SurvivingInfidelity.com^®

In light of our upcoming move later this year to the East Coast, I am researching new psychiatrists. When we moved to the West Coast 4.5 years ago, I grieved so much for my Midwest psychiatrist - she was phenomenal. It took me a couple of tries when we got here, but I found someone who I can work with now. When we first got to SoCal, I was a little over a year out from that even which shall not be named here, and the relocation did a number on me. I ended up in the hospital for a week and a half, about two months after we arrived. Let's just say, there was a lot going on in my life.

We will be six years out from 'that' event when we move again. But I am worried about the reality of making another major transition, even though this one will put me four doors down from our daughter, SIL and grandson. I've gotten the names of several psychiatrists very convenient to where we will be living, and have begun reaching out to them. I got the names from the college friend (who's a psychiatrist no longer accepting new patients but practices in the town we will be moving to, so she's familiar with the options) of my former psychiatrist in the Midwest who I adored. I've heard back from two of them (I just reached out on Friday). One of them lists on her website that she only sees patients between 18-65; I will be 63 this April, so when I emailed her, I asked her about her limitations of 65+. She replied back that she only treat patients up to age 65 as she's not able to see patients with Medicare for insurance reasons. I'm very confused. I understand that she doesn't take Medicare (none of the people I was referred to accept insurance - they're all out-of-network and I knew that to find someone I liked, that's the route I would have to go. But what if someone who has Medicare wanted to pay cash for her services? Why would she not see patients over 65 if the patient was paying out-of-pocket? I will not work with a psychiatrist that only does 15-20 medication management appointments. I want someone who is trained in psychotherapy even if I decide to use someone else for therapy. I know it's a dying art, but there are still some out there.

So can someone explain to me how Medicare works if you choose to see someone who doesn't accept Medicare? This might affect other providers I need to find. FWIW, we will have H's medical insurance (Blue Shield CA) until he retires, which won't probably happen for another 2-3 years (he's a year younger than me). If he does retire before then, we have the option of picking up his previous employer's medical insurance through the pension plan. It's really good insurance.

I'm sure others will be along to advise on this, but from what little I learned, there is some sort of rule that providers cannot accept cash from a Medicare patient. I asked my long-term GYN that question when I hit 65 and he was going to stop doing annual exams. The answer I got was that I couldn't pay for interim testing out of pocket; I'd have to go with Medicare screening intervals, regardless of my risk - for reasons we don't go into on this forum.

So if we opted for H's pension medical insurance, this wouldn't be an issue? I mean, it would be a lot more expensive for us, but it would be an option?

OK, to muddy the waters even further, I had a phone consultation with another psychiatrist yesterday. She told me she doesn't accept Medicare, but has signed an 'opt-out' with Medicare that means she can see patients with Medicare, but promises to never submit a claim to Medicare. She says this is working for a current patient she sees who is of Medicare age. She 'opted-out' of Medicare when this patient, who she'd been seeing for a long time, became eligible for Medicare and the patient wanted to continue to see her. I think she indicated the patient has secondary insurance that she can file for some reimbursement. I don't know how that works, though, because I thought if you had Medicare, you always have to first file with them before you submit to the secondary. Oy vey.

I wish somebody with more direct knowledge would have replied by now, but here I am to commiserate. 🙂

At least it's good news you located someone who has a work-around for the limitations of Medicare coverage.

If you don't mind being on hold for ages, maybe try calling the Center for Medicare Services and ask them about this. I'm sure they'll have some guidance! I get a big booklet every year about what is covered and what isn't, but honestly I haven't read it through, either. Sorry!

I saw a shrink who opted out of Medicare. He billed me, and I paid him directly.

When a provider opts out of Medicare, they should have a signed contract with you where you both agree that Medicare would not be billed. You would pay out of pocket for the services. You would need to check with your insurance if they would cover any of the services. Different insurance companies have varying policies.

