Note to Medicaid Patients: The Doctor Won’t See You.

Wall Street Journal, Thursday, July 19, 2007

Note to Medicaid Patients: The Doctor Won’t See You

As Program Cuts Fees,
MDs Drop Out; Hurdle
For Expansion of Care

By VANESSA FUHRMANS
July 19, 2007; Page A1

BENTON HARBOR, Mich. — Medicaid provides health-care coverage for millions of Americans — but a growing number of doctors won’t accept it.

In February, Jada Garrett, a 16-year-old sophomore, developed what seemed at first a mild case of strep throat. Within a couple of weeks her joints ballooned. Many afternoons, her swollen ankles hurt too much to walk.

To get to the bottom of her symptoms, Jada needed to see a rheumatologist. But the local one listed in her Medicaid plan’s network wouldn’t see her in his office. The wait to get into a clinic was more than three months. By the time she found a rheumatologist in a nearby county to take her in mid-April, Jada’s debilitating pain had caused her to miss several weeks of school.

“You feel so helpless thinking, something’s wrong with this child and I can’t even get her into a doctor,” says Jada’s mother, Nicole Garrett, who enrolled her three teenage daughters in Medicaid after they lost private coverage. “When we had real insurance, we could call and come in at the drop of a hat.”

On paper, Jada’s Medicaid coverage is real insurance. Funded jointly by states and the federal government, the safety-net program is intended to provide comprehensive health-care coverage for more than 50 million Americans too poor or disabled to afford it elsewhere. Like the majority of Medicaid recipients in Michigan, Jada receives her benefits through a private health-maintenance organization contracted by Medicaid to administer the program.

[Nicole Garrett]

But when Medicaid patients seek care, they often find themselves locked out of the medical system. In a 2006 report from the Center for Studying Health System Change, a nonprofit research group based in Washington, nearly half of all doctors polled said they had stopped accepting or limited the number of new Medicaid patients.

That’s because many Medicaid programs, straining under surging costs, are balancing their budgets by freezing or reducing payments to doctors. That in turn is driving many doctors, particularly specialists, out of the program.

The dwindling number of doctors who accept Medicaid is a large, little-discussed hurdle to some ambitious efforts to broaden health-care coverage. Expanding Medicaid eligibility or using the private Medicaid HMOs is a linchpin in universal-coverage initiatives in Massachusetts and other states — as well as some 2008 presidential candidates’ platforms.

In California, a key component of Gov. Arnold Schwarzenegger’s universal coverage proposal calls for a controversial 2% to 4% surcharge on doctors’ and hospitals’ revenues. The money would be used to pay for higher Medicaid fees so that doctors will take in more enrollees. About 51% of family physicians in California participate in Medicaid. For a number of specialties, such as orthopedic surgery, the percentage is much lower, according to the California HealthCare Foundation.

Michigan’s governor, Jennifer Granholm, is also pushing a plan to extend coverage to more than 500,000 of the state’s uninsured. Because physician groups have balked at taking more people at Medicaid-level reimbursements, policy makers hope the new program will pay doctors rates similar to Medicare — about two-thirds higher than Medicaid. But many people fear that will give doctors even less reason to accept people on Medicaid.

In Michigan, the number of doctors who will see Medicaid patients has fallen from 88% in 1999 to 64% in 2005. Many of those doctors tightly cap how many they’ll see or refuse to take on new Medicaid patients. At the same time, enrollment in the program in Michigan has risen more than 50% to nearly 1.6 million since 1999.

Paul Reinhart, the state’s Medicaid director, says he doesn’t believe difficulties finding specialists is a pervasive issue. But he acknowledges that patients can run into access problems. “That’s a problem that we’re working on and one that probably can only really be resolved with increased [fees],” he says. To safeguard against access problems, his agency requires the plans to have at least one primary-care physician for every 750 people in a given region. The program also checks a few times a year whether the specialists listed in the plans’ networks are indeed available.

“At this point, I have to pay money out of my own pocket to take care of that [Medicaid] patient, and it’s only going to get worse,” says AppaRao Mukkamala, president of the Michigan State Medical Society and a radiologist in Flint, Mich. There, auto-industry layoffs have helped push one in five people onto Medicaid or into the ranks of the uninsured.

For every chest X-ray Dr. Mukkamala performs, for instance, Medicaid pays him $20. Commercial insurers such as Blue Cross pay about $33 and Medicare pays $30. But with technicians, film and other equipment, his costs are about $29 per X-ray, he estimates. Medicaid patients he sees at Hurley Medical Center in Flint make up 28% of his work there.

Like many states, Michigan hires private Medicaid HMOs to administer benefits. The state pays HMOs a monthly fee for each patient. The HMOs then pay doctors, usually amounts close to government-set payments. As in many states, the managed-care plans win Medicaid contracts based partly on how robust their networks of doctors and hospitals are.

The HMOs’ directories of network providers in Michigan seem full, but phone calls to listed specialists in some places find big holes. The three HMOs which operate in the county around Benton Harbor — Community Choice, Great Lakes Health Plan and Health Plan of Michigan — post on their Web sites lists of local specialists participating in their network.

Of the 11 obstetrician-gynecologists that Community Choice lists for Berrien County, four doctors said they were listed in error, and another one no longer practices in the area. One took only Medicaid patients referred to her by doctors within her practice. Three others were only seeing new Medicaid patients at a nearby clinic, not in their offices. And two more were taking patients at the same clinic.

Many doctors on Health Plan of Michigan’s list, which includes many of the same names, had similar restrictions. Great Lakes’ Web site noted that none of the six on its ob-gyn list were accepting new patients.

