My Doctor Retired!

[Art Mann]

The problem gets much, much worse when you reach 65. Most family physicians where I live will not accept medicare patients and it is illegal for them to just send you a bill instead. I have a friend whose primary care doctor treated him for free after being with him for many, many years because he could not accept Medicare from only a select group of people. Eventually, the government caught up with the doctor and forced him to stop treating my friend at his own expense. He has been searching for several months now and can't find anyone who will treat him. He goes to a Doc-In-A-Box.

[Mike Henderson]

The problem gets much, much worse when you reach 65. Most family physicians where I live will not accept medicare patients and it is illegal for them to just send you a bill instead. I have a friend whose primary care doctor treated him for free after being with him for many, many years because he could not accept Medicare from only a select group of people. Eventually, the government caught up with the doctor and forced him to stop treating my friend at his own expense. He has been searching for several months now and can't find anyone who will treat him. He goes to a Doc-In-A-Box.

I don't believe that's correct. Doctors do not have to accept Medicare - I've been to some that do not. You have to pay them out of your pocket and then YOU can file a claim to Medicare. Medicare will then pay YOU (not the doctor) the standard rate that Medicare pays for a procedure (you may have paid more).

[Edit: I made this sound like you have to pay before you file a claim to Medicare. You do not have to pay first. As long as you went to the doctor and got a paper saying what was done, you can file. Many people don't have the money to pay first so they have to wait until they get the reimbursement from Medicare to be able to pay the doc.]

Doctors who do accept Medicare must accept all Medicare patients who come to their practice - they cannot say that they will take x person over 65 and not y person over 65 - providing they have not closed their practice. A closed practice is one which is not accepting ANY additional new patients because the doctor has all he or she can handle.

Doctors can certainly do pro bono work, including pro bono for those over 65, and no one will object.

Are you sure your friend was not a Medicaid patient? Many doctors will not accept Medicaid patients because the reimbursement is too small.

Mike

[If you go to the Medicare web site they'll probably have an explanation of how Medicare works with doctors who take Medicare and with doctors who do not take Medicare. A doctor is incented to take Medicare because the payment goes directly to him or her. If the doctor does not take Medicare, the payment goes to the patient and then the doctor has to get the patient to pay. And a lot of times, the patient just pockets the money and never pays the doc.]

[Art Mann]

No, doctors are not obliged to take medicare but their policy must be consistent. That is to say they can't accept medicare for some patients and not others. My friend's doctor treated him for free because he felt a certain loyalty to him after decades but didn't want to accept medicare from any patient. The compensation was too low for him to stay in business otherwise. I don't believe you can file a claim directly with Medicare for reimbursement, but even if that is so, the doctor would still have to accept only what Medicare dictates is fair compensation. It isn't legal for a doctor to accept supplemental compensation from a patient, no matter how unfair the medicare policy is. I didn't research the law regarding pro bono treatment on a regular basis but my friend says that is why his doctor of 30 years had to stop treating him and I believe it. He is not prone to lying or exaggeration. It just sounds to me like typical government policy - no good deed goes unpunished.

[Tom Deutsch]

I would recommend anyone to look for a primary care doc who is practicing with a "functional medicine" certification. From what I've been able to tell, these are generally ... general doctors (internal medicine, etc) who have picked up on this increasingly recognized certification. They spend a lot more time looking for the root causes of symptoms, vs treating a diagnosis. Lots of so-called diseases (diabetes, arthritis, MS, fibromyalgia, depression, etc) are just a bunch of symptoms that lump into a diagnosis for which there are drugs marketed. Functional docs don't ignore the diagnosis but they work a lot harder to understand what's going on (blood tests) and and use the body's own chemical and hormonal loops to keep the symptoms at bay. In other words - to produce remission from those chronic conditions a lot of us have probably been sentenced with.

[Mike Henderson]

No, doctors are not obliged to take medicare but their policy must be consistent. That is to say they can't accept medicare for some patients and not others. My friend's doctor treated him for free because he felt a certain loyalty to him after decades but didn't want to accept medicare from any patient. The compensation was too low for him to stay in business otherwise. I don't believe you can file a claim directly with Medicare for reimbursement, but even if that is so, the doctor would still have to accept only what Medicare dictates is fair compensation. It isn't legal for a doctor to accept supplemental compensation from a patient, no matter how unfair the medicare policy is. I didn't research the law regarding pro bono treatment on a regular basis but my friend says that is why his doctor of 30 years had to stop treating him and I believe it. He is not prone to lying or exaggeration. It just sounds to me like typical government policy - no good deed goes unpunished.

I went to the Medicare site and found an explanation here. It's fairly complex. The groups apparently break down into "participating" and "nonparticipating".

A nonparticipating physician may accept the Medicare fee schedule for certain services and not for others. And it appears that they are required to file a claim for you. My memory is that if they are nonparticipating, the payment goes to the patient and not to the doc. There is a limit to what nonparticipating providers can charge you - you are right about that.

If your friend was being treated pro bono, there's no way that anyone would know of it. One possibility is that the provider submitted certain claims and that's how they found out about what he was doing. The other possibility is that the doc wanted to stop treating pro bono and just told your friend he was not permitted to continue.

I'm sure that if he was truly doing the work pro bono no one would object.

Mike