We are all set to go. We received our id cards which identified our GP as Dr. Arrocho. Who is he? Not our doctor. We called them up and they reissued the cards with the correct doctor's name. Then we got a letter from our doctor. He would be leaving the network effective February 1. But I still want to choose my own doctor. A careful reading of recommendations on NextDoor indicated that Dr. Fernandez was the way to go even though there were numerous rumors that she was leaving to go to Miami.
We asked Devoted to assign us to Dr. Fernandez, which they did. Her office policy was that we had to see the nurse practitioner before we could see the doctor. We saw the nurse practitioner in February and then, the week before our March 1 appointment with Dr. Fernandez, we got a call from Soni Family Practice to inform us that Devoted had transferred us to them. Wow. No. These are the people who threatened to call the police when Mark asked if the driver's license requirement was office policy or state law. No way do I want anything to do with them. But the downside was that on March 1, Dr. Fernandez would no longer be in the network. (A fact that her office wasn't even aware of.) My appointment, that I'd been trying to get since January wasn't going to be covered unless I changed insurance companies that week.
And since Devoted seemed to be hemorrhaging doctors and we'd been assigned to four since January 1, (Shamim, Arrocho, Fernandez, and Soni) and hadn't actually been able to make an appointment with any of them that would take place while they were still in network, we decided to leave Devoted on the spot.
The first thing that came to mind was Florida Blue. It was going to cost us more - $20 copay instead of $10. But if you can't actually see a doctor, it doesn't make much difference about the copay. Drugs were going to be about the same, but we had to change pharmacies. Most importantly, we would be able to keep our appointment with Dr. Fernandez on Monday, which was critical because we couldn't get a referral to the hematologist Mark needed without seeing a primary care doctor.
Dr. Fernandez was wonderful. I asked for a referral to my cardiologist, which was processed (not without drama, but before my appointment), and a dermatologist. Mark asked for a referral to a hematologist and an endocrinologist. She also wanted both of us to see an ophthalmologist. And then the real trouble started. For some reason, these referrals were not going through. Everyday I called the doctors offices to be told that the referral had not gone through. We never had issues like this in Texas. What was going on in Florida? I immediately suspected the doctor's office staff. (After all, these were the people who told me they didn't take Medicare, told me I needed a referral when I didn't, and threatened to call the police when asked about driver's licenses.)
My first thought (having spent so many years in Texas) was to go over to the doctor's office with a gun or a baseball bat and stay there until they processed the referral. It's rare that people inspire me to violence, but it can happen.
Mark had a different idea. He suited up and took a folder with all of the paperwork in it and surprised the office staff. He followed up with them in person and on the phone until he had the hematology appointment, which was the most critical. The dermatology appointment came through, but nothing on the endocrinologist or ophthalmologist.
The problem must now be with the insurance company. I phoned them and got answers that once again inspired me to violence. Time for Mark to take over. He had a conversation with them and that's when we discovered the death panels.
As it happens, your doctor can write all the referrals he or she wants, but the final decision on whether you actually get to see the specialist is made by an RN. We should be grateful that it isn't made by a bookkeeper. (Okay, so panel is an overstatement. An exaggeration. It's not a panel. It's ONE individual. You can have a panel discussion. How do you do that with one person? Perhaps it's the angel of death.) My feeling is that if you can't trust the doctors in your network to make referrals, then perhaps they shouldn't be in your network.
The bottom line is that we couldn't get the referrals through with Florida Blue, so we once again changed. We're trying CarePlus. We've had a discussion with their customer service department so we understand how their death panel works. They've assured us it's a doctor. The term she used was "medical professional" which could be an X-Ray technician, but Mark pressed her until she said "doctor". (But again, it's a doctor who hasn't seen you and knows nothing about you who is questioning the judgement of the doctor who has seen you and knows your medical history.)
We've been assigned to a new doctor with the new plan. I'm not going to fight it. We're just going to go with it, unless we have our first visit and it's a complete disaster. But I'm still trying to figure out how anyone benefits from having a doctor that I'm going to meet today, refer me to a cardiologist that I've been seeing for two years and then have someone else, whether it's a doctor, nurse or bookkeeper put their stamp of approval on it.
These Medicare Advantage plans offer great advantages to the insurance companies - not sure what the advantage is to the consumer. But if you have pre-existing conditions, you're stuck with an advantage plan because you can't buy a supplement. Also, it's a good thing I'm retired because dealing with medical offices and insurance companies has become my new full time job.
But in truth, I worry about this because I can advocate for myself and I have the time. At least I can now. Ask me again in 10 years when my health may be worse than it is now and I have less patience. (Trust me, that is in short supply already.) But there are people who just don't understand how the system works, don't have anyone to advocate for them and don't do a good job of advocating for themselves. There are also people who are working and don't have time to navigate the convoluted system. What happens to those people?
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