Medicare didn't cover a routine doc visit?

[biscuitmom]

Originally Posted by xz2y

Well, the issue is that doctors in new locations want to have a comprehensive physical exam in order to become an "established" patient. If you have already had the initial comprehensive exam (Welcome to Medicare exam at age 65) prior to moving, Medicare isn't going to pay for another one in a new location with a new doctor. That's the problem. How do you become an "established" patient in a new location with a new doctor without paying for a comprehensive physical exam?

As far as I know, you can't call a clinic anywhere as a "new" patient (who hasn't been seen by anyone at that clinic) and tell them you want to see a doctor for a particular medical issue. They will tell you (I've called and asked) that you first need to be an "established" patient after having a comprehensive physical exam before seeing a doctor for a specific medical problem. Otherwise, you end up in the ER.

It wasn't a problem for DH & me.

We never had the Welcome to Medicare exam; we had been going to the same doc for many years and when we switched to Medicare, we continued seeing him as usual. His office switched to coding our annual visits as Wellness exams, he listened to our hearts and lungs through clothing, and ordered lab tests covered by Medicare.

We relocated to another state this year. DH & I enrolled in a PPO here, made an appt. with a new primary care physician, stating it was for the annual Wellness exam. He didn't require a comprehensive physical but did exactly the same things our previous doc had.
I'm on thyroid med and a statin and he required a follow-up visit to review the prescriptions since he didn't have the lab results during the Wellness exam. There was only a $10 co-pay for follow-up. He told me I can avoid that charge and a follow-up in the future by going to the lab and getting my blood drawn a week before my next Wellness exam.

[Pat Answers]

I have medicare and the supplement F policy. Once a year I get the "free" medicare visit, which is just the bp, pulse, oxygen, weight, check. Also, I go a week before the visit and get lab work done, and at the visit the Dr. discusses the results. 6 months later I get a physical exam. Dr. looks at everything, gives me a regular physical exam, and then gives me a page of labs to go get. Between the Medicare and my medigap, I have never paid anything for these.

At my last medicare exam the Dr. suggested a specialist to go to.

I've been told as long as you have regular medicare and a supplement policy, one does not have to get a referral to go to a specialist. I have found this to be true. I don't know how the Advantage plans work, I suspect those people need a referral.

[reed303]

Originally Posted by Pat Answers

I have medicare and the supplement F policy. Once a year I get the "free" medicare visit, which is just the bp, pulse, oxygen, weight, check. Also, I go a week before the visit and get lab work done, and at the visit the Dr. discusses the results. 6 months later I get a physical exam. Dr. looks at everything, gives me a regular physical exam, and then gives me a page of labs to go get. Between the Medicare and my medigap, I have never paid anything for these.

At my last medicare exam the Dr. suggested a specialist to go to.

I've been told as long as you have regular medicare and a supplement policy, one does not have to get a referral to go to a specialist. I have found this to be true. I don't know how the Advantage plans work, I suspect those people need a referral.

The need for referrals depends on the specifics of the MA plan you enroll in. My plan does not, but it has a higher premium than the plan that does require referrals.

I have been examined, and treated, by my ophthalmologist and my dermatologist without referrals.