[Fee Disparity]

All three HMOs’ listed gastroenterologists — another high-demand specialist area — only saw Medicaid patients at an offsite clinic where appointment waits can be three to nine months.

The health plans say they encourage members and their referring doctors to call them if they have trouble getting an appointment with a specialist. “We can’t just rely on what’s in the directory — it would be our obligation to help any member,” says Pamela Morris, president of CareSource Management Group, which manages Community Choice’s health plan. She adds that a wait of several months is “unacceptable.” The company says that all of the doctors in its directory are indeed contracted with it. It says sometimes staff at medical practices make mistakes about what plans they accept.

Health Plan of Michigan’s chief operating officer, Shery Cotton, says that in some places, it will pay doctors bonuses to encourage them to see ob-gyn patients. It also periodically checks in with primary doctors to see if their Medicaid patients are being refused by specialists. And it doesn’t require plan members to use just network doctors.

But Ms. Cotton acknowledges that low reimbursements from the state sometimes make raising participation a struggle: “We literally get on the phone with doctors and beg, ‘Will you see this patient?’”

Steve Matthews, a spokesman for AmeriChoice, the Medicaid arm of UnitedHealth Group Inc., which owns Great Lakes Health Plan, said that the plan’s customer-service records don’t show a doctor-access problem in Benton Harbor. He added that if a patient has difficulty, the company will help set up an appointment “anywhere in the state, regardless of whether they’re in the network.” Many primary-care doctors, however, say they don’t have the time or resources to call the plans for all of the patients for whom they have trouble finding referrals.

Robert Ward III, a neurologist in nearby St. Joseph, says the only new Medicaid patients his practice now sees are those who were admitted to the local hospital first. Occasionally, he will see a patient referred by a doctor he knows. But all three of the local Medicaid HMOs have Dr. Ward listed as a network provider — only Great Lakes Health Plan’s Web site notes that he isn’t accepting new patients. Dr. Ward says his office has pointed this out to the Medicaid plans.

When he started his practice in the early 1990s, Dr. Ward says he placed no limits and Medicaid patients flocked to his practice. Medicaid patients soon ballooned to 35% of his roster.

“It was a rookie mistake,” says Dr. Ward, one of only two full-time neurologists in the tri-county area.

Commercial health plans such as Blue Cross pay him between $72 and $85 for a typical neurological exam. He receives about $31 from the Medicaid plans. Now, 12% of his patients are on Medicaid.

Southwestern Medical Clinic, a multispecialty group, sees some Medicaid patients in its offices across the county because of its involvement in Christian-based medical mission work. That group now accounts for some 20% of the clinic’s patient mix. Yet the clinic limits many appointments to Medicaid patients who live in the same or surrounding ZIP codes of its various branches.

“We don’t want people driving past their community provider to come see us,” says Kenneth O’Neill, Southwestern’s medical director. “Otherwise the model of everyone doing their fair share starts to fall apart.”

Delays in getting treatment can have serious consequences. Jennifer Kinchen, 47, enrolled in Medicaid in late 2005, after Hurricane Katrina forced her to leave her home in Louisiana and move near family in Benton Harbor. Since late last year, she has suffered from tremors severe enough to cause her to drop her coffee mug or sometimes fall, liver problems and high levels of ammonia in her blood.

Her family doctor has searched and waited to get her an appointment with a neurologist or gastroenterologist. In the meantime, Ms. Kinchen has gone to the emergency room a few times because of dehydration and blacking out.

In Benton Harbor, more than 300 patients lost access to counseling services after the main provider of Medicaid mental-health services, Riverwood Center, stopped accepting payments from Medicaid HMOs. Riverwood says the reimbursements it was receiving from the Medicaid HMOs for outpatient sessions didn’t cover their costs.

Payment delays and other administrative hassles compounded the crunch, says Riverwood’s president, Allen Edlefson. The center lost $350,000 in 2003, the year before it decided to quit its Medicaid HMO contracts. “It was a painful decision, but we just couldn’t make it work financially,” he says.

The Medicaid HMOs helped slow costs by more tightly managing care, such as reducing hospital admissions and assuring that recipients are at least assigned a primary-care doctor. The state estimates HMOs have saved Medicaid more than $300 million annually in recent years.

Nestled along Lake Michigan’s southeastern shore, Benton Harbor has been hard hit by job losses. Manufacturers have steadily cut or relocated elsewhere good-paying union jobs with health benefits. About a quarter of the community of 12,000, poor and predominantly black, are unemployed.

As the city’s middle class dwindled, most doctors, along with the hospital, relocated in the late 1980s and early 1990s across the St. Joseph River to its much more affluent twin, St. Joseph, a picturesque lake-resort town. Most of those doctors are listed in HMO networks but many don’t accept Medicaid patients in their offices. Instead, many spend an afternoon every one or two weeks seeing Medicaid patients at a clinic set up in a building that once housed Benton Harbor’s hospital.

[Don Tynes]

The doctors say they prefer the arrangement because the clinic — which is run by the St. Joseph hospital — pays them a flat rate for the afternoon, instead of Medicaid fees for each service. They don’t have to worry about the administrative hassle of filing claims or no-show patients — a common problem since many Medicaid recipients don’t have ready transportation. But for patients, this can mean waiting months for an appointment.

The specialist crunch means that more of the burden is falling on primary-care physicians such as Don Tynes. Dr. Tynes runs one of the few primary-care practices left in Benton Harbor. Three years ago, he left his job as a salaried physician in a local community health center to set up his own practice in a former dry-cleaning shop across from Benton Harbor high school.

