Letter to the editor: No courtesy extended to Medicare recipients

1124
12

To the editor:
My husband and I moved to Edmonds in 1998 and chose Edmonds Family Medicine (EFM) as our provider. We both had excellent primary care from EFM physicians from 1998 until a year ago, when they would no longer accept our insurance for 2017.

I am a retired state employee, and we get our health insurance through the Public Employees Benefit Board (PEBB). We are lucky to be able to buy supplemental insurance as part of the state employees pool where our individual medical histories and pre-existing conditions are not a barrier. But EFM has a policy that “all patients who have traditional Medicare with or without a Supplement or other retirement health plan insurance must change to a Medicare Advantage plan.” Through PEBB, there was only one Medicare Advantage plan available to us, and it was not a satisfactory choice for our medical needs.

My husband had lengthy conversations about this with his physician and with the staff in several EFM business offices. In the end, there was no leeway. We were kicked out after 18 years as patients and had to find new providers and establish new relationships with new primary care physicians.

So you can imagine our—well, let’s say SURPRISE—when we received a letter and read “As a courtesy to our patients, EFM has occasionally allowed exceptions to this policy. Going forward we will continue to honor exceptions given in 2017. “ We can’t imagine why we didn’t receive this “courtesy.” Too bad we’re so old. Too bad I had a career working in our state’s community colleges. Too bad.

I suspect we are not alone, and I bet there are other Medicare recipients in our community with fewer options than we had.

Sincerely,

Susan Kostick
Edmonds

12 COMMENTS

  1. I am also a retired state employee of nearly 30 years as a social worker and have the same plan. Also have my husband covered and pay almost $ 800 for his plan. I have heard about this problem and dont understand because its through Regence. Thankfully our doc in Ballard is still covering us. But guess what.. Im going to double check. Thanks Susan! Hope it works out for you and your husband.

  2. Hello Susan
    I had the same issue and was able to find another doctor at Pacific Medical Center in Lynnwood who is great and Pac Med easily coordinated with my other Swedish providers. It seems the Advantage plan pays EFM more for my care than Medicare and a Supplement. Thank you for speaking out!

  3. Here’s another one to join the club. I don’t know how many years I was with my Dr Sargent at EFM, but I liked him very much and received outstanding care – until I got the same heave-ho from the business office. I have found a new doctor, whom I like, but feel strongly that at the very least, EFM should have kept the Medicare patients who were enrolled, and “aged us out,” so to speak. After such good care it felt very much like having a door slammed in my face.

  4. I add my name to this growing list. I was at the Clinic over thirty years. When Medicare time arrived; my supplemental insurance was always considered fine, until suddenly it wasn’t. One of the things that upset me the most was the seeminly callous manner in which this change was requested. There appeared to be no concern for the patient. And now I just received a letter with Dear Patient; as if somehow no one even realized I have not been one of EFM patients for over a year now, advising me of the rulings for those of us with Medicare stamped on our files.It would appear that a good review of PR is needed.

  5. Change is rarely fun especially when it means changing doctors. As a medical insurance broker for past 25 years we are seeing more change in a more rapid fashion then ever before, as in daily.
    Believe it or not, the over age 65 market is much more stable than the under 65 market. Is it better to have a MedAdvantage or Medicare Supplement plan? Often when plans offer better coverage to you they pay doctors less and/or they have higher premiums.
    The (<65) Individual choices, well, are almost gone. In Snohomish County outside of the Exchange you have only Kaiser (Group Health). In the exchange there are only 3 carriers left; Kaiser, Ambetter & Premera.
    Regence and LIfewise will stop selling Individual plans in 2018, and they are cancelling their current plans, (except LW older then April 2010).
    This has thousands of customers scrambling to find new plans among a field of limited choices.
    The frustration level is at an all time high among doctors, brokers and patients. This is compounded by a small window called "open enrollment". It is vital to be more educated like never before. Prescriptions are also changing. Drugs can move on and off of plans, even mid year.
    It is also important to take a deep breath and exercise persistence along with patience. Oh, ya, do it now!
    Open Enrollmentc Deadlines:

    MedAdvantage: till Dec 7th

    Individual (<65): Jan 15th (some carriers may hold to Dec 15th)

    MedSupp: no medical questions if you get it when turning 65 or leaving some Group plans. You can change anytime, but subject to health questionnaire.

