Looking for better treatment
 

I am going to be kind and just say that I am very disappointed with TVHS.. My current Doctor (for some reason... money?) refuses to see me regarding an ailment that the Practical Nurse says could be "Serious". I have been ill now for almost two months. Getting the required imaging is taking a month. I know the "Snowbirds are here but I live here year round. Shouldn't that account for something?

Anyway, can anyone, please, recommend a Doctor that is responsive, please!

You should try looking to see IF there are any doctors in the area that will accept your advantage plan, you appear to be experiencing one of the problems with managed care programs. If (big if) you have not been in the advantage plan for a year you MIGHT be able to get back to traditional Medicare and then you will have a much wider choice of doctors.
I hope this works out for you.

Please specify what you mean by TVHS. I am enrolled in The Villages Health System (the official system owned / operated by the developer). In my experience there is no way your scenario would happen there.

I have no idea what a practical nurse might be. Maybe you mean nurse practitioner certainly not an LPN. But might be serious is a long way from is likely to be serious. No doctor who likes keeping their medical license will refuse to see an established patient. That is abandonment and is taken very seriously by medical boards and trial attorneys.

If you are in the Villages Health System, they are not paid by you or per patient seen so it is not money. There are lots of places besides Lake Medical Imaging that can do Xrays and scans. They are going to get you in sooner. Lake Medical does not do stat MRIs no matter what the nurse ordered.

A headache can be just a headache or a brain tumor. See what I mean by "might be serious" A good history and good exam often guides the intensity of the evaluation. The nurse practitioners have far less training than MDs and DOs and within the Villages system they certainly discuss their cases with their supervising physicians.

If you want to communicate with your doctor, who you claim refuses to see you, send a portal message to the doctor asking what is the next step. What you might learn is that the next step is to wait until it is your turn to be imaged then to come back and be seen with that information now available.

If you're on TVHS, you're on a Medical Advantage Plan ... which means you don't have control of your healthcare, your provider does. You're on a "managed plan", which is exactly what it sounds like ... they manage, you suffer.

Medicare Advantage Plans are paid a fixed amount by the Medicare program and they have to services their clientele with that amount of money, less the "freebies" they give out, to get people to sign on. There's currently an open enrollment period (until 3/31) when you can switch out of an Advantage Plan. Unfortunately, if you switch out in Florida, you're not guaranteed coverage or pricing.

Medicare Advantage plans are popular, but some seniors feel trapped when ill : Shots - Health News : NPR

2023 51% of all seniors are on an Advantage plan. That's a lot of suffering ! Apparently misery likes company - lots of it !

Mrs Bogie and I have been on the managed plan for15 years…..neither of us has suffered!

I know. It's unfortunate that Medicare didn't turn out like it was designed and so many Americans are stuck buying Advantage plans, because they can't afford Medicare & Supplemental insurance. It's a national tragedy.

We have been on an Advantage plan since we moved here four years ago and happy with it. When we need specialist dr has no problem referring us to one either in their group or outside it.

Note to self - Notice how this went from what doctor do you recommend to Medicare plus supplement Vs Advantage plans in a heartbeat ?

No.

It went from "my medical provider/insurance company" won't schedule an appointment with a specialist I need ... to ... "here's why that's likely happened".

Show me ! I can't find "that quote "!

There you go.

I'm not the brightest bulb on the tree but please direct me to the quote "my medical provider/insurance company" Interpretation is vastly different from quotation.

Not everyone using TVHS is on Medicare Advantage. I have FloridaBlue, from the marketplace. Not managed care at all, it's a PPO and I have no problem with TVHS at all. I might change my mind in 3 years when I'm eligible for Medicare but right now I'm happy with my doctors and my medical care at TVHS.

Yet.

I thought ACA was supposed to fix that? I guess they didn’t read it did they?