“I don’t want to pull any punches taking care of people,” says Dr. Tynes. “I’m a spiritual man, not a businessman.” In his waiting room, gospel movies play round the clock on a DVD player and patients can sign up for his weight-loss coaching.

On a recent day, 22 out of the 37 patients were on Medicaid, and another 12 had Medicare or other government-sponsored insurance. Only three had commercial health coverage. Dr. Tynes tries to make ends meet with a bare-bones staff. He has also cultivated a loyal patient base by offering specialty services such as sexual-dysfunction treatment and marriage counseling. Depending on how good business is, he tries to pay himself an after-tax salary of $500 to $750 a week to support his family of five children.

But three times so far this year, he’s forgone his biweekly paycheck to keep the practice out of the red. Last year, he cut his office staff from seven to four people. “We [primary-care physicians] are the ones keeping this Medicaid system together, but we’re the ones getting killed,” he says.

Write to Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com

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28 Responses to “Note to Medicaid Patients: The Doctor Won’t See You.”


  1. 1 RK July 19, 2007 at 5:03 pm

    Agree with Dr. Tynes Family physicians are getting killed with the medicaid patients, its very difficult to survive as a family physician, we know how much struggle we had to become a physician with all the debts and lost our family life…now these insurances esp. medicaid payments such low reimbursement..can u imagine a family physician is working less than $40/hr in which he sees almost 5 patients which is $8/patient…come on $8/patient visit..that’s really sucks… how can we survive…

  2. 2 Darwin Corby December 5, 2007 at 11:26 am

    Quote

    “But when Medicaid patients seek care, they often find themselves locked out of the medical system.”

    It’s a shame that money is the reason health care is denied to some people. How much suffering goes on unreported?

  3. 3 sam March 11, 2008 at 1:02 pm

    i try 100 s of doctors offices but everybody ssays ssssoooory!
    we not accept madicaid.
    why government not do some?

  4. 4 Lea Schorr March 11, 2008 at 4:52 pm

    Even if the doctor WILL see you and accepts MedicAid as insurance, there’s no way to be sure the doctor is a Good Doctor.
    My current private practice dr who does accept MedicAid claimed at our first meeting interview-the-doctor apppointment that he had several patients already who are trying to deal with Chronic Fatigue Syndrome and Fibromyalgia.
    He may indeed have several such patients. If the way he treats me is any indication he really doesn’t know much about we who have CFS/F.

    It’s his habit to go very far “off-label” in prescribing meds he feels might help me. So far I’ve gotten medications for epilepsy, diabetes, herpes, cardiac issues, and have been told to report to a psychiatrist.
    Except for the cardiac issues, I have none of the above problems. CFS/F are not mental conditions. What they are, are physical illnesses that may sometimes cause mental aberrations.
    That’s NOT the same thing, despite the obvious opinion of the several doctors I’ve consulted.

    As with many CFS/F patients, I often react oddly to medications to the point I cannot continue their use or the medications have no effect whatsoever. Dr goes into a ham-actor version of showing frustration, rolling his eyes, grimacing his mouth, and frowning at me.
    I’m sorry I have this problem. It wasn’t my idea to get it.

    It’s annoying to be put through his act at the majority of my appointments with this man.

    Having finally had enough, I called a local hospital and asked for names of MedicAid-accepting private practice doctors.
    I was told to go to the county clinics. It seems the person at the hospital either didn’t hear or failed to understand the “private practice” phrase.
    When I told the phone answering person the clinics were not a good option for me, she suggested I go through the phone book and call each listed physician to ask if MedicAid was accepted by each physician.

    I’m sorry but when a Chronic Fatigue patient looks at such a task it’s much too daunting.
    Such calls also interrupt the normal flow of business at a doctor’s office.
    I really feel it would be possible for general operators at hospitals to answer my question…it’s truly not that complicated for a relatively healthy working person…and wouldn’t interrupt the flow of that person’s day for more than the minutes it took to utter the names of a few doctors.

    Thanks very much for the option of posting this quandary.

    Sincerely,
    Lea Schorr.
    ca21595423@mchsi.com

  5. 5 Saundra May 18, 2008 at 5:16 pm

    I know about Fibromyalgia i take Pamelor for it and it works. I am moving soon to Lexington,Ky. and i am trying to find a doctor in the area. Any suggestions??? I don’t know where to start to find a doctor. This whole thing is crazy that because i was in a bad wreck back when i was 17 and became disabled i can’t get a doctor to see me. Thank You,Saundra

    • 6 Melody October 24, 2010 at 12:00 pm

      Sandra,

      Good luck finding a doctor in Lexington that will take Medicaid. I used to live there and was on Medicaid for pregnant women for a short time. My primary care doctor dropped me like a hot potato, urgent care clinics wouldn’t see me and I had to beg my OB to keep me. I couldn’t even get a pediatrician for my daughter after she was born.

      I truly hope you find a good quality primary doctor.

  6. 7 Lea Schorr August 17, 2008 at 12:05 pm

    QUOTE: Saundra
    May 18, 2008 at 5:16 pm
    I know about Fibromyalgia i take Pamelor for it and it works. I am moving soon to Lexington,Ky. and i am trying to find a doctor in the area. Any suggestions??? I don’t know where to start to find a doctor. This whole thing is crazy that because i was in a bad wreck back when i was 17 and became disabled i can’t get a doctor to see me. Thank You,Saundra

    Saundra, I am very sorry I didn’t get back here until now to see your entry.
    Just one of the downsides of CFS (now being called myalgic encephalomyelitis as it is in Europe and other more-medically-precise as to illness names places)is a maddening thing that wipes out memory.
    In short I forgot I even posted my own thoughts.

