Re: medicaid and specialists

[Guest guest]

Sorry,  I'm not help.  Medicaid in our area is next to impossible, which is why we stopped taking it ourselves.  We recommend patients go to a Medicaid clinic, where that's all they see and where they know who to send patients to and how to get them seen.  ER sounds like a viable option, but make sure the hospital takes Medicaid.  Our local hospital doesn't take non-emergent Medicaid. 

 

 

Good afternoon everyone,

 

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

  I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

 

I guess I'll have to send her to ER

 

Thoughts?

 

-- Pratt

[Guest guest]

yes  lots of this  I don't know if there is an  answer for you My answer is  what I call shoe leather medicine n You pick up the phone and call and talk to the doc And then acall another one then another   Where do your colleagues send folks? That  is a resource

 Er doesn't really work Patients may have  to travel  to a doc  some distance Some health centers  have specialists I do that for derm a FQHC has derm  2 hrs away    wrote:

On Fri, Oct 14, 2011 at 1:52 PM, Debra Karinu

 

Good afternoon everyone,

 

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

  I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

 

I guess I'll have to send her to ER

 

Thoughts?

 

--      MD          ph    fax

[Guest guest]

Have the patient call Medicaid or if Managed Medicaid (better for this) call the carrier and say Hey I have no network of providers in teh speciality I need will to see me, take any new patients with my product... Find me a neuro who is accepting new patients with my Medicaid.... Again if Managed speak the frightening to them because this is a legal obligation of theirs to me an HMO like organization, "You don't have any doctors in YOUR NETWORK who are willing to see me and treat me in this specialty"... That should light a fire under them and fast because they could get shut down because they are obligated to have enough docs in all the needed areas to properly cover the number of members they have on their panel.... BUSTED!

To: Sent: Friday, October 14, 2011 2:04 PMSubject: Re: medicaid and specialists

yes lots of this I don't know if there is an answer for you My answer is what I call shoe leather medicine n You pick up the phone and call and talk to the doc And then acall another one then another Where do your colleagues send folks? That is a resource Er doesn't really work Patients may have to travel to a doc some distance Some health centers have specialists I do that for derm a FQHC has derm 2 hrs away wrote:

On Fri, Oct 14, 2011 at 1:52 PM, Debra Karinu

Good afternoon everyone,

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

I guess I'll have to send her to ER

Thoughts?

-- MD ph fax

[Guest guest]

reason why i dont take medicaid.

you become the specialist and they (medicaid) sue your boots off of you for not

sending these patients to one.

i decided years ago that there will have to be another way through which i can

save the world.

good luck

grace

>

> Good afternoon everyone,

>

> Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for

> Medicaid pts?

> I had 2 who were accepting, then the MD denied my pts need for services

> without seeing her... (she has severe issues and refuses to go to ER)

> And now at her check in the tell her no were are not taking any more

> medicaid.

>

> I guess I'll have to send her to ER

>

> Thoughts?

>

[Guest guest]

,

when patients call... medicaid gives them a list that includes physicians who

left the area 10 years ago.

go figure.

grace

>

>

> On Fri, Oct 14, 2011 at 1:52 PM, Debra Karinu

>

>  

> >Good afternoon everyone,

> >

> >Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for

Medicaid pts?

> >  I had 2 who were accepting, then the MD denied my pts need for services

without seeing her... (she has severe issues and refuses to go to ER)

> >And now at her check in the tell her no were are not taking any more

medicaid.

> >

> >I guess I'll have to send her to ER

> >

> >Thoughts?

> >

>

>

> --

>

>

>

>      MD

>     

>     

> ph    fax

>

>

[Guest guest]

Great thought.. I get right on that as you are correct in your view

 

Have the patient call Medicaid or if Managed Medicaid (better for this) call the carrier and say Hey I have no network of providers in teh speciality I need will to see me, take any new patients with my product... Find me a neuro who is accepting new patients with my Medicaid.... Again if Managed speak the frightening to them because this is a legal obligation of theirs to me an HMO like organization, " You don't have any doctors in YOUR NETWORK who are willing to see me and treat me in this specialty " ... That should light a fire under them and fast because they could get shut down because they are obligated to have enough docs in all the needed areas to properly cover the number of members they have on their panel.... BUSTED!

