RVers and prescription refills

[sandsys]

6 hours ago, Vladimir said:

Last time, Medicare regulations required TWO trips to the office for a routine physical.

A Medicare wellness visit is not the same things as an annual physical. When I first started on Medicare my doctor said I could do one or the other as the wellness visit restricted what we could discuss. My doctor now does both in the same visit but they are billed as two different codes.

Linda

[Kirk W]

8 hours ago, sandsys said:

A Medicare wellness visit is not the same things as an annual physical. When I first started on Medicare my doctor said I could do one or the other as the wellness visit restricted what we could discuss.

From Medicare.gov:

Quote

Medicare covers a “Welcome to Medicare” visit and annual “wellness” visits. While both visit types are available to Medicare recipients, recipients aren't required to participate in either visit type to maintain their Medicare Part B coverage. They are there as something that you can do on an annual basis but you do not need to take part in them in order to maintain your Medicare coverage.   Medicare does not pay for routine preventive physical examinations.

Quote

The blood test must be deemed medically necessary in order to be covered by Medicare. Original Medicare (Medicare Part A and Part does not cover routineblood work as part of a general physical examination or screening.

 

 

 

 

[Barbaraok]

2 hours ago, Kirk W said:

The blood test must be deemed medically necessary in order to be covered by Medicare. Original Medicare (Medicare Part A and Part B does not cover routineblood work as part of a general physical examination or screening.

Bingo!   And given our age, it is likely that your physician has several codes identifying what problems are being checked.   I get one blood test every 3-5 years (CA125) that looks for the reoccurrence of ovarian cancer.   And I always make sure that the lab understands the coding is for someone IN REMISSION for ovarian cancer.   Physicians, and their office staff, know the various codes and take care of it.   I have, several times, been asked at a lab if I know the CA125 will not be covered, at which point I again reiterate that they must make sure to indicate I'm a cancer patient (you are never cured, just in remission even if it has been 25 years) . 

[docj]

8 hours ago, Kirk W said:

The blood test must be deemed medically necessary in order to be covered by Medicare. Original Medicare (Medicare Part A and Part does not cover routineblood work as part of a general physical examination or screening.

I am on a medication for which "best practices" dictates I should have a PSA test every 6-12 months.   Regardless of how my physician codes the request, it always gets bounced by Medicare as not covered.

However, each time it bounces I file a "level 1" appeal which takes only a few minutes.  The appeals process results in Medicare directly the laboratory to provide specific information about the lab request.  The interesting thing I've discovered is that neither LabCorp or Quest care about responding to these appeals in the time-frame specified by Medicare. When they fail to respond, the net result is that my appeal is denied but, at the same time, the denial letter states that the patient (me) can't be billed for the service (because they didn't respond).

This has happened three times in a row so I know it's not a fluke.  I wouldn't be surprised if it's a considered decision, that it is cheaper to lose the fee for an inexpensive lab test than it is to go through the trouble to respond to Medicare's paperwork.  I can't think of a better explanation.

[chirakawa]

3 hours ago, docj said:

I wouldn't be surprised if it's a considered decision, that it is cheaper to lose the fee for an inexpensive lab test than it is to go through the trouble to respond to Medicare's paperwork.  I can't think of a better explanation.

You may be right.  I get a full slate of blood tests every six months, including a PSA.  Every time, I have to sign a form acknowledging that Medicare doesn't pay for some of those tests.  I've been having these tests done twice a year for five years by two separate physicians and have never paid a penny.

[docj]

On 7/21/2019 at 9:58 PM, chirakawa said:

You may be right.  I get a full slate of blood tests every six months, including a PSA.  Every time, I have to sign a form acknowledging that Medicare doesn't pay for some of those tests.  I've been having these tests done twice a year for five years by two separate physicians and have never paid a penny.

I was only billed for the PSA one of the times.  I told the lab company that I was appealing and then the process was as I described  it above.  The company didn't respond to Medicare, therefore, they were forbidden from billing me for the procedure.

[richfaa]

It was our understanding that medicare  was always primary.

[Kirk W]

50 minutes ago, richfaa said:

It was our understanding that medicare  was always primary.