    The Pamelor you say has been prescribed for Fibromyalgia, which is similar in many ways to Myalgic Encephalomyelits, is an anti-depressant medication.

    I do not understand why doctors insist on prescribing psychiatric medications for physical illnesses.Too many drs claim “M E and Fibro are exactly the same,” “M E and Fibro occur simultaneously,” “M E and Fibro are mental ailments.”
    Those claims are wrong, patient-dangerous, and generally useless.

    True, depression can come along with both Fibro and M E. My gosh, who in our situations wouldn’t be depressed?

    Downside to SSRIs, SNRIs, even the old-school TCAs is that they can burn out as many brain cells as do the diseases Fibro and M E.
    Sometimes the braincell burn-out caused by psych meds such as your Pamelor is WORSE than that caused by the d’d (M E/ Fibro shorthand for D****d Disease).

    Quite often M E/Fibro patients become even more seriously depressed because of the use of the anti-depressants. I cannot find, and I’ve searched long and hard,honest records as to how many M E/Fibro patients who chose suicide rather than try to go on with these d’ds and the quacks who think that running to Big Pharma for advice as to what to do for or to the patient with either illness is a good idea.

    Of course BP tells drs to prescribe junkmeds that do nothing, make us worse, or cause some of the most amazing adverse effects the medical community at large has ever seen.

    Now. Having said all that, there are several online message boards regarding M E/Fibro. One fairly good one is at http://www.prohealth.com.
    Heads-up: ProHealth likes to tout vitamins and supplements priced vastly higher than at other sites.
    If you need vitamins and supplements I suggest you go to http://www.puritan.com. Puritan has very good sales quite often. Being able to buy one bottle of something and get two more of the same…for FREE…is wonderful for those of us who survive somehow on Social Security Disability (SSA) pittance.

    No, I do not work for Puritan. I cannot work due to being so ill. I have no stock in the company, no vested interest, nothing. I’m just passing along what I feel is good info.

    The FDA has recently approved a drug to be prescribed to
    M E/Fibro patients. The drug is called Lyrica.
    It is made by Pfizer, and was invented to hopefully treat people who have epilepsy, diabetes, herpes that present as shingles.
    Pfizer struck out with Lyrica’s not too bright relative, Neurontin which was supposed to be effective against our pain and suffering. Newsflash: Neurontin might as well be water for all the good it does.

    Please don’t buy the claim that anti-depressants work for pain such as what comes along with M E and Fibro. It’s a lie.

    Lyrica, according to what I read at ProHealth, works in a very small way for a tiny number of M E/Fibro patients.

    Here’s what it does to most people:
    It impacts blood sugar levels. People with hypoglycemia should not go anywhere near it for that very reason.

    Lyrica also causes weight gain. One doctor stepped out boldly and claimed “Oh, it’s not the Lyrica. People who take it just eat more and don’t remember it.”
    I’m very glad that doctor is not mine and I suppose he should be grateful I’m not one of his patients.
    Trust me, when I eat I know it. For one thing there’s that growing stack of dishes in the sink!
    Lyrica can cause dizziness to the point that the patient must baby-crawl on the floor as compared to walking upright, in order to not go into whirling head sensations and crashing to the floor, possibly to break bones.
    Drs seem not to care about the effects of the C*** meds they issue prescriptions for.That’s because of a dr-denied thing called Kickbacks.

    I wish you the best of luck in finding a Fibromyalgia-literate doctor where you live.
    Back to ProHealth for a moment. On the PH message board exists a thing called the “Good Doctor List.”

    Downside: often drs SELF-REFER to get onto the list, whether they know anything about M E/Fibro or not. It’s all about the $$$$$.

    Posting the name(s) of Not Good Doctors to PH is not permitted. So finding one who knows anything about what ails us, one who cares about our ever-declining health and capabilities, is nothing but a crap-shoot.
    This is unconscionable. We are ill. We need help. We have to slog through myriads listings of doctors, possibly find one or two who might fit our needs, we have to interview them to find out if they really know squat about what our problems are…and the very nature of the diseases that we have makes all that effort next to, if not totally, impossible.

    Oh, and don’t go to the trouble of contacting CDC Atlanta. All CDC does is shuffle the words of its’ Mission Statement regarding Us and What Is Wrong With Us each few years.
    CDC allowed the theft of monies supposedly earmarked for research into the d’ds.
    Just about all that CDC is doing presently, despite its’ protestations to the contrary, is trying to whip up interest in changing the prior name of CFS to M E.

    CDC claims the rotten mess must have a Proper Name before it can be investigated and treated, no matter how poor that treatment is.
    I’m just glad Dr Jonas Salk didn’t quibble about such things when he was working on a cure for polio.

    Call the d’ds I Don’t Know What’s Wrong With You, call it anything. Just get off chairs, CDC, and DO something for us.

    Saundra, I again wish you very good luck in your doctor-search.

    Lea Schorr.

    • 8 Lea Schorr March 6, 2012 at 3:40 pm

      update to my August 17 2008 post.
      Still with Dr Wonderful a k a “Let’s go waaaay off-label and see what happens to the patient THEN.”
      So dear dr did prescribe more junkmeds that (yes, you got it already) were never formulated for Myalgic Encephalomyelitis and the Fibromyalgia he flippantly told me I have despite the fact he never did Thing One to diagnose me as having the latter monster.

      He lied about knowing what to do for ME/F patients. Still clings to the Let’s order just any old thing, I don’t care if his/her insurance covers any of the cost of whatever med, I’ll order it up for her (me) and, if she shows up for a follow-up appointment a month from now telling me that the effects of the med I ordered hurt her more than the original issue, I’ll do my usual and roll my eyes at her, tell her she is SO frustrating to treat, smirk, toss in still more eye-rolling, and ridicule her because facets of the M E (myalgic encephalomyelitis) make it so that she reacts oddly to the meds I order for her.