 

To: Sent: Friday, October 14, 2011 2:04 PM

Subject: Re: medicaid and specialists

 

yes  lots of this  I don't know if there is an  answer for you My answer is  what I call shoe leather medicine n You pick up the phone and call and talk to the doc And then acall another one then another  

Where do your colleagues send folks? That  is a resource Er doesn't really work Patients may have  to travel  to a doc  some distance Some health centers  have specialists I do that for derm a FQHC has derm  2 hrs away 

  wrote:

On Fri, Oct 14, 2011 at 1:52 PM, Debra Karinu

 

Good afternoon everyone,

 

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

  I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

 

I guess I'll have to send her to ER

 

Thoughts?

 

--      MD          ph    fax

[Guest guest]

Finding specialists to take Medicaid patients here in Colorado is nightmarish. Of course, we have about five times the patients on Medicaid than just a few years ago -- since our unemployment rate went from 2% to 10%, and no increase in the number of subsidized clinics or HHS employees to handle the claims, since the state is nearly bankrupt in this economy.

This morning I had a patient come in with a very obvious (recurrent) carcinoma on his nose, with a big, deep ulceration near the bridge. We tried calling 15 different dermatologists listed on the Medicaid website, but none will take a new patient. We called National Jewish, but they only have derm for pediatrics. The derm clinic at University Hospital is accepting no new Medicaid patients. I finally called and "guilted" my regular dermatology specialists into taking the patient by telling them all of the above and then saying, "Listen, I send all my commercially insured patients to your practice, and this guy got laid off and has custody of his four boys, and has nowhere else to go. Sometimes you just have to do the right thing. Please have one of your providers call me." A few minutes later, the receptionist called back and said the office manager had approved taking the patient.

It's a sad country where a patient can have cancer and you can't get anyone to see them because of their insurance coverage. Very sad. We should all be ashamed. As a society.

Deanna Tolman, DNP, FNP

Good afternoon everyone,

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

I guess I'll have to send her to ER

Thoughts?

[Guest guest]

I am in Colorado. I run a small IMPish medical dermatology practice. Like many of you, I am constantly battling overhead to make ends meet while providing patients with quality care. I never wanted to be the guy who made the diagnosis from the door in less than 3 minutes. Most derms make big bucks on either volume, cosmetics, or Mohs and I don't do any of those. I

absolutely feel and believe that all patients, including medicaid patients, deserve the type of quality care that I can offer as an IMP physician. But, I simply cannot survive if the stitch I use for the biopsy on the face costs more than what I am reimbursed. That is the truth, a 6-0 Prolene stitch is more than the reimbursement for a biopsy of nose- forget overhead and lost revenue. So, before you beat on the specialist, please ask yourself how much care you provide for free or at a loss. I am guessing most of us cannot operate a business like that. FYI, in Colorado medicaid can go to Denver Health, DH gets an

additional subsidy from the state for each Medicaid patient they see, in addition to the fee for service-do ask me why they don't do this for all docs, but that is the way it is.

To: Sent: Friday, October 14, 2011 2:44 PMSubject: Re: medicaid and specialists

Finding specialists to take Medicaid patients here in Colorado is nightmarish. Of course, we have about five times the patients on Medicaid than just a few years ago -- since our unemployment rate went from 2% to 10%, and no increase in the number of subsidized clinics or HHS employees to handle the claims, since the state is nearly bankrupt in this economy.

This morning I had a patient come in with a very obvious (recurrent) carcinoma on his nose, with a big, deep ulceration near the bridge. We tried calling 15 different dermatologists listed on the Medicaid website, but none will take a new patient. We called National Jewish, but they only have derm for pediatrics. The derm clinic at University Hospital is accepting no new Medicaid patients. I finally called and "guilted" my regular dermatology specialists into taking the patient by telling them all of the above and then saying, "Listen, I send all my commercially insured patients to your practice, and this guy got laid off and has custody of his four boys, and has nowhere else to go. Sometimes you just have to do the right thing. Please have one of your providers call me." A few minutes later,

the receptionist called back and said the office manager had approved taking the patient.

It's a sad country where a patient can have cancer and you can't get anyone to see them because of their insurance coverage. Very sad. We should all be ashamed. As a society.

Deanna Tolman, DNP, FNP

Good afternoon everyone,

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

I guess I'll have to send her to ER

Thoughts?