If you are on the origional Medicare, have a supplemental health plan, and are not employed or in any way covered by another health insurance plan, then you are correct. But there are many situations where that is not the case. The link below takes you to the official Medicare Guide to Who Pays First and it goes to great lengths to explain the various situations.  

[richfaa]

1 hour ago, Kirk W said:

If you are on the origional Medicare, have a supplemental health plan, and are not employed or in any way covered by another health insurance plan, then you are correct. But there are many situations where that is not the case. The link below takes you to the official Medicare Guide to Who Pays First and it goes to great lengths to explain the various situations.  

That is exactly our situation.We just never knew of anything else.

[Vladimir]

Lots of good information....learned something new today....always a good thing.

It was a “wellness” visit.  I just wanted a physical.  

Then my doctor asked if I had guns in the household....my reply was...”not enough, I am still looking for a good lightweight 12 in a over/under or side by side”.  She just gave me a dirty look and said she was required by the government to ask the question.

Quite frankly....there is NO REASON in my eyes to see my doctor for a physical.  Just take a blood, urine, and stool sample.  Send the results to me and my doctor.  

I will send her my BP, and pulse readings.

Then we can have a conference call and save the taxpayers a whole bunch of money!!!

At my age, the thrill of being naked with another woman is definitely gone.

Edited July 24, 2019 by Vladimir

[Kirk W]

10 hours ago, Vladimir said:

Then my doctor asked if I had guns in the household....

At 76 years old, neither I nor Pam have ever been asked if we have guns in the house? She sees several doctors on a regular basis and I see a civilan doctor and annually a VA doctor. We have both been asked if we feel safe at home and if we have wanted to hurt ourselves. 

[chirakawa]

5 minutes ago, Kirk W said:

At 76 years old, neither I nor Pam have ever been asked if we have guns in the house?

That would be a reasonable question to ask someone who lives alone and is in the early stages of dementia.  I've never heard of anyone being asked that either, and some of my friends fit the bill.  I don't believe that's a government requirement, but I'll ask next time I see my PA.

[richfaa]

We have never been asked about guns by anyone in the medical profession anywhere.

[sandsys]

I have never been asked about guns either. Drinking, smoking, and if I feel safe are the standard questions. The feel safe one started as a response to abuse not weapons. Signs about physical abuse were posted all over the place at the same time that question started being asked.

Linda

[Barbaraok]

5 hours ago, chirakawa said:

That would be a reasonable question to ask someone who lives alone and is in the early stages of dementia.  I've never heard of anyone being asked that either, and some of my friends fit the bill.  I don't believe that's a government requirement, but I'll ask next time I see my PA.

The questions about safety are asked in different ways and at different stages in one's life as they age.  We are always asked if we have had any falls during the past year.  What's funny is I fall less now (which is usually when I'm going up stairs and miss squarely landing on the next stair) than when I was younger - - whacked my knees several times as a kid doing that.   Our opthalmogists office asks during the initial "how are things going, see any changes" to include "have any trouble seeing the edge of pavement, etc.   My mother (97 and going blind)  can no longer distinguish the edge of pavement, stair depth, etc. if there isn't a STRONG color marking.  

As to asking about guns, a physician might do that in an area where a lot of people have guns and there is a lot of domestic violence.   And more and more physicians are getting training in looking for elder abuse that might go unreported.   As people are living longer, and often having to rely on children or hiring people to take care of them, elder abuse increases.

 

[chirakawa]

1 hour ago, Barbaraok said:

The questions about safety are asked in different ways and at different stages in one's life as they age.  We are always asked if we have had any falls during the past year.  What's funny is I fall less now (which is usually when I'm going up stairs and miss squarely landing on the next stair) than when I was younger - - whacked my knees several times as a kid doing that.   Our opthalmogists office asks during the initial "how are things going, see any changes" to include "have any trouble seeing the edge of pavement, etc.   My mother (97 and going blind)  can no longer distinguish the edge of pavement, stair depth, etc. if there isn't a STRONG color marking.  

As to asking about guns, a physician might do that in an area where a lot of people have guns and there is a lot of domestic violence.   And more and more physicians are getting training in looking for elder abuse that might go unreported.   As people are living longer, and often having to rely on children or hiring people to take care of them, elder abuse increases.

