wished he had moved while mom was still living as they both would have blossomed there. Hindsight is 20/20. Talking and preparing for your later years is the best gift you can give your children. Making the move before you need it as one set of our parents did added to their quality of life .

 

Do as much as you can without the assistance of you children as you do not want to burn them out before you really need them.

 

We started our mail service a year before we hit the road and notified all friends and family of our new mailing address. We did not submit a change of address so greatly reduced junk mail following us.

 

DH has several chronic health issues which prompted us to start fulltiming early, so we used COBRA the 1st 18 months then bought our own health insurance. Pricey but the trade off to travel while we still had our health was worth it. On the road we found Dr's through recommendations of others in the area we stayed and http://www.healthguideusa.org/

 

We keep a copy of all our health records, MRI's, X-Rays etc with us and can provide them to then new dr. Also helpful is to go online to the dr's website and download the forms they require and have them filled out ahead of time. Many you can complete on your computer and printout to prevent errors from misreading handwriting. Many Dr's do network so you may want to ask your current Dr if he may know one in the area you want to domicile?

 

To help compare the cost of health care in one place to another there are several calculators on the internet ie: http://www.bestplaces.net/cost-of-living/

 

Cost differs by state and sometimes by zip codes within a state. The obvious California and New York are the most expensive for medical care.

 

If you find a Dr you really like the cost of the plane ticket back once a year may be worth it?

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Thank you ALL for sharing your experiences with us. I think you've help me realize that I've been with an HMO for so long, I've forgotten about flexibility and having choices. Because of the expense, I will probably keep my HMO until our S&B sells, then I will be able to switch to a PPO. This way I don't have to change at annual enrollment, since moving is one of those "life event" exceptions they allow you to make.

 

I still need to get a better understanding of how the mail service works. I assumed we would be enrolling in it with Escapees, I just don't understand how it's all processed. I'm hearing the pharmacy by mail is workable with the mail service, and that's what I really needed to be certain of. Somewhere I'm sure it will make sense to me about how I can be boondocking somewhere and I'll still be able to get my mail, and more importantly my medication.

 

You guys are all such a valuable resource. I can't imagine how people worked through all of this before the network of like minded people was formed, but I am glad it is here now for those of us who want to follow in your footsteps.

 

Barbara

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If we assume that you plan to use the Escapee mail service, start by going to the Escapee website and then log in as a member. You can then visit the Support Services menu and select the mail service and choose which level of service you wish to use. We have used category B for most of our time on the road. I would plan to have my mail service set up at least three months prior to your leaving the house and if not possible as soon as you can. Once you have been assigned an address I'd start to give address changes to your business contacts, but if you plan to keep your present domicile, you will want your driver's license, vehicle registration, your vehicle insurance and health insurance to use whatever you are using for your domicile address. You could move everything to Texas including your domicile and still return there to make your doctor visits as needed. If you plan to make Texas your domicile, download a copy of the booklet How To Become A Real Texan right away as that will help you a lot.

 

You may also find the article on choosing a domicile location that I wrote for Escapees Magazine to be helpful. If it were me, I would start to use the mail service prescription service right away just to get used to the process. Most such services are very easy to use and most can be done online if you have internet and that will speed things up greatly. You probably have the option to set up a permanent address for mailing prescriptions and also a place to set one time mailing addresses as most such serviced do have that. We used the permanent one for most things but if we stopped for several months in one spot, we then used the temporary address service to get our meds mailed directly to us for that one time, just to speed things up a little bit and save the postage of remailing. You need to allow at least a week for the prescriptions to get to the Escapees and then however much time you want but at least another week for Escapees to get the mail to you. You can have mail forwarded to you on a weekly or less often basis, according to your needs and the only extra cost for more frequent mailings is the postage. You can also call the mail room and they will happily check for you to see if the prescriptions have arrived there before you have the mail forwarded on to you. I think that once you get used to the mail process you will find that you like getting your medications that way.

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Most mail order pharmacies allow you to provide a temporary address. We use Express Scripts just go on the web site and put in a new temp Addy and our meds arrive on time. The only area we had trouble was general delivery in Quartszite, AZ

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We are not full timers as we have a S&B but we are on the road most of the year. Our primary care physicians are in our hometown and we are always here for a period of time in the summer months. We have BC/ BS and Medicare both nation wide of course . Our prescriptions are written by our primary care physicians and we use Wall mart Pharmacies across the country.

 

Everything is on line these days and we have no problem in refilling scripts. We have used Physicians in different States and Emergency rooms , hospitals , clinics in Florida. Medical records can be transferred between Dr and Hospitals with ease. We have been in travel mode for 10 years with not a problem.

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We have a stix and bricks but we travel for long times. We use our local docs once a year but we travel to obtain specialty care from docs we feel are better than our locals. We have used The Mayo Clinic and some in California. The difference in care can make a significant difference. Being mobile has its advantages!

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You asked about boondocking and using the mail forwarding service. We boondocked a lot and typically stayed in public parks. If you are staying at a RV park, ask and many times they'll let you receive your mail package there - especially if you're staying there a month or so.