      Fact: this body I’ve been stuck in for 64 years has constant pain. Pain ranges from “merely” intolerable on so-called Good Days to downright intractable pain on Very Bad Days.
      But doctor absolutely knows if I would just shut up and accept meds that are not made for the damned disease I would instantly become All Better.

      The H*** I will! His c***meds hurt me much more than they help because the purported doctor gives me junk that is NOT made for any problem I have to deal with.
      What the heck, he doesn’t have to cope with the adverse effects he doesn’t know about because he doesn’t do anything beyond blindly accepting the BS from Big Pharma about “Oh just give her this; you won’t have to see her again for another month which is when the next appointment will be set up.”
      So recently Dear Boy decided that what I need is, first, Prevacid, then Prilosec, leading me into using Relafen.

      NEWSFLASH: Same as I don’t have epilepsy so do not need his D****d Lyrica….oh, and at most recent appt he lied about what I told him of the actions and inactions of his WonderPill called Lyrica…he claims I said “Waaah, I used only two or three days’ worth of the med and I HAD to quit using it because it made me feel funny.”
      Wow that is so far from what I actually told him of the effects of his wonderful-in-HIS-mind Lyrica that I cannot even explain how far away from the truth his spouted words are.

      Lyrica. Well, I’ll tell you: If people who really do have epilepsy are given that C***, it’s likely they will die because of the effects. Some of the effects are: adult onset diabetes, incredibly large weight gain doctor then can have the joy of yelling at his patient about…he actually said “Oh you are just eating more and forgetting. You KNOW that one of the symptoms of both M E and F is memory issues so there you are…you ate, you forgot that you did that, and now you are lying about having done it.”
      Same old BS, in short.

      Oh how I wish I could replace the jerk. Unfortunately he is the last doctor in marginally-decent travel distance (because I’m sick and travelling hours each way to a dr appt at which the dr will do NOTHING is very awful for me and everyone else who has either or both of the rotten diseases) who accepts the “insurance” of MediCare/MedicAid here in Lake County CA where I’ve lived since 1981.
      I don’t want to go on like this. I’ve told Dr Wonderful that fact. He responded as usual with the ^*)_++&%%$$() eye rolling, smirking, ridicule…and denied he was doing any of those things. How can he deny doing what I say here he did, when I had a friend accompany me into the cubbyhole “dr” calls his office and she saw and heard all he did in the two and one half minutes I got of his precious time.

      No wonder so many of us with M E/F or both resort to suicide. Drs don’t understand this mess and don’t care to learn anything. They become angry and show that very clearly when patient dares to check up on anything dr wants them to use; SOMEone has to do the checking because Dear Dr will not do it.

  7. 9 Cindy November 12, 2008 at 8:21 am

    The Medicaid system is broken. I work for a specialist in Florida. It may seem a “shame” that healthcare is denied for money, as one poster put it, but it’s reality. We went from a two doctor, five staff office to just me and the doctor, that’s it. We can’t whittle it down anymore. We don’t have money to pay our answering service, and both of us are behind on our payroll checks. We can’t give anymore.

    The government needs to step in and work out a realistic payment system for Medicaid. $13 for a hospital visit is just not enough to cover our expenses. It is not fair that the doctor’s must carry the financial burden of the state, so many doctor’s refuse Medicaid.

  8. 10 Sharon July 23, 2009 at 9:14 am

    I have found even doctors who are supposed to take medicaid, often shuffle their patients to “welfare” hospitals that are mandated to accept patients on medicaid – and provide substandard care.

    I have a hospital that takes Kansas medicaid less than 2 miles from my house. While they saw me for the appointment (possible cervical cancer), I was referred to KUMC to a “specialist.” The specialist was rough, rude, and made me uncomfortable. Have pain for 2 days after a PAP smear was something I had never experienced. I refused to go back. The doctor close to me told me that if surgery were needed, I would HAVE to go back to this “specialist.” They went to school together, and she seemed abit defensive that I was questioning her friend’s bedside manner.

    While the doctor close to me is on medicaid’s list, and, according to her qualifications, she has performed numerous hysterectomies, and is more than qualified, she does not seem to want to treat me. Obviously, she can do 4-5 medicaid surgeries for the cost of one private health insurance surgery.

    After living in Canada previously, I am waiting to move back. While Canada has medical problems as well in some cases, these problems do not even touch the severe issues we have here in America.

  9. 11 Thomas Rogers June 8, 2010 at 9:47 pm

    Granted they system is not working well for the Doctors. They do need to be paid; but what about he person who needs the treatment. Are they just supposed to go without the diagnoses or treatment. There has to be someway for hem to get treatment at a timely and reasonable manner.

  10. 12 the poor September 29, 2010 at 4:52 am

    Treating the poor fairly…

    Selling out of the Poor? What would Elmo say?