I am on Medicaire. I do not use the Red white and blue card. Instead I have Empire Blue across and Blue Shield. I do not pay the Medicaire annual deductible but rather copays for visits and so on. Perhaps this is an option for you. I am in NY if this helps you.

Medicare Part C, aka Medicare Advantage plans, very by regional location. Check with your physician's billing office, a reputable insurance agent, or your state wide insurance benefits advisors (SHIBA) website. Doesn't change things for opt out physicians.

I turned 65 in Nov. Hub is 4 years younger. I was told the only time you can get Medicare accepting pre existing conditions is the first year.

My psychiatrist retires in 3 years his cash fee is 350. It was less expensive for us to go on medicare part g. So my primary is medicare part Part A &B, but anything they don’t pay passes to aethna. I have a deductible of 230 dollars and that is my total out of pocket deductible.

Aetna has a list of doctors who accept there coverage.

[This message edited by PricklePatch at 3:55 PM, Monday, March 6th]

I was told the only time you can get Medicare accepting pre existing conditions is the first year.

Could you clarify this for me please? So basically, if I go into Medicare with hypothyroidism, I can only get Medicare to cover that condition is in the first year?

It was less expensive for us to go on medicare part g

Damn... how many parts of Medicare are there?

I suggest looking at the Medicare website, which ends in 'gov'. They provide a good outline, IMO.

At the top level, there's parts A, B, C, D, and 'Medicare Supplemental Insurance' (AKA 'Medigap'). 'Part G' refers to the 'G' tier of supplemental insurance.

[This message edited by SI Staff at 3:52 PM, Tuesday, March 7th]

First of all when you get Medicare, you pay a premium for part an and b, that is deducted from your social security check. The a b will cover portions of hospital bills and doctor visits. You can shop throw a broker for a supplement plan. The supplement plan is from various insurance company’s, like Kaiser in California, aethna, etc, then there are tiny ones no one has heard of. The supplementals are the ones I was told are only forced to take you with preexisting conditions. The plan I chose was Aetna part G. I have a yearly deductible of 226, then no copays for doctor visits it picks up where type an and b leave off.

I chose this because specialists are 50 dollar copays on my husband a month. I have a GI, cardiologist, kidney doctor, psychiatrist and oh gyn.
I also chose a prescription plan.

It is really complicated, call a Medicare insurance agent. I was told a very popular insurance was though AARP, they have United Healthcare.

I also called my doctors to see what insurances they would accept. My GI will not accept United Healthcare, so I had been seeing another practice I dislike. I got to go back to my original GI yesterday! Yeah!

Some agents push Medicare C ('Advantage'). I'm not alone in thinking Part C is a kludge that falls apart all to often, because the in-network choices just don't match hw most people live. Be very careful about the limitations of Part C. It might work for you long term, but then again it might not.

One of the issues is hearing aid coverage ... apparently it's often limited to high-cost providers, and you end up paying what uninsured people pay. That means the hearing aid benefit is worthless. The trouble is, of course, that it will be something between top-notch and worse than worthless, but you won't know until you need it. As I say, think very carefully before signing up for Part C.

[This message edited by SI Staff at 9:39 PM, Wednesday, March 8th]

@sisoon - I had a long talk with a friend of mine a couple of days ago who's been on Medicare for several years. She told me she often steers people away from that Medicare Advantage for reasons that you suggested.

For those of you have recommended finding a Medicare agent, how do you find them? Do they work on commissions? That would turn me off.

Try your SHIBA helpline for your state. They are volunteers that can help you. It's a part of your state's insurance commissioner's consumer protection programs.

Medicare Part C has good and bad. In our area, there are so few plans that it would be difficult to find providers in the netwirk. Some of the plan administrators are awful.

Our insurance agency has a dedicated health insurance specialist who was the best help when I reached the age for Medicare sign up. I don't envy her the job of keeping up with it all, and can't imagine what I'd have done without her wisdom and guidance. She told us that if you forsee a lot of travel around the country, Medicare Advantage isn't your best bet, as it works only within a specified regional network of providers.

