Wednesday, February 24, 2016


Fool me once . . .


I HAVE "GEEZER" INSURANCE, a Medicare Advantage plan. The company making money off the government is AvMed and the plan is AvMed's Medicare Choice plan.

Normally, AvMed is "pretty good." It is head and shoulders above a plan I had with a different Medicare Advantage plan provider.

But AvMed seems to have a continuing problem.

Some of the practitioners listed in its thick AvMed Medicare Choice Provider Directory don't accept AvMed Medicare Choice members.

But they're listed in The Book.

Image from NEWSOM EYE

THERE ARE MANY MEDICARE ADVANTAGE plans available in my geographic area. The reasons there are so many mainly are two:

  1. The area has thousands of people eligible for Medicare and Medicare Advantage programs
  2. The plans get far more federal (taxpayer) money than the roughly $104/month most Medicare clients pay to the government (on top of what we already paid over the years).

The more the plans pay out, the more they get from Washington.

Last year I had the cataract in my right eye "fixed." The process, from initial visit to post-op check was "OK." Nothing to write home about.

The primary complaint was that I had to travel a fair distance to the doctor's facility and my spouse had to take me to the surgery center even farther than the doctor's office. She is not a confident driver and because the equipment in the surgery center failed (fortunately before anyone was "under the knife"), we had to make several trips.

This year I was looking for a surgeon to "fix" my left eye, long overdue for surgery.

I checked the WWW for ophthalmologists in my neck o' the woods. I came up with several likely prospects and did what due diligence I could, checking their resumes and patient comments on line.

With the selection narrowed, I checked my AvMed Medicare Choice Providers' Directory.

I asked my Primary Care Physician (PCP) to give me a referral to the doctor at the top of my list. He did and I hied myself off to collect the New Patient paperwork and to set an appointment.

    Why can't they put these forms on line. Fill-in-the-blanks PDF would be great,


One of this surgeon's New Patient documents amounted to a model release, stating that I would permit the doctor to use my image in his MARKETING materials. Chutzpah!

Now I think I'm cute, but I'm not inclined to allow my continence to shine on anyone's marketing material. The catch was, unless I consented to be used for marketing purposes, the surgeon would not accept me as a patient.

When I reported this to my PCP's office the reaction was "Unheard of!"

Back to the search.

At this point I had some alternative practitioners lined up. I selected one and, via several email exchanges, determined that "Doctor G" was my surgeon of choice - or perhaps "surgeon du jour."

I made the trek out to her office in an area that not so long ago was a cow pasture. I asked the receptionist to let me see the New Patient forms and I explained why I made the request.

After satisfying myself that the New Patient forms were pretty standard, I was giving my insurance information when -STOP! We don't accept AvMed Medicare Choice.

"But you're in the AvMed book," I said.

This was no surprise to her; I apparently was not the first AvMed Medicare Choice plan member to stroll into the office.

When I returned to my home office I composed a long email to AvMed that I expect will be answered later rather than sooner. (AvMed DOES respond, albeit sometimes slowly.)


I had sent a snail mail missive to a third surgeon's office asking four or five questions and requesting an email response.

I got the email response.

It asked me to call to discuss my concerns.

If I had wanted to call, I would have called.

I don't enjoy playing telephone tag and I don't enjoy having to repeat myself due to a poor connection.

Besides I had   c a r e f u l l y   spelled out the questions I wanted answered.

I responded with an email by repeating my questions and adding one more: Does the doctor have a contract with AvMed's Medicare Choice program?

I learned my lesson.

The only questions now are:

  1. Will AvMed respond to my email?
  2. Will the doctor's office reply to my email?

High hopes.

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