Medicare Benefits and 2nd Opinions

[6357axbz]

My MO left the major cancer center I’ve been going to since dx but recently resurfaced at a nearby hospital. This week I visited her replacement at the cancer center but saw her the next day at the hospital where she’s now practicing. I called Medicare today and asked if I continue to see both MOs will they pay for both visits. Surprisingly I was told as long as both institutions accept Medicare then Medicare will pay for both visits. I was surprised. Anyone else have experience with this? It almost sounds too good to be true…

[Tall_Allen]

What if they recommend different things? In L.A. most of the major hospitals are connected online, so if I talk to a doctor at one hospital, the doctor at another will see the report. Your doctors will approve of second opinions, but I have never met any who approve of two cooks.

[6357axbz in reply to Tall_Allen]

Even if they disagree, how would effect what Medicare covers? Why would Medicare care?

[Tall_Allen in reply to 6357axbz]

Medicare doesn't care, but you might and the doctors might.

[6357axbz in reply to Tall_Allen]

Cross that bridge when/if I come to it. Thanks TA

[dhccpa in reply to Tall_Allen]

What would the doc do? Get angry?

[Tall_Allen in reply to dhccpa]

not angry- just fire the patient.

[cesces in reply to Tall_Allen]

"L.A. most of the major hospitals are connected online,"

That's so very interesting.

And so very difficult politically and technically.

Do they have a coalition organization that manages this?

If so do you have the name? I would so like to know what institutions are participating in it.

Thanks

[tango65]

If you do not have Medicare advantage or other similar plan managing your Medicare insurance, Medicare will pay for second or third opinions. Medicare advantage or similar plans may pay for other opinions but it depends on each company and if the doctors are or not in the network associated with the company.

I have a supplemental plan that pays part of Medicare part B, but my Medicare is not managed by the insurance company and Medicare always paid for second and third opinions.

[6357axbz in reply to tango65]

Neither is mine. I have Medicare supplemental plan F. Thanks Tango

[tango65 in reply to 6357axbz]

In general, if Medicare pays the company managing the supplemental insurance will also pay.

best of luck on your journey.!!

[6357axbz in reply to tango65]

Thanks

[Break60 in reply to tango65]

It’s not in general, it’s always. All Medigap plans are required to pay the 15% of part b not paid by Medicare. They’re coordinated. That’s what you’re paying your Medigap premiums for. If Medicare doesn’t cover it however neither will Medigap. So be sure to ask before agreeing to a procedure or visit.

[cesces in reply to tango65]

"In general, if Medicare pays the company managing the supplemental insurance will also pay."

Are there any instances when this is not true?

[tango65 in reply to cesces]

My information by talking with my medigap insurance is that they may not pay for out of network treatments or tests without having previous authorization. If it is in their network they always pay.

[cesces in reply to tango65]

Hmmm

Anyone who takes Medicare should by definition be in network.

Yes?

[6357axbz in reply to cesces]

Folks who opted for a Medicare “advantage” plan typically have to conform to networks. The “advantage” folks manage the Medicare part. I have a BCBS Plan F supplement. No networks.

[tango65 in reply to cesces]

The insurance company may have its own network of doctors and hospital taking Medicare. If you go for a second opinion outside your County/State you may end up with a doctor or hospital taking Medicare but outside the network of your medigap insurance company.

Before getting consultations or tests/treatments outside of your County/State it is advisable to call your medigap insurance company and be sure they will cover the consult and tests/procedures or if you need to get prior authorization.

The worst situation is with Medicare advantage. Medigap PPOs are the best but they may be difficult to get, they are more expensive and they may not available in your County of residency.

[cesces in reply to tango65]

Hmmm

What if you move?

Are you sure this type of thing isn't limited to those Medicare advantage plans?

The whole reason I avoided those Medicare advantage plans was to avoid this cr*p. LoL

[tango65 in reply to cesces]

I do not know. I also avoid the advantage plans.

[Hidden]

Sounds like a recipe for problems.

[6357axbz in reply to Hidden]

How so

[Schwah in reply to 6357axbz]

I have two MOs and it works perfectly. One is my primary and the other is for second opinions. The key is to know which one is # 1 or it can get confusing and the drs won’t like it. They shouldn’t mind the Second opinion but they will mind two treaters and two people writing prescriptions.

Schwah

[6357axbz in reply to Schwah]

Yes. I’ll have to let them know who is primary.

[dhccpa in reply to Schwah]

I know some folks have a regular doc and an integrative doc.

[Gearhead]

I would be concerned that being treated for the same illness simultaneously by two physicians might negatively affect the physicians' attitudes, opinions of you, and the quality of care you ultimately receive.

[maley2711 in reply to Gearhead]

These are BIG decisions being made...and if someone desires to know if there is difference of opinion re what to do next, why not? The Docs are supposedly working for you, not the other way around. Why should they care .....as long as treated with respect and open and honest with them!!

Only very insecure, or very egoistics would care...and who needs them anyway? Just let one or the other know that he/she is primary.

[cesces in reply to maley2711]

It could be that they respect the difference of opinion.

But if they take exception and don't want to be responsible for a course of treatment, they should resign.

But if you find yourself in that situation you really need to understand why the strong difference of opinion.

[dhccpa]

Don't know yet but I'm liking Medicare so far. Saving gobs even with separate supp and pharma plans.

[EdBar]

I have both a local MO and a PCa specialist that I travel to see every 6 months and no problem with Medicare paying for it. I’ve done it this way since I was dx almost 8 years ago. I always have the final say if they recommend different things.

Ed

Ed

[6357axbz in reply to EdBar]

I like your approach Ed.

[j-o-h-n]

Lucky you.... I was always into threesomes........... (now it's nonesomes)....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/23/2021 7:23 PM DST