Keys to a Successful Doctor's Appointment

@dizzyprizzy and @bmspector, I used to have feelings similar to yours when it came to doctors. Over the years I have had both great doctors and doctors that I have not liked much. Yes, the healthcare system has changed and doctors don't have as much time to spend with each of their patients during the day but I don't fault the doctors for all of the changes that have had a negative impact on my care.

My neuropathy and no answers brought me to Connect where I could learn from the experiences of others. One of the bright moments in my life a few years ago was the opportunity to attend a meeting with what I would like to think is a new breed of doctors that is hopefully growing exponentially. I was part of a group of patients who were at a presentation by Dr. Victor Montori on his mission in life to help patients and change healthcare as we know it. He also gave us each a copy of his book Why we revolt: A patient revolution for careful and kind care. That meeting gave me hope and has helped me become a better advocate for my own health. If you want to give it a try and learn more about the Patient Revolution, here's a good place to start:
--- The Challenge - The Patient Revolution: https://www.patientrevolution.org/thechallenge.

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Thank you for your input, Vic83. Yes, many Advantage Plans do have a poor reputation and work the best when near home. With my PPO I can self refer to any doctor in the USA that accepts Medicare as I stated before. In the area covered by my plan it would be a major feat to find a doctor that is not covered by my plan and I think I would be unsuccessful. I pay anything from $0 to $10, usually $0, at appointments, all lab work, mammograms, echocardiograms, .., are $0 copay. My former employer pays 95% of my premium, my share is under $200 a year. I, too, have absolutely no insurance issues. My surgery at the Mayo Clinic in Rochester along with all of the other services were covered, in fact the insurance company customer service with the Mayo billing department always had good results. The insurance company promotes preventive care big time, wellness, and is rated top by US News and World Report. That said, your explanation is one to bear in mind and we should all be aware that changes happen. People need to study their individual unique situations. For now, there is nothing better out there than the Advantage Plan I have and I would change if necessary.

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You are preaching to the choir on getting respect. I have had Fibromyalgia for more than 35 years and have dealt with way too many “it’s just in your head” mentality. I learned not to mention it at Mayo specifically as any mention would prompt a “would you like to talk to a psychiatrist?” question.

If I have a run of the mill legal or tax, etc. issue then sure, don’t have to do much. If I have a complex legal, tax, etc. issue, then I will put in the time/effort to speak in their language so there is zero confusion or misunderstanding. In the end, any misunderstanding is more likely to affect me than it is the attorney, accountant, etc.

If I put in the effort and fail, at least I tried. If I don’t put in the effort and fail, am I blameless in the failure? I am jaded enough to know doctors aren’t just waiting for me to walk in so they can put there hero cape on and save the day. They are overworked, stressed by the system, and have bad days just like the rest of us.

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There is one more issue with the Advantage Plans I forgot to mention. When one first goes on Medicare, all plans (Advantage or Medigap) must accept you no matter your health issues. But after that when one is no longer satisfied with the Advantage Plan they have and would like to go back to Original Medicare and buy a Medigap Plan to cover the 20% Medicare does not pay, then there is a problem. The other insurance plans do not have to accept you or can charge you a higher premium....and if you are then having health issues...why would they want to accept you??? Sick people cut into their profits. Advantage Plans are profitable for insurance companies because they cut what they pay their doctors, require approvals and deny coverage, charge for visits, and push people towards the least expensive treatment. Look at their financial statements - percent profit, administrative costs, sales and marketing costs (think of what all the advertising on TV costs!) ....there are lots of articles in the press about this and there are lots of complaints.

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There is one more issue with the Advantage Plans I forgot to mention. When one first goes on Medicare, all plans (Advantage or Medigap) must accept you no matter your health issues. But after that when one is no longer satisfied with the Advantage Plan they have and would like to go back to Original Medicare and buy a Medigap Plan to cover the 20% Medicare does not pay, then there is a problem. The other insurance plans do not have to accept you or can charge you a higher premium....and if you are then having health issues...why would they want to accept you??? Sick people cut into their profits. Advantage Plans are profitable for insurance companies because they cut what they pay their doctors, require approvals and deny coverage, charge for visits, and push people towards the least expensive treatment. Look at their financial statements - percent profit, administrative costs, sales and marketing costs (think of what all the advertising on TV costs!) ....there are lots of articles in the press about this and there are lots of complaints.

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You are correct. I have been in traditional Medicare with a supplement. I wanted to change from one supplement plan to another. (It was cheaper and offered the same benefits, as supplement plans are required to do). I needed “medical underwriting” to switch. Medical underwriting consisted of a non-medical person calling me on the phone, asking 12 questions. I was denied because I was taking one mg of prednisone, which was on his list of medications which led to denial. Couldn’t believe it. My agent said they don’t like unusual conditions??? The next year, I started sooner, pressed my case and changed supplements. I’m sure if I was in an Advantage plan, I would never have gotten into traditional Medicare. Advantage plans can change benefits, list of providers, etc. at any time. Traditional Medicare cannot.

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So interesting your reply! I wondered how it would be if one stayed with Traditional Medicare and just wanted to switch Medigap Supplemental plan.
Yes, Prednizone is a sign of something!!!! I was on it.
I have an "expensive" medigap plan but I am happy with it because it is no longer "expensive" with all my medical stuff. And I don't have to worry about my doctors "leaving" the Medigap plan or any change in benefits. I always tell people to not try to save money on their health insurance. You don't get healthier with age.

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I have a major Spinal Surgery scheduled in a couple of days. From my previous surgical experiences, hospitalists seem much more reluctant to treat pain, even surgical pain, when a patient carries a diagnosis of Fibromyalgia.

Any tips on how to help navigate through this situation, and yet still advocate for myself when my pain is not controlled?

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Between us, vic83, we are giving people much food for thought over insurance, a good thing. My advantage program is: "We are a not-for-profit, physician-directed health plan licensed under Article 44 of the Public Health Law of New York State." I have a PPO as opposed to a HMO and do not require approvals and am not denied coverage as long as who and where I go accepts Medicare. Anyone who can find such an excellent insurance company - and I agree that many cannot, unfortunately - should have it. My doctors are quick to send me for tests, referrals, etc., as needed. I even got to go to the Mayo Clinic in Rochester for heart surgery without a referral from them! I have not heard any complaints from other people, a high percentage in this area use this same insurance company, both the HMP and PPO plans. We are fortunate. Yes, you are right that there have been negative articles in the press and many complaints, I have read them, some of them should not be in business according to the way they treat their customers. As we are both discussing, each person needs to evaluate the options available to them and find the best one for their specific situation. I think that people concerned about insurance and Mayo should call both Mayo's billing department and their insurance provider to discuss their unique concerns. I did and they both were so pleasant and helpful.

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