 

If the RV park won't accept your mail, all you have to do is to check out your nearest, SMALL TOWN post office and get their General Delivery postal code. Do this through the U.S. Postmaster web site. You can also get the street address and telephone number from the web site. You might want to check that they will accept General Delivery for you. In 18 years we've never had a problem with this but some folks do occasionally.

 

I mentioned a SMALL TOWN post office. This is very important so there are no mix-ups. Larger cities will have multiple post offices and usually only one will accept general delivery. Using a small town will assure that your mail will go where you are expecting it to go.

 

Then give a call to Escapees mail forwarding - or whoever you use - to see if your prescriptions have arrived. Your mail order service will normally give you a mailing date. If they haven't arrived yet, keep checking. When they do arrive ask the mail forwarding service to send your mail on your specified date, ONE TIME ONLY, c/o General Delivery, City, State, Zip. We normally get our mail from Escapees in 2-4 days, usually 2 or 3. It's sent Priority. When you expect delivery just go to the post office to pick it up. Usually you'll have to show an ID to get your mail.

 

This all sounds like a big job but you'll soon get the hang of it and it can all get done very easily.

 

Sometimes, as we've traveled, we weren't planning on spending a lot of time in a particular small town. At those times we requested our mail 7-10 days prior to be sent to our General Delivery spot. Then when we arrived we could pick up our package that's waiting for us, spend a night or two and take off.

 

This whole process has worked even on our all summer Alaska travels although instead of 2-4 days we allowed 7 days. It was usually at the post office in 5 days. For Canada, we didn't even bother getting mail as it has to go through customs and takes a lot longer. Just plan ahead and it works.

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I have Medicare and a United Healthcare policy through AARP that allows me to use doctors anywhere I want without a referral. I chose it specifically because of its flexibility. I have been on the road for three years solo and have never had problems getting health care, except for some current problems with trigger fingers and getting an appointment with an orthopedic surgeon. Hopefully, I will have that solved on Monday.

 

I started out using a mail order pharmacy, but that got to be too difficult. Now I just use Walgreens which is actually a bit cheaper and a LOT easier to access. There are also Walmart and CVS pharmacies all over the country. Try to get your doctors to write out 90-day prescriptions when they can because that will simplify things.

 

One important tip: Most medications need to be kept at "room temperature" which is difficult in an RV. Meds can lose potency if kept too hot or too cold. (Check the bottles for storage temps.) I have a small Styrofoam cooler which tucks next to my bed. I keep all my prescription drugs there, other than a week's worth I count out and keep in the bathroom drawer. When I know I am going to be driving through or parking in very hot weather, I toss in one of those tiny ice packs. You don't want to use large ice packs or stick ice in the cooler because then they would be too cold.

 

Finally, I still see my primary care physician once a year, and she renews my meds and sends me off for the regular blood tests and such, but I ended up getting some kidney stones zapped near my son's house in California and also had carpal tunnel surgery done out there. The important thing is to ask for reports and medical records any time you see someone on the road and take those back to your primary physician. I keep a complete file in a storage bin. I also keep copies of all recent test results in an envelope I can easily grab and take with me to an urgent care center if I need to go to one. Otherwise, a new doctor will have to stick you and repeat them all.

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I had cancer surgery in CA and I had cancer surgery in AZ I thought I was in a new world at the hospital in AZ....The Nurses and Drs were just so much more caring and friendly. Prescriptions we mailorder through XUBEX.com They call when we need a refill and I give them an address to mail to. We are spending the Summer working in CA and then back to domicile in AZ and probably a CT scan just so the doc can keep my warranty active..lol

Remember when retired we get to spend more time figuring out where we need or want to go and we dont have to plan it all in one day...Oh and one last thing once we get so old we are authorized to get grouchy if that helps get a Drs attention :)

 

EDIT : Dont worry about records if you go to a new Doc they can have records faxed to them in the blink of an eye.

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As far as prescriptions go we always get a 90 day supply with 3 refills, which pretty much covers us for a year. We get refills done at either CVS, or Walgreens. We've never had a problem finding one or the other. We've considered Walmart because they now seem to be everywhere, but have never had to yet.

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Thanks again, to all of you. This has been very informative. While my husband can get prescriptions anywhere with his Medicare, I'm pretty much stuck with the mail pharmacy, as my retiree benefits require me to use it for all long term prescriptions, short term (30 day supply) I can take to Walgreens or CVS etc.,, at least until I go on Medicare in 7 years. I hadn't thought about the "temporary address", but I can see how that would be useful to send something general delivery, especially with my medication which requires them to send it in a cooler. There is a lot I'll need to talk over with all our doctors, but it sounds like we should be able to get a doctor in a different location for my 6 month and my husbands annual check ups instead of having to fly home to Chicago in December....ugh! Our doctors also use "My Chart" which makes for easy access to all our medical records from anywhere we can log in. So we like having all that information online and accessible without having to carry copies.

 

We're learning more every day from each of you. Thank you for taking the time to guide us through these decisions.

 

Safe travels!

 

Barbara

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