[Guest guest]

,

I wasn't being critical of the dermatologist, but of the system, of our society, that would let this happen. I understand exactly what you mean about losing money on every patient, since I accept Medicaid, but I'm having to close my practice to new Medicaid patients now that I'm up to 15%.

And unfortunately, only people who live in the City and County of Denver can go to Denver Health. This gentleman lives in Arapahoe County, and thus University Hospital is his only recourse. And almost all of their clinics are now closed to new Medicaid patients. Not sure how they're getting away with that, because they get additional subsidies from the state just like Denver Health. I know they're overwhelmed at University. Patients of mine that have gone to the ER there in recent months say it's like an army or disaster triage hospital. They get treated on stretchers in the hallway, never getting into an ER room at all. That's the 5x/patients because we have 5x/unemployment problem.

Really didn't mean to sound like I was beating up on "us." It's the problem with all insurance and our "system" creating these terrible inequalities that I was griping about.

So, where are you? Can I send you my insured patients? Do you take Medicare? TriCare?

Deanna

I am in Colorado. I run a small IMPish medical dermatology practice. Like many of you, I am constantly battling overhead to make ends meet while providing patients with quality care. I never wanted to be the guy who made the diagnosis from the door in less than 3 minutes. Most derms make big bucks on either volume, cosmetics, or Mohs and I don't do any of those. I absolutely feel and believe that all patients, including medicaid patients, deserve the type of quality care that I can offer as an IMP physician. But, I simply cannot survive if the stitch I use for the biopsy on the face costs more than what I am reimbursed. That is the truth, a 6-0 Prolene stitch is more than the reimbursement for a biopsy of nose- forget overhead and lost revenue. So, before you beat on the specialist, please ask yourself how much care you provide for free or at a loss. I am guessing most of us cannot operate a business like that. FYI, in Colorado medicaid can go to Denver Health, DH gets an additional subsidy from the state for each Medicaid patient they see, in addition to the fee for service-do ask me why they don't do this for all docs, but that is the way it is.

To: Sent: Friday, October 14, 2011 2:44 PMSubject: Re: medicaid and specialists

Finding specialists to take Medicaid patients here in Colorado is nightmarish. Of course, we have about five times the patients on Medicaid than just a few years ago -- since our unemployment rate went from 2% to 10%, and no increase in the number of subsidized clinics or HHS employees to handle the claims, since the state is nearly bankrupt in this economy.

This morning I had a patient come in with a very obvious (recurrent) carcinoma on his nose, with a big, deep ulceration near the bridge. We tried calling 15 different dermatologists listed on the Medicaid website, but none will take a new patient. We called National Jewish, but they only have derm for pediatrics. The derm clinic at University Hospital is accepting no new Medicaid patients. I finally called and "guilted" my regular dermatology specialists into taking the patient by telling them all of the above and then saying, "Listen, I send all my commercially insured patients to your practice, and this guy got laid off and has custody of his four boys, and has nowhere else to go. Sometimes you just have to do the right thing. Please have one of your providers call me." A few minutes later, the receptionist called back and said the office manager had approved taking the patient.

It's a sad country where a patient can have cancer and you can't get anyone to see them because of their insurance coverage. Very sad. We should all be ashamed. As a society.

Deanna Tolman, DNP, FNP

Good afternoon everyone,

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

I guess I'll have to send her to ER

Thoughts?

[Guest guest]

. Where in colorado are u?

 

Finding specialists to take Medicaid patients here in Colorado is nightmarish.  Of course, we have about five times the patients on Medicaid than just a few years ago -- since our unemployment rate went from 2% to 10%, and no increase in the number of subsidized clinics or HHS employees to handle the claims, since the state is nearly bankrupt in this economy. 

 

This morning I had a patient come in with a very obvious (recurrent) carcinoma on his nose, with a big, deep ulceration near the bridge.  We tried calling 15 different dermatologists listed on the Medicaid website, but none will take a new patient.  We called National Jewish, but they only have derm for pediatrics.  The derm clinic at University Hospital is accepting no new Medicaid patients.  I finally called and " guilted " my regular dermatology specialists into taking the patient by telling them all of the above and then saying, " Listen, I send all my commercially insured patients to your practice, and this guy got laid off and has custody of his four boys, and has nowhere else to go.  Sometimes you just have to do the right thing.  Please have one of your providers call me. "   A few minutes later, the receptionist called back and said the office manager had approved taking the patient.