    Full Name: Wayne Berman Title: Vice-Chair; Finance Co-Chair; Adviser
    Over the course of three years, Berman’s lobbying firm was paid $660,000 to lobby on behalf of UnitedHealth subsidiary Americhoice, a managed care HMO providing health insurance to Medicaid, Medicare, and SCHIP recipients. Specifically, according to the lobbying report, they lobbied on Medicaid issues in the Deficit Reduction Act of 2005.[Americhoice Lobbying Reports 2004 – 2007; Americhoice.com ] Berman Also Lobbied For “Absurdly Low” Rates for Medicaid Managed Care Companies to Pay Out of Network Hospitals. Also included in the DRA, and mentioned as a lobbying issue on Berman’s Americhoice lobbying report, was a provision setting rates managed care companies must pay to out-of-network providers — mainly hospital emergency rooms — for care received by Medicaid beneficiaries. Rather than forcing managed care companies to reimburse out-of-network hospitals an amount comparable to network providers, the legislation set the default amount to the state’s “fee-for-service rate,” which often is “absurdly low.” The provision thereby shifted financial responsibility for services to Medicaid beneficiaries from the managed care companies to the hospitals themselves, permitting managed care companies to rake in huge profits, while hospitals incurred added losses.[Modern Healthcare, 1/29/07; Text of S. 1932] To Save Money, Bill Cut Services to Medicaid Beneficiaries, But Left Managed Care Providers Untouched. Under the final budget package, substantial Medicaid spending cuts were achieved by imposing new premiums and increased co-payments on Medicaid beneficiaries; some costs were also shifted to the states, who in return were awarded new powers to drop coverage or reduce benefits to certain beneficiaries. In a letter to Senate Majority Leader Bill Frist, the AARP CEO decried the final bill, saying it “protects the pharmaceutical industry, the managed-care industry and other providers at the expense of low-income Medicaid beneficiaries.”[Inside CMS, 12/29/05; Los Angeles Times, 12/22/05; World Markets Analysis, 12/21/05; The Hill, 12/20/05]

    The Players and whats up for grabs. Profits United Health Group 2010 $4.293 billion
    Here are some other 2010 budget numbers: Wonder what it cost CMS ( Can’t Manage Sxxx) to operate each year.$453 billion Medicare///$290 billion Medicaid ///$78.7 billion Department of Health and Human Services/// UnitedHealth Group Awarded TRICARE Managed Care Support Contract … Jul 13, 2009 … UnitedHealth Group Awarded TRICARE Managed Care Support Contract for more than $20.3 billion. BILLIONS awarded and still to be awarded United’s AmeriChoice unit is the largest government contractor administering state Medicaid programs for the poor and federally sponsored plans for children. AmeriChoice’s revenue rose 34% last year, to $6 billion. United Health Group and its subsidiarys must be exhausted from signing Corporate Integrity agreements each and every year and as reward for their violations well what happens? they are awarded more contracts and more money and maybe even an ambassadorship here and there and if anybody should question what the heck is going on, then send them a Elmo doll.(Americhoice sponsors Sesame Street) Up side, Billions to be made, down side pay some fines (cost of doing business) move on and nobody goes to jail or gets excluded from the game. Get up the next day put on your Elmo costume and its back to work as usual. WOW, even in the Casino world or Mob world this would be a no no, suprised Hollywood has not done a movie on this or maybe even great TV.
    The Government created this monster and now they don’t know what to do about it, like shooting yourself in your own foot etc.Tons of money to advance their national growth, its market positions, tons of money for political donations, tons of money to send 75 millon back to its home office from New York state alone, tons of money to suppot National TV shows, tons of money to pay hugh State fines, tons of money to hire the very best law firms, tons of money to pay for bribes and kickbacks, tons of money for hugh salarys and bonuses, all done on the back of the American taxpayor, you see this company receives all its money from the Federal State governments. Should your tax dollars it be held to a higher standard? Should the government agencys responsible for there review be held to that same standard? Should the IRS audit their corruption? Why has this company not been charged? How long can the buck be passed here in more ways then one?

  11. 13 Taylor October 30, 2010 at 3:08 am

    this is a huge problem – even for pregnant women on Medicaid. In Texas, I received NO prenatal care because no doctors would take medicaid. I called every single doctor – even calling to Austin (6 hours away) and was told, “No, No, No – Medicaid doesn’t pay. Sorry.”

  12. 14 Beverly January 28, 2011 at 4:59 pm

    I know this is an old post I’m replying to, but the cuts continue on in 2011. My husband was just recently informed by his doctor of 25 years that he will no longer be able to take Medicaid patients. I know my husband won’t take this well; he not only has numerous physical issues, but mental ones too. I dread telling him. He will probably be able to find another doctor, but not one like his old friend. I feel like crying.

    The poor are always kicked to the curb during a recession.

  13. 15 yolanda May 10, 2011 at 12:05 pm

    im a 40 year old mother of three who possible could have lupus the doctor is not sure so he gave me a referal to see a rheumatologist every were ive called has turned me down because of my medicaid insurance i think thats realy sad you have insurance but can,t use it what do i have to do to get herd kick the bucket i know it no laughing matter but when you on low-income and black know one seems to care

  14. 16 rsmith September 10, 2011 at 9:31 am

    I was in an automobile accident. I went to the hospital where they did a ct scan. It was negative for any serious fractures. I was told I have whiplash and to follow up with my doctor. Problem is I don’t have a doctor. I have Medicaid(Molina) and I have not been able to find a doctor that is either accepting new patients or are not accepting any more medicaid patients. I am in severe pain.The only way I can move is if I take my pain medicine. Then I’m loopy. I called a few more doctor’s and they were accepting new patients but told me that they were not accepting automobile accident victims??? I’m afraid my condition is going to get worse because I am not being seen by anyone. I can’t believe this is happening.

    • 17 Lea Schorr March 7, 2012 at 11:25 am

      rsmith, did you EVER get a MedicAid-accepting dr to see you? It’s ridic that we who survive somehow on SSI/SSA and no other so-called ‘insurance’ have to beg on bended knees (IF we can still bend our knees, that is) for the ubiquitous Dr Wonderful to let the beyatch at her waiting room desk stuff 3 appointments into each 15 minute segment of time that the office is not locked tightly.