As a retired ER/ICU RN, paramedic supervisor, and county coroner let me just state that almost all LPN's know just enough to be dangerous. Note that you also quoted her/him as saying "could be". Yes, pretty much every ache, pain, dizzy spell, upset stomach, heartburn, etc "could be" signs of something more serious but Doctors train for 12 years and they might know a thing or two that a LPN somehow missed in their brief 12 months of training or if fast tracked, in only 6-9 months. A Practical Nurse (or anyone other than another doctor who has also assessed the patient) should never offer a patient their opinion or even worse, contradict a doctor's working diagnosis. It's a good way to end up unemployed. Know your place. There is an established hierarchy in every health care system and woe be to those who talk out of turn.

I do not know if this is correct, but I go to the emergency room when this happens. They always see me and I do not have to pay a dime. When one medical professional tells me I am dying and another tells me to wait my turn, I take matters into my own hands.

My wife was told by a doctor that she may have cancer. I took her to the emergency room. It ended up being a bladder infection. That was 35 years ago. Not a single doctor has told her she has cancer since. She remains healthy as a horse. True story.

Options
 

I needed an MRI and called Shands and 3 days later it was done. My wife needed an MRI called Lake Imaging and was told there would be a 3 week wait. She called Rayus and got it done the next day. My neighbor needed a CAT scan and was told 2 weeks by Lake. I mentioned my wife's experiance and he called Rayus and got in the same day. Lake Imaging is convenient but there are other options. Rayus has offices throughout the US.

We are both on the advantage plan with TVHS. Nothing but great care. There has to be more to the original story.

Apparently you didn't read the ACA. It is a law to provide care and establish minimum levels of coverage for private, not governmental, health plans. You know the ones you or your employer buy. It forced insurance to cover women, ignore pre-existing conditions, cover mammograms and colonoscopies, cover your children to age 26, the list goes on.

But it did not change Medicare, or supplements. Now if you think that supplements are too expensive, guess how much the government controls that cost. Zero. They are sold by the private insurance industry and are not part of Medicare.

Now the ACA did impact Medicare Advantage plans cutting the payment to them as they were making too much of a profit and a few other tweaks including lowering the cost of the "donut hole" for seniors and some adjustments in Medicare taxes for high earners.

I have Medicare Advantage so there is no need to buy a supplemental policy or dental and vision insurance.

For those of you that have traditional Medicare and medigap, what does a medigap policy cost??

And if you have dental or vision, how much is that?

I have Medicare Supplemental in MA, which is different than most states, as it doesn't allow Insurers to sell their "low cost - low coverage" policies. My Supplemental costs about $115/month.

Here are the various levels of Supplementals you can get. Not all are available in all states.

Compare Medigap Plan Benefits | Medicare

I went online and found this tool. Medicare is very complicated. There are a lot of different plans but it appears that the monthly price ranges from $68 a month to $369 a month. This is in addition to your part B premium.

Find a Medicare plan

The plan you select, should be dependent on your anticipated needs in the coming year. Once you're on a program, you can always change it (upgrade). The worst that can happen, is you're behind for 9 months or so, until the next enrollment cycle, when you can change (upgrade) plans (at least that's how it's been explained to me).

Hmmm
 

You must be lucky or very healthy. Thank you for your post

Thank you
 

Thank you for your thoughts!

Not all advantage plans are the same, some are PPO/open plans. But, my understanding is that TVHS' plan is not.

Thanks
 

Thank you!

I wish I was very healthy. I speak from experience with "The Villages Health" from their inception. I also have observed many newbies refer to "TVHS" as to any health facility / service within the bubble. TVH is the health network in TV owned and operated by the developer. There are hundreds of other facilities within TV that have to affiliation to the TVH system. Again my experience with TVH is no way would your doctor refuse to see you unless there is more to the story. TVH has a network available for their patients to call 24/7. They answer the phone immediately. They also have a patient portal which I usually get a response back within one hour or less.The majority of the time they ask if you can come in by the end of the day. You may have to see your primary doctor's nurse practitioner under that circumstance but that has worked well for me. I have liked every nurse practitioner my primary has had in the last 11 years.

So you did not answer my question. What do you mean by TVHS ?

Does this "practical nurse" work for your doctor? If so, the nurse is SUPERVISED by your doctor and is privy to the same information that the nurse is. Seems that a lot of primary care physicians have two or more APRNs working for them who see the patients on a routine basis, with the doctor seeing patients on the first visit or on subsequent visits when something serious or outside the APRN's expertise pops up. But it is the doctor who makes that call, not the patient.