 

It's a sad country where a patient can have cancer and you can't get anyone to see them because of their insurance coverage.  Very sad.  We should all be ashamed.  As a society. 

 

Deanna Tolman, DNP, FNP

 

 

Good afternoon everyone,

 

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

  I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

 

I guess I'll have to send her to ER

 

Thoughts?

 

[Guest guest]

Wow, this was a great discussion.. I agee, most of my Medicaid patients had commercial issuance just a few years ago.

 

RI is offering a lower % than the 30% Medicaid pt encounters per practice; as the MU Medicaid incentive.

I am considering applying for this vs. the Medicare; it's much simpler to meet and I have many Medicaid encounters.

 

I did have my pt. call the Medicaid office and will find out today how she made out obtaining a neurosurgeon.

 

We do have a big University Hospital in Providence, RI

which has clinics; but most of my Medicaid pts do not have reliable cars to make the 20-30 min drive; or no cash for the gas and parking fees...

This is a very said world we are in.  I am not sure how any of the current health care reform will help this..

I wish they (politicians)  would ask the average PCP what we think would help ..

[Guest guest]

I am at Centennial Medical Plaza in Centennial CO. I do take most insurances including Medicare and Tricare, but do not take Medicaid or Colorado Access (except their Advantage plan). I don't do any cosmetics. www.AppliedDermatology.com

g

To: Sent: Friday, October 14, 2011 6:31 PMSubject: Re: medicaid and specialists

. Where in colorado are u?

Finding specialists to take Medicaid patients here in Colorado is nightmarish. Of course, we have about five times the patients on Medicaid than just a few years ago -- since our unemployment rate went from 2% to 10%, and no increase in the number of subsidized clinics or HHS employees to handle the claims, since the state is nearly bankrupt in this economy.

This morning I had a patient come in with a very obvious (recurrent) carcinoma on his nose, with a big, deep ulceration near the bridge. We tried calling 15 different dermatologists listed on the Medicaid website, but none will take a new patient. We called National Jewish, but they only have derm for pediatrics. The derm clinic at University Hospital is accepting no new Medicaid patients. I finally called and "guilted" my regular dermatology specialists into taking the patient by telling them all of the above and then saying, "Listen, I send all my commercially insured patients to your practice, and this guy got laid off and has custody of his four boys, and has nowhere else to go. Sometimes you just have to do the right thing. Please have one of your providers call me." A few minutes later, the

receptionist called back and said the office manager had approved taking the patient.

It's a sad country where a patient can have cancer and you can't get anyone to see them because of their insurance coverage. Very sad. We should all be ashamed. As a society.

Deanna Tolman, DNP, FNP

Good afternoon everyone,

Has anyone had issues trying to finds a specialist (IE: neuro surgeon) for Medicaid pts?

I had 2 who were accepting, then the MD denied my pts need for services without seeing her... (she has severe issues and refuses to go to ER)

And now at her check in the tell her no were are not taking any more medicaid.

I guess I'll have to send her to ER

Thoughts?

[Guest guest]

Medicaid is an obviously broken system in many states. It is (egregiously) the second tier of health care as many are denied access or simply have to wait so long to get care that it is like denied access because of reimbursement. It will only get worse with the health care law bc many more will qualify for Medicaid. These so called politicians dont care, bc these are not the folks who vote. Lets face it, if you cant get to the hospital for neurosurgery, then how are you going

to get to the polling station. Did you know that are some states where medicaid pays even more than Medicare, anyone work in Alaska or North Dakota?

g

To: Sent: Monday, October 17, 2011 5:19 AMSubject: Re: medicaid and specialists

Wow, this was a great discussion.. I agee, most of my Medicaid patients had commercial issuance just a few years ago.

RI is offering a lower % than the 30% Medicaid pt encounters per practice; as the MU Medicaid incentive.

I am considering applying for this vs. the Medicare; it's much simpler to meet and I have many Medicaid encounters.

I did have my pt. call the Medicaid office and will find out today how she made out obtaining a neurosurgeon.

We do have a big University Hospital in Providence, RI

which has clinics; but most of my Medicaid pts do not have reliable cars to make the 20-30 min drive; or no cash for the gas and parking fees...

This is a very said world we are in. I am not sure how any of the current health care reform will help this..

I wish they (politicians) would ask the average PCP what we think would help ..