      That ‘three appts in each 15 minutes’ thing implies that each person will get 5 whole minutes of Dear Dr’s time.
      It does not work out that way.
      Some patients cannot make decisions regarding “Write the top three most urgent-to-you health issues on a note pad,” and talk with doctor about those things and ONLY those things.

      See, some people who are not in dr’s office just to get drugs of some sort or other. They actually have problems such as what you describe in your post. I’m so sorry for you and all others who have to deal with maltreatment such as that…and the ‘all others’ does include myself.

      Would I change doctors in hopes of getting one who knows anything at all about what I need him/her to know? In a heartbeat.
      Are there any MediCare/MedicAid-accepting doctors opening office doors wide for we who have only Medi/Medi as ‘insurance?’ Not here where I live.

      It’s horrible that all across this country doctors are opening that door alright…but they are opening the door in order to shove the patient back outside. “Go find another doctor,” or “You know, you have the right to go somewhere else and get another doctor if you do not like the treatment course(s) I am suggesting for you.”

      Right. Out of which giant and invisible pool of doctors are we supposed to select one or more to set up an “interview-the-doctor” appointment. During that appointment, basically nothing gets done FOR the patient but if patient asks the right questions such as “Do you know what to do for __________?,” fill in the blank, patient might learn whether or not Dr A or B or C is The One To Choose.

      Key word there is “might.” As in Fat Chance. I still feel it’s a crime or nearly so that doctors asked MediCare for more money per each seen patient and, when MediCare honchos roared back “NO!!,” drs then decided to cut back on the numbers of Medi/Medi-insured patients.

      What the bleep are we supposed to do now? Damfino. But I continue to wish you and all the rest of us the best of luck in the decent doctor search.

      • 18 Lea Schorr March 7, 2012 at 11:35 am

        OOPS, Made a glaring mistake in paragraph three of the post I hope gets accepted by the moderators I now see (by way of the advisory “Your comment is awaiting moderation) have to slog through all posts and decide whether Post number whatever makes the cut.

        I said: See, some people who are not in dr’s office just to get drugs of some sort or other.

        I meant: See, some people are not in dr’s office…and etc.

        Please excuse my ME/FMS-fogged mind. I’m sorry. That brain fog is just one of the less charming facets of the albatross multi-multi-thousands of people the world around deal with every day.
        Are drs trying to help us? Well they say they want to help us. But they go right on as usual, contacting Big Pharma to find out what to do to the patient this time.

        What’s really a scary thing is how doctors resent it when patients look up what doctor wants to inflict on the patient … well, SOMEone has to pay attention to what might happen to the patient as a reaction to the junkmeds proclaimed by FDA/Big Pharma/Medi-Medi to be Just The Thing for patients 1 through 100 or however many people get funnelled into and out of dr office.

        Again, rsmith, I wish you the very best of good luck!

  15. 19 Sharon January 5, 2012 at 7:25 pm

    Government does indeed need do something ! Although, requiring doctors or dentist to see medicare or medicaid patients is not the answer. 1. step up the amount and pay our educated doctors and dentist a fair price 2. If medicare or medicaid patients dont show for 3 or more appointments, they loose it for so much time 3. drug test patients 4. Investigate that they truly meet requirements to even receive it I have worked in the medical field and doctors can only do so much , so if due to poverty, accident or disablity and the government decides to help people out temporarily or permanently its a team effort but medical professionals can’t always except medicaire or medicaid if there expenses out way the payment received . They will eventually shut down and there will still not be doctors, so start with contacting your local officials and state officials etc!

  16. 20 Chronically Lymie October 24, 2012 at 6:49 pm

    Is an old article, but I am wondering if anyone is experiencing what I suspect is the new medicare/medical assistance game…where the doctor will see you, and despite being very ill if it is not life threatening at that moment, tells you do not have an issue in whatever their specialty is? Effectively doing nothing but still getting paid?

    And,does anyone know whether one can tell medicare/medical assistance not to pay those claims?

    Thanks.

  17. 21 Dr Art Aspen December 11, 2013 at 6:37 pm

    I am a family doctor. The practice I am at DOES take Medicaid, but only because it is a county owned practice. The practice loses roughly 1 million dollars per year. The only way it can stay afloat is through the county supporting it. So the bottom line..IT IS NOT FEASIBLE FOR A PRIVATE PRACTICE DOCTOR TO SEE THESE PATIENTS. THEY DO NOT PAY ENOUGH.

    There is more to the story as well. I am going to throw out some stereotypes. Certainly, they do not apply to everyone, but more often than not:
    1. They usually have many more problems making them take more time (I get 15 minutes per appt).
    2. They are typically less compliant and smoke more than my private insurance payment. Few exercise.
    3. They flood the office with often frivolous complaints because they have to pay little to no copay.
    4. They are more likely to be pain medicine seekers/abusers.
    5. They are usually less pleasant (often rude, telling me I have to treat them).
    6. Bottom line: They are high maintenance, force us to operate at a loss, and suck the life out of me.

    Yes. I have a few Medicaid patients that I love who understand. They usually come in with “one” complaint (they make an appt for each one realizing I have 15 minutes). They know I don’t do pain medicine unless it is something acute (chronic pain goes to pain medicine), and don’t constantly badger me to give them pain medicine. They are compliant with their regimens and try to do things to improve their health. And finally, they are appreciative, knowing they are a drain on our profitability.

    So, if you are a Medicaid patient that feels snubbed, pay attention to this last paragraph. Most doctors do like to help those who need it. What we don’t like is “HAVING” to have unpleasant interactions from people who actually cost us money to see.