  6. “Direct Primary Care” <- There's a big push by the few family doctors who are left (those who chose not to punch clocks at hospitals) to not accept Medicare, Medicaid or health insurance in their small practices. I commend those doctors. I'm a small business owner who really got screwed by the ACA. My family boycotted the health insurance industry and joined a health sharing ministry called Liberty HealthShare. It, effectively, is the high deductible plan that my family needs. The Bronze plans in WA were as expensive as rent, which is immoral; forcing healthy people to pay higher prices so older folks can pay lower prices. I feel for older people, but health is wealth, and the system we have now is what was made by the older generations, like those with public sector jobs and state subsidized schemes. Young people don't have savings, are struggling to start out, forgoing having children of our own, yet the government taps into our health like a it's a slush fund, forcing people to subsidize others. The only way to fix healthcare is to deregulate it. The AMA is a monopoly that should be broken up, we should be able buy high deductible plans from across state lines (even from overseas), and the drug industry is off the rails. Rick Perry shut down Planned Parenthood in Texas simply by regulating abortion clinics like hospitals. He put Planned Parenthood out of business there because they needed Admin Rights, wide doors, oxygen systems and machines, underwriting, etc, just like hospitals. Why can't all healthcare be unregulated like abortion "healthcare" is? The meninist in me gets frustrated when women say they don't want the government involved in their bodies, but are OK with government being so involved in men's bodies.

  7. Thank you all for sharing your thoughts on the matter of Edmonds Family Medicine and Medicare Advantage. Because the healthcare system cannot be understood in sound bites, we invite you to view the Medicare section of our website: edmondsfamilymed.com . It does not address every situation nor emotion but hopefully it will deepen the discussion of topics like the future of primary care, the future of Medicare, and also express our struggle with finding the correct balance of how to face the future of both primary care and Medicare. The situation is the risk of losing patients in one group (traditional Medicare) in order to be available to serve the broader community.

    We believe in free speech so please continue to share your views. We appreciate the opportunity to serve the local community young, old, and in-between. We continue to treat patients with traditional Medicare coverage in our Urgent Care Walk-In Clinic (as we have for years). Our choices about Medicare Advantage are explained on the website (http://www.edmondsfamilymed.com/EFMdev/index.php/category/efmnews/). Thanks again, Edmonds Family Medicine

    • EFM, many thanks for the reply. I understand it’s a tough situation when your business is the subject of news. Do you consider yourself part of the Direct Primary Care movement? Are you trying to move towards a prices-on-the-wall business model? Is part of your decision to not accept Medicare due to the administration overhead or regulatory overhead of billing through Medicaid/Medicare? I ask the last question because I had clinic offer me two prices for a procedure a few years ago. They said $1900 if I pay with a check, and $2500 if I bill through insurance. I had a high deductible plan (which Obama made illegal), and I am healthy so I never meet the deductible, so I paid the $1900. It was explained to me that the differences are the administrative costs with billing the insurance, having portions of it rejected, and waiting for payment; over just cashing my check.

  8. My family have been patients at Edmonds Family Medicine for years and have Doctor’s we like, unfortunately our excellent PEBB state of Washington retirement medical insurance is not acceptable at EFM but is acceptable at the Everett Clinic. Do not understand EFM decision in this matter.

  9. EFM has chosen to be part of the problem not the solution. One positive course of action could be for both old and young members alike to now move to other doctors and clinics on their own.

  10. The problems occur when something or someone gets between the Doctor-Patient relationship.
    Why would any clinic want to do anything Medicare? There are Medicare police, so to speak. The risk of penalty is huge and the burden of dealing with Medicare is enormous. Some of the best doctors have cut ALL contracts with insurance companies and only take cash. they also have much lower fees.

  11. My son just finished a book about our medical system so know I have a viewpoint. Our system is so complicated that few have the time and energy to understand it. It is good to see that some have figured out how to deal with it. The complication makes it good for some people who benefit from the complication. This includes hospitals, insurance companies and pharmaceutical companies.
    When having lots of tests, unnecessary procedures etc. makes money, but prevention does not, we have a screwed up system. There are some primary care practices which are making headway with different ways of doing business.
    The other downside of this system is that high medical costs take away from other important needs such as schools and city services.

LEAVE A REPLY

Please enter your comment!
Please enter your name here