I was very lucky when it came down to applying for Social Security Disability. I waited as long as I could before filing… I didn’t want to apply for it until I truly needed it to survive… and when it finally got to that point, I had to rely on family to help me through it. I believe I have written about it before, but if not, I will post my experience soon.
Then, what sucked WORSE than needing it in the first place was that after being approved, I had to wait a full year for Medicare. Can you say, “Are you serious”? I tripped out and frantically asked my case worker what I was suppose to do for a year with mental health issues and no other insurance… I NEEDED the medicare in a bad way.
Guess what she said??? Drum roll please…. “Go to the emergency room.” HUH?? If any of you have visited the emergency for mental health issues, you know that they do not prescribe psychotropics and they give out handouts about “sliding fee” psychs, but you learn quickly that as much as we like to think it is that easy, it is not. Every number I called was either out of service, or it was inaccurate information. It is worthless…
So, for a year I waited. I still needed to rely on others for help because my entire disability check was going to “out of pocket” medical expenses, including my prescriptions.
Once my Medicare kicked in, it was a God-send (even if for just a moment). Then, it got bad… really bad. My Doctors started dropping Medicare, no longer accepting assignment. AND, every Doctor that they tried referring me to, well, they also were dropping Medicare. I don’t live in a small town. I live in a very busy, highly active city… a 24 hour type of place… and I can’t find a doctor to treat me… not an MD, and of course, no Psychs. This is completely ridiculous.
I am stuck in this revolving door. Now that I have medical insurance, the Doctors out there are refusing to take Medicare any longer. Why?? Well, I don’t know if what I am going to say is completely true, but it is true in my situation…
When a medical office tells me they no longer accept Medicare Assignment, I ask to speak to someone in the billing office… or someone in the “prior auth” department… so I can speak to them to figure out what my options are. What is the consensus?? In short, Medicare is failing me. 🙁 This is totally unacceptable. I think of all the elderly patients who struggle to afford their medical care… often cutting their prescriptions doses to help with their costs… or not using their air conditioning in the summer, nor their heater in the winter, resulting in serious problems, and the worst of course, death. It is disgusting to think of all these people who struggle and can’t get the care they worked hard for, and they have to make serious cutbacks just to survive. This is tremendously heartbreaking.
I am told that many offices are dropping Medicare because Medicare is not paying. They are notorious for taking a very long time to reimburse the physicians, and when they do, of course it is at a fraction of the cost. They make it incredibly difficult for the Doctors to submit payment, often refusing because they somehow did not file the appropriate paper work, diagnosis codes, or somehow missed a step that Medicare requires of them. It isn’t because they are incompetent, it is because Medicare makes them jump through so many hoops, hoops on fire, and claims get rejected. Then more man-hours are spent correcting the mistakes and resubmitting for payment. Often not receiving payment for months and months, and sometimes, years.
I also learned that Medicare often will come back and claim that patients were “over-billed”, therefor causing Medicare to “over-pay”, and years after the fact, they come back and inform the Doctor that they over paid by 2$ and want the 2$ back, only now it is 200$ because of interest and penalties and if they don’t pay up in a short amount of time, Medicare threatens a lawsuit.
I have been completely disappointed and at a loss. I cannot get additional insurance through the marketplace, so I feel stuck. I had Medicare Original to start and I chose it because it is basically a PPO, and I could choose any doctor I wanted as long as they accepted assignment. Well, that didn’t go so well… so I just changed it (which can only be done one time a year during open enrollment). I went online and compared the Medicare Advantage Plans and chose a Humana PPO in hopes that I will have more options for physicians and specialty practices.
I am nervous and hoping it isn’t any worse than it is right now… and considering I have to pay quite a bit more for this plan, it better be an improvement.
I am staying positive about it, and I will keep you posted on how things go.