Not saying that this is the case...but many of us geezers interpret every ache, pain or twinge as "something serious".

Not true. One of the plans TVH accepts is AARP Medicare Advantage Choice PPO. This is a very flexible plan with a huge out of state network.

Furthermore
 

I appreciate your interest "Sage" I have been ill for 2 mos. The Doc sent me for ultra sound which showed a potential problem. She is now sending me to get a CT. This whole process is taking a month ??? I requested an appointment with my DOC to review the results. Someone returned my call and said the DOC said for me to see her nurse. Who earlier suggested that this could be serious. I just feel that I should get the diagnosis from a Doctor. I just can't believe how indifferent the doctor is. I guess that is why VHS mandated that I sign a waiver before the doctor would even see me.

I could go on and on but really just want to get a reality check on medicine here in the Villages. Can I expect better? If so, where can I find it? Your thoughts are much appreciated. If you reply please send a private message. Thanks again

Listen to this man. He is an excellent M.D.

this has not been my experience with the villages health system. i've always had prompt replies & have not been kept waiting for an appt longer than 24hours. if they say only a nurse can see you @ the moment, do it. it's getting that 1st step completed before a dr sees you. i use Creekside & they are wonderful. if you still get no replies, drive down & speak to 1 of the reps, it will get fixed. remember to use complete communication with all staff, from the guy who takes your blood to the gal who does your bp. i hope you have better success.

We (husband and I) were enrolled with The Villages Health System until they changed the policy regarding patients 65 and over. Being skeptical of letting an insurance company manage our health care, we kept our supplemental insurance and went with a doctor outside the system.

The medical system here has changed over the years. Lake Imaging (which the doctors seem to use) went from readily available appointments to a 3-week delay in our case, likely caused by the population explosion in this area. When this happened (more than once) we simply called another imaging center (in Ocala) and went there the next day. Having Original Medicare allowed us to do this.

Having Original Medicare also allows for choosing one's physicians, but it can be a rocky path, too. GP's must juggle Medicare's rules, maintain a competent and polite office staff (different every time we go to our GP), and make enough income to maintain the practice, plus, hopefully, diagnose patients correctly, with prompt follow-up care. I remember way back when I use to go for a yearly physical it was a real hands-on workout. Now, under Medicare, it is a twice-a-year blood test, followed up by a quick 10 minute discussion with the doctor in person.

It sounds like your doctor is not seeing you, because your cat scan hasn't been done. Will your Advantage policy allow for using another imaging company? If that were so, then the doctor might see you sooner. It is tortuous waiting and not knowing.

TVHS was established on the premise that their doctors would not be burdened with an excessive patient roster, and that would allow sufficient time devoted to each patient. Has that changed?

I have the TVH AARP Medicare Advantage PPO plan and like you can go to
other imaging centers. I have frequent ultrasounds and have used three different imaging centers here in TV with no problem. I also have the imaging done in New York State with no issue. Probably different than you I have a deductible up to out of pocket amount but then again I don't have a supplemental premium.Given my health I would probably financially be better off with picking Medicare and a supplemental at 65. However like you I was in TVH health and had to go on their acceptable Advantage Plans or leave the system. We liked TVH system so much we decided to stay with them. I still do not regret that decision.We also have had no problems with being on the advantage ppo plan (we are snowbirds). We have had 100's of thousands of $'s of claims with no problem in Florida and New York State.

I have been lucky with my primary doctor. I have the same primary I started with 11 years ago. My spouse has been in the same system with me but has had her primary changed 3 times.

In states where there's medicaid expansion, it's working pretty well. Florida opted out of that though, and so Floridians have to accept the consequences.

So, you could go in and get the information that you need and perhaps a plan for care. But you are choosing not to go because you insist on seeing the doctor (who no doubt has a loaded schedule) rather than a nurse. OK. Got it.

Please make an appointment and get yourself moving forward. The nurses and especially the nurse practitioners are great. They will absolutely help you. I see my doctor once a year. For all other care, I see the nurse practitioners. I actually prefer them.