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The Villages
Monday, November 28, 2022

The state of the Medicare health system in Florida ain’t pretty

To the Editor:

I originally planned to move to the Philippines after retirement. After spending quite a bit of time over there, I realized that the majority of their doctors and nurses have immigrated to the USA. Getting health care over there is not a good option.
If you have retired and think that you are in good shape because you quality for USA Medicare, well, you’d better hold off on that assumption until you get a little experience with the system.
This article will be based primarily upon my own personal experience since we moved to Florida 6 years ago.
I am 80 years old and have had a good relationship with the Medicare system while living in Arizona.
I was a captain for a major airline and have 39 years experience in that field. I am accustomed to dealing with professionals. To say that I have not had a very good experience in the Florida healthcare system is barely touching the real facts.
Before I start ranting about my own specific case, let me ask you a few things. What do you know about how professionals get approved to practice in Florida? If you are a lawyer and you do something unprofessional, you will get disbarred. That means that you will be forbidden from practicing law in the state. Every year, about 200 lawyers get sanctioned by the Florida Bar Assn. It looks like The Florida Bar have their act together.
Now, let me propose a situation. You are lying in a deathbed, which would you choose to be there for you, a lawyer or a doctor? Most of us think that a doctor is more important, especially as we age.
In the state of Florida, a doctor can be a felon, lie on his application to practice, and no-one will check his background. Think not? We still have a surgeon who did that, was exposed by a local newspaper, and is currently working in one of our hospitals. I’m definitely not saying that he is a bad guy, as I have never met him. I am questioning the effectiveness of the government department that oversees the Florida medical system.
There are numerous medical insurance companies in Florida that specialize in Medicare. The US Government calls them Medicare Advantage providers.
These corporations supposedly offer additional benefits and operate in place of original Medicare.
Every year our mailboxes are flooded with their proposals. The fact that they are competing so hard to sign you up should be your first clue. This is a highly profitable business and they all want a piece of it.
I have had contracts with three of these providers in the last six years. All three operate thru Access Health Care, a corporation that controls the doctors, appointments, etc. Access Health Care is a corporate middle man between you and your needed services. It seems that their prime concern is NOT your welfare. Typical to many corporations, Access Health Care seems to make their decisions based solely upon profit.
Once you sign a contract with most of the Florida Medicare Advantage Insurance corporations, Access Health Care will have full control over which doctors you can see and what services they are allowed to provide.
Let’s talk about specific instances.
Do you have a favorite doctor that you trust for his/her experience and knowledge of your history?
Forget them. It is highly unlikely that an experienced professional will be on the Insurance Company’s list.
The majority of doctors that are on the approved list are fresh out of med school and have little experience.
If you can wade thru the foreign accent, you may learn to like the new doctor. Just understand that they have little authority over what treatment you receive. You will get the basics, don’t expect more.
These doctors are worked beyond belief. The Access Healthcare offices are happy to make an appointment, but that seems to be the only good thing about them. The doctors are scheduled extremely tight, and you can wait a long time for an opening in their schedule. Don’t expect to get to know the people in the office as they turn over so rapidly that you will see new faces on every visit.
I spent three years with the first doctor that I was assigned to, but never saw his face, not even once. His shingle was on the office, but my bet is that it is only there to make it look like there are two doctors in that location. On every visit I saw a pleasant Mexican doctor who always said that Dr XXX was too busy to see me on that day. (for three years) My bet is that Dr XXX has already retired and is renting out the use of his license.
Every time you need a specialist, you will wait for a response and written approval. You wait a few weeks to see the PDP that you are assigned to, then a request goes to the Insurance Corporation and maybe that comes back in a couple of weeks, then you can call their assigned specialist and try to make an appointment on his overloaded schedule. You could die waiting. That seems to be of no consequence to Access Healthcare Corp.
A large portion of men over 60 will develop Prostate problems. There are tests to monitor Prostate Cancer. Your Access Health Care doctor is not allowed to request those tests. They tell you that Prostate testing is not accurate, and you will be denied those tests. My previous Arizona doctor insisted upon them
If you have an accident, can you go to an Emergency Room for treatment? Nope. Not until you make an appointment with your doctor and they get written approval from Access Healthcare. I’m speaking from my own experience.
I had a bad fall. The injury was that the tendons had been ripped off of the shoulder and my arm was dangling like a rope. The accident was on Feb 15th. My surgery took place on April 26th. The surgeon stated that the delay was so long that it was almost too late to repair the damage properly. My mistake, I called the doctor.
I should have gone straight to the ER. Sometimes, you will have to bite the bullet and pay out of your pocket.
At our age, everyone knows or should know the signs of a heart attack or stroke. When I had several of the signs and collapsed, I called the doctor that I was assigned to. I was instructed to go immediately to an Emergency Room. Within days, I received a letter stating that the Insurance Corporation would not pay the hospital bill since I did not have written approval.
What I am stating here are documented facts. What I am saying to you is that you’d better look hard and close before you sign a contract with ANY insurance company. The fact that these businesses call themselves “medical providers” is very misleading. They are in fact INSURANCE COMPANIES, with only their profits in mind. Good luck and Good Health.

Richard Wilson
Crystal River

 

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