I am disabled from another condition other than the MCTD, so I have Medicare.. My rheumy mentioned several 'consults' she wants me to have before the end of the year. She wants me to see a Neurologist, Endocrinologist and Pulmonologist. I already see a GP Opthalmologist, Dermatologist, Psychiatrist, have PT and a life counselor... Rheumy wants me to make one appt with these doctors "so they know me" but wants me to eventually see all of them twice a year, and my GP, and her !
My calls to Medicare about coverage have turned up only more confusion. Medicare states "We won't know if it is covered service or not until we see the claim"... Well, that's too late for me... I can't seem to get Medicare to say yes or no... Anyone else dealing with Medicare coverage ? and a second question... I'm really nervous about having all of these doctors and appointments... It's seems like one won't know what the other is doing... My symptoms have really worsened rather quickly which is her concern, but do all of you see all of these doctors on a routine basis ? this seems a little much....
Hi SeaBreeze!
I cant answer your question about specialists and Medicare...hopefully someone will come along who can but I can tell that it is very common to develop a team of "ologists". Doctors today all seem to specialize and when you have a diagnosis that gets complicated like autoimmune issues do and that affect so many parts of your body...you start to develop your medical team!
I currently have a rheumy, a neuro, a gastroenterologist, my PCP of course, my gyne, a dermatologist,a pulmonologist, a urologist, ophthalmologist, optometrist, dentist, an orthopedic doctor,chiropractor, and I have to start Physical Therapy again in the next few weeks....whew...I think I'm done!!!
Its kind of embarrassing to list all of those doctors.....but I have issues in all of those areas.....but if someone just looked at that and didn't know about sjogrens and my related conditions...they would think I was NUTS!!! But they are all needed and legit....unfortunately.
Good luck to you in getting the appts you need covered! I hope it works out for you!
hi Seabreeze,
Im getting myself a little collection of ologists too. I have my gp, immunologist, psychiatrist, gastroenterologist, ENT specialist, optometrist and dentist so far and i dont even have a dfinitive diagnosis. Oh forgot the endochrinologist. Sorry doc.
Do you keep your own medical file? I find this helps keep everything in track. i have copies of my blood work, scan reports. dr reports. My list of ologists and meds. Its a race to see which is bigger. And also my diagnoses.
I say to the docs that with all of them the only common link is me. so i become the source of information to add to the referrals.
Don't worry about how many ologists you have. As long as they can help you.
As for medicare, i cant help. i am in a different country and our system is different to yours.
Good luck with it all
Pud
Seabreeze, I got the same answer when I called to find out something a while back. That is the standard answer of anything related to potitics.
I am on disability since 2005 for my autoimmune stuff and have been on Medicare for several years plus also have a BCBS supplement. I don't know which state you live in and what supplement you have as the state and supplement can make a difference on what is paid by the supplement.
First of all medicare has paid all my "ologists" and some of them have not been referrals. If you read your 2008 Medicare Handbook I think that a referral is not needed. That will probably change in the next several years.
Be aware that you would do well to ask the office staff at your doctors if their service is covered by medicare. You can usually be sure that things ordered by a doc and docs visits themselves are generally covered (at least some portion of bill---usually classified as the "approved amount"). The doctor always has a charge and then the Medicare pays the accepted amount as approved by their rules and regs.
The bottom line is that if the service is not paid for by Medicare the office/doc stands to not get paid much of the time so the offices are pretty good in their insurance department to check these things out. If in doubt always ask is my motto.
Also, if you have a medicare supplement the service needs to be approved by Medicare before the supplement will make up the difference on the bill. I think it is such a pain to have to keep track of all these things. I try to check through my invoices periodically to see just what is being charged to medicare and what is being paid. Irish ;D
Thank you for the responses. I guess I have to get used to the idea of having a few more doctors.
Irish- I have tried to get a supplement but everyone I contacted (mostly ins co's) said you have to be 65 in order to get any more coverage.
I would love to know more about your BCBS coverage if you are not over 65. You can PM me if you want.
Thanks all...........
SeaBreeze,
Call the Highmark Insurance Co. (Blue Shield) in your area. Tell them you are on Medicare and ask to speak to an insurance representative. They have quite a few different programs and I'll be they can help you. Not only with coverage, but a plan that will fit your budget.
We have Medicare and BS Medigap and it's very reasonable. Of course, both my hubby and I are over 65, but I'm sure they have plan for you too.
Let us know how you make out.
Hugs, Pooh
I'm under 65 and on disability. I have Medicare and Blue Cross. Once I was on disability for two years, the Medicare kicked in automatically.
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I'm with Irish and saying that my "ologists" have for the most part been covered. Get in touch with the Blue Cross/Blue Shield office in your city/state for more info. Lucy
Don't you just love all the"ologist" I don't know much about your insurance issues but sure can relate toquestions about the doctors. I just asked a similar question on another thread. I dont even know who to call anymore about what problems cause there are so many "ologists" to choose from these days and the list seems to grow every time you go the doctor. Sure hope you can wade through all the paperwork and specialists dont get discouraged!
I got my disability when I was 60 and after 2 years I was then approved for Medicare. When I started Medicare in 2005 I then was able to add the BCBS supplement. I don't know what state you are in but you need to check on this. You have to be very proactive to make sure you are covered appropriately. My hubby was on disability for many years and was also able to add the BCBS Senior Gold supplement many years ago after his 2 years on the medicare. We are both blessed with autoimmune diseases. Life is always interesting---not always fair, but interesting.
I will cut out a lot of things out of my life in order to keep our BCBS supplement and MedicareBlue Rx or part D that helps pay for meds. With all the autoimmune stuff one just can't be without insurance if at all possible. If anyone is having financial issues and can't afford health insurance please make sure to contact your local social services in your county. The state and federal governments have plans set up that are very reasonable. It takes a lot of perserverance and paperwork but if you don't give up you should be able to get covered. Irish ;D
Irish------------very well said. Important message! Lucy