    If you don’t like it, you need to complain to the government. They are to blame as they are the ones paying so little for your care. Stop complaining about the doctors. Would you pay money to actually DO work? I don’t know of very many other professions who do this every day. Most docs do mission work on an annual basis and we frequently do charitable exams at schools and free clinics. When was the last time you spent days doing volunteer/free work?

  18. 22 Mr Becker December 25, 2013 at 10:34 pm

    Yeah medical system need many changes to improve.

  19. 23 Dee M March 5, 2014 at 6:31 pm

    why is it when I call my clinic and Im sick they always say no appt available Im on medicaid and medicare I recently went to a clinic and was diagnosed with strept throat and still dr wont see me

  20. 24 Ben May 21, 2014 at 3:00 pm

    After Obama has cut more for the poorest Medicaid patients it is even harder for someone to find a Doctor & especially a specialist. Neurologists & Neurosurgeons are absolutely impossible to find. My wife broke her odontoid (the superman break, Dale Earnhardt) Hang mans break. She’s not paralyzed-she’s truly a miracle! She’s been searching for 2 years constantly. Can’t find a DR. she’s slowly getting worse, it’s like she’s slowly going paralyzed at times. The car wreck was 5 years ago. She was 22 & she’s 27 now. She didn’t want to get put on Disability because she wanted to go to school & make something of her life. In the last 2 years her health has become very bad. She’s gone so far down hill. She now has levoscoliosis, kyphosis, arthritis, bulging discs in her neck & back. Has serious fluid in her adontoid area. She also has TMJ, chest pain, arm & leg numbness & tingling, nerve damage, migraines & numerous other very serious problems. After Obama recently had many Medicaid cutbacks, there are way to many people not getting the help they need. She is now FORCED to sign up for disability. She will 100% get it because she has so many problems of which I did not even list. We have both been calling for help for years now. Would the smarter thing have been to help her so she would not have gotten worse? Now she will not be going to college, working, etc. Now she will have to be disabled & will cost the government much more than if they would have helped her. It will possibly be 5 years of back pay-just that alone would have been 10 times+ enough to send her to a neurosurgeon or even a neurologist would have been a great help. Now for however long she lives, she will most probably get it. She’s 27, so she could get it for many years. I’m sure most everyone would agree that it would have cost so much less for her to go. On top of that now she won’t be able to work, so it’s not only money the Government will have to pay, but it’s the lost earnings she would have had over her lifetime. SO there will be many more cases where the Gov. will be losing a worker & having to pay for someone disabled-A DOUBLE WHAMMY. There should be certain circumstances where Medicaid will help pay for someone who will be disabled & could have been prevented. I am wheelchair bound & disabled. I get 720.00 a month for a family of four! This is our only income. I am unable to get my drivers license, so work will be hard to find. She’s bedridden & unable to do much at all.
    Is there anyone who can help us? Is there any way to get a Doctor or Medicaid to help her?

    Does anyone know a Neurologist or Neurosurgeon in Louisiana

    Does anyone know a Neurologist or Neurosurgeon in Mississippi?

  21. 25 Ben May 21, 2014 at 3:28 pm

    Oh yes, 8 million people signed up for Obama care. Our leaders did not even read the bill. It is thicker than the potter harry series books. They don’t even know what they signed! Now there are hundreds of millions having serious trouble with their existing insurance. It has done nothing but disrupt millions & their pre existing insurance companies are doing less & covering less, yet they have jacked the price up tremendously.

    My dad is 65 & he said he pays insurance through his employer. He said his insurance tripled in price, going from 200 a month to close to 600 a month. He said he has to work almost 2 weeks just to pay for his insurance & gas to work-He’s less than 20 miles from his job site. He gets taxed tremendously & then he has to pay thousands at the end of the year. He makes 11.00 an hour!!!!!! He is 100% in the poorer bracket, possibly the lowest middle class. He says he works 2 weeks just to pay for his car & health insurance. I saw a paycheck & it was not even 280.00 after taxes!!!
    With gas costing 4 a gallon, milk at 5-8 a gallon, bread is 4 a loaf, a dozen eggs is 3 plus. Lunch meet is 5-12 a pound. How can the middle class of America make it? How will they continue to make it? Prices of everything has & is only going to get worse. Will America be working 4-40′s just to be able to eat? How many will have to drive that old car because they can no longer afford the insurance, much less the 3-1800 dollar monthly house, car, truck, boat, RV, 4 wheeler notes? I have a friend who (10 years ago-before all the chaos) was reusing Ziploc bags & eating road kill. He would turn every light out so he could have a 40 a month light bill! But he had a brand new car & house. Paying 1200 plus a month on only those 2 items. He made 10 an hour???? How can they do that? I hope he did not go bankrupt or has starved to death!
    How many people are tens of thousands in debt? How many people can’t even afford their existing notes? How can they afford to pay hundreds on health insurance? What if they are 25 or younger & have wonderful health? Many people don’t have to have insurance when they’re 18.


  1. 1 Will Americans be satisfied with the quality of health care.............. - Politics and Other Controversies - Democrats, Republicans, Libertarians, Conservatives, Liberals, Third Parties, Left-Wing, Right-Wing, Congress, President - Page 13 - City-Data F Trackback on December 27, 2009 at 6:48 pm
  2. 2 Will Americans be satisfied with the quality of health care.............. - Politics and Other Controversies - Democrats, Republicans, Libertarians, Conservatives, Liberals, Third Parties, Left-Wing, Right-Wing, Congress, President - Page 14 - City-Data F Trackback on December 27, 2009 at 6:56 pm
  3. 3 The Medicaid Bait and Switch | www.statehousecall.org Trackback on December 31, 2009 at 8:11 am

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