 

I think we can all agree and have experienced what you've written.  However, Vladimir says that his doctor told him " she was required by the government to ask the question" about guns in the house.  I don't believe that's true, but I'll gladly concede if you can show me otherwise.

[Barbaraok]

She’s required to ask about safety.  How she goes about it would be her decision.  Sounds like she was trying to placate him and instead let her concerns come out.  She should have figured out a better way of doing this.  

BTW, lots of elderly gun owners end up with accidental misfirings because of infirmaries of old age.  We all talk about hanging up grandpa’s keys ......

[Kirk W]

Each year I do get asked if I feel anxious or nervous, am depressed, or if I think about harming myself. I don't remember at what age that became part of my annual checkup but it is done by both the VA doctor and the civilian one. 

1 hour ago, Barbaraok said:

BTW, lots of elderly gun owners end up with accidental misfirings because of infirmaries of old age.

While I can see where that could happen, yours is the first statement of that happening any more frequently with the elderly than with any other group. If there is a source for that data, I'd be interested to read more?

[Barbaraok]

1 hour ago, Kirk W said:

Each year I do get asked if I feel anxious or nervous, am depressed, or if I think about harming myself. I don't remember at what age that became part of my annual checkup but it is done by both the VA doctor and the civilian one. 

While I can see where that could happen, yours is the first statement of that happening any more frequently with the elderly than with any other group. If there is a source for that data, I'd be interested to read more?

By law, those things can not be tracked by CDC as other types of accidents are tracked.

Everyone who is on Medicare get asked those questions, part of trying to do more prevention/interventions to reduce costs.  

[richfaa]

Strange we have never been asked these questions.

[Barbaraok]

31 minutes ago, richfaa said:

Strange we have never been asked these questions.

Are you seeing the same physician you’ve seen for years?  Does she/he chat with you as the exam starts, etc.?  Often clues are picked up then or your tone, mannerisms,  of talking about family, friends, etc. that says you are your usual self.  If you were seeing someone in an area with LOTS of retirees I expect you would different interactions at the start of the visit.  In our case it is the assistant who goes down a form they have for all Medicare patients that go through the Banner system.  The one thing our physician does ask us is whether we have had any falls, she knows we are RVing all summer and is always checking on our balance.  

[sandsys]

4 hours ago, Barbaraok said:

Are you seeing the same physician you’ve seen for years?  Does she/he chat with you as the exam starts, etc.?  

Yes and yes. But she doesn't ask me about falls. Maybe because I don't have a history of them as you seem to do?

Linda

[Barbaraok]

32 minutes ago, sandsys said:

Yes and yes. But she doesn't ask me about falls. Maybe because I don't have a history of them as you seem to do?

Linda

Dave is diabetic and had a stroke, so balance problems come with those  two diagnoses.  I’ve been a klutz all my life when it came to stairs - probably do to my being pigeon-toed and knocked knee (normally not seen together) - and mentioned it in passing.  It is now just part of the regular check each year to see how we are doing. 

[Kirk W]

5 hours ago, sandsys said:

Yes and yes. But she doesn't ask me about falls. Maybe because I don't have a history of them as you seem to do?

Your age may also be a factor. Both Pam's doctor and mine do ask about falls and anxiety and Pam has been with the same doctor for the past 8 years. But we are also both past the age of 75 and we can't recall when those questions began to be asked, but it does happen each visit and my VA doctor asks them (or the nurse does before I see the doctor) at my annual VA checkup. It may also be that Medicare says the doctor is to ask but yours doesn't because you are well known?

[richfaa]

Yes we have been seeing the same physician  for many years and he knows our  history well. We do chat during the visit and I always give him my ...list of complaints. I am fortunate to this point of not having any serious  medical problems,Heart attacks, strokes , etc. We have in the last 14 years seen Doctors outside of our local area mainly Florida and do not recall being asked these questions. We have filled out that long 4 or 5  question sheet and perhaps the questions are on that but I do not recall. A question about guns would have got my interest and I do not recall being asked that question/

Edited July 25, 2019 by richfaa