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My PCP won't refer me for specialist or authorize MRI

Spine Health | Last Active: Apr 19 9:33pm | Replies (35)

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@alexis7

You are on Medicare Advantage, an HMO, which is a total disadvantage to the consumer. Regular/Original Medicare doesn't require referrals to see specialists. I've had a back, hip, SCS implanted, shoulder and neck surgery - I went to the doctors/surgeons of my choice. Hopefully you can change at the next enrollment period 10/15 - 12/7. Preexisting conditions are covered by regular Medicare. Shop for a secondary policy (picks up the 20% Medicare doesn't cover) through a private insurance agent/broker to get the best rate.

I'm sorry you are going through this. I'd get a new PC doctor.

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Replies to "You are on Medicare Advantage, an HMO, which is a total disadvantage to the consumer. Regular/Original..."

Ard you retired and on medigap? If they didn't get medigap in the 6 months around their bday, they probably can't. I try to talk to retirees about it I know I'm fortunate to even begin to afford medigap. Its not cheap and a privilege to afford it on retirement, but id give up food to pay for my medigap. And its going to keep getting more expensive as we get older. In 4 years I've gone from $130/mn to this year $180! Goes up as medical costs go up. People think medicare is free. Surprise folks. Medicare, plus medigap plus part D cost me more than $400/mn. Then the $230 medicare deductable off the top in Jan/feb. And $500 deductable for part D of the top. Affording medical insurance is a privilege. But HMO is a death trap. I waa on one my whole life as I've been 100% disabled on ssdi since I was 24. Terrible.

Know anyone retiring, you kind of only have one time in your life to get 100% medical coverage without medical clearance with medicare and a supplement. Make yourself afford it. I gave up eating out mostly but my MRI today fof a maybe broken back? 100% covered without approval needed. Dr orders. I go.

Dont get taken in with free eyeglasses instead of a CT scan. Gym membership instead of chemo. Free dental care isn't dentures and crowns. Its pull if you can find a local dentist in your plan.

Look up "medicare school" on YT. Very knowledgeable.

Ok, back to the regularly scheduled programming.