I elected to mail in monthly payments for the supplemental and drug plan insurance policies she sold me, which is a lot of paperwork. I worry about how that system works with elders who get forgetful. With the mail slowdowns, it can be a lot of "check is in the mail" pestering phone calls or texts one may be obliged to deal with, whenever an envelope doesn't arrive at some processing center. I've had a couple such payments just disappear, never to clear my bank, yet I stubbornly refuse to allow those companies automatic access to my bank account. Every year during sign up time, you can elect to change insurances and plans. You do have to give Medicare your bank routing information for automatic deposit, but I'm ok with that!

Another pointer is the prescription drug plan is more or less mandatory, as you will be assessed a penalty by Medicare if you don't carry it, yet for me, it's more than the co-pay on my 1 regular generic Rx.

Good luck with all this!

[This message edited by Superesse at 3:11 AM, Saturday, March 11th]

I worry about how that system works with elders who get forgetful.

This is exactly what happened to my friend who I talked to a couple of days ago. She wasn't good about keeping up with her mail (meaning, opening time-sensitive pieces) and completely missed the notice for authorization to have monthly withdrawals from her bank for her drug plan. So it didn't get signed and they dropped her. She didn't find out until March of last year when she went to pick up some meds and found out they weren't covered, that she didn't have an active drug plan. She found a county advocate volunteer who was willing to go to the mat for her. This woman made several phone calls, including to some board of her state and they agreed to review the situation. They reinstated the policy, reluctantly, after an appeal, and make it retroactive to the beginning of the year.

So even if you have it set up to have the premium automatically withdrawn, you have to authorize that withdrawal every year or they'll cancel your policy. I do think it taught her a lesson, but damn, it's so much work. She's never been good about keeping up with her paperwork and finds it overwhelming.

Up until four years ago, we had State Farm for all of our insurance needs - auto, homeowners, umbrella. But when we moved into our house State Farm wouldn't insure us because they said we lived too close to a high brush area. If you drive one block north of us, State Farm covers those residences. Ugh, I was so angry because now I had to find different insurance companies for different policies. We have different companies for home, umbrella, auto, and earthquake. Each one is billed differently, and at different times of the year. Some of them automatically charge our credit card on file (with a notice sent to us saying they are going to do this a few weeks ahead), and some require us to send in payment. I think our earthquake insurance is the one that doesn't allow a pay online option. It's hard to keep track of who requires what kind of payment, and when, even if you do get reminders in the mail. I can't imagine having to add Medicare policies in a couple of years.

Yikes, number4, exactly what I meant.

I wasn't the bill payer for a number of years after I retired but before I started SSI. When I finally got some income I could allocate, I took on paying my home and farm insurance and all those pesky health insurances. I was so rusty about paying bills, I had a hard time writing my name on a check! (mental reluctance?) Even though I used to handle it all when I was single. Just like anyone who goes through a change in their marital status, after D or widowhood, it's an unpleasant little lesson to find out how much you trusted the other person to handle those little details.

Here's what helped me: get one of the many free paper calendars businesses hand out every year, go through it in January with a heavy marking pen and put all the dates for monthly, quarterly or annual payment due dates, and tax filing dates for the whole year. Then hang it over the desk where you do your bills, separate from your general planning calendar (mine hangs on a wall in the kitchen).

Another thing you will find with Medicare is how every insurance company sends a LOT of paperwork. Fat envelopes every month, full of wasted pages of filler information, plus notices given in every possible language, that force you every month to sort through them to see if they are bills or just claims notifications from your last doctor visits (the envelopes look the same). I have to throw pages away every month from each insurer to glean my billing info and what might still be owed to providers. It got out of control real quick so I started a big 3 ring binder for them, to get the clutter off my desktop! (It's really nuts after a hospital stay, claims can trickle in for months.) After 8 years I need another binder, it cannot take another month! Of course, I could just throw the older stuff OUT, right? RIGHT?! 😆