Robert LeFevre: How Medicare Advantage works

08/16/2014 12:00 AM

08/15/2014 3:42 PM

The op-ed by Dr. Amy Nguyen Howell, “Medicare Advantage: Better option for some” (Aug. 7, Page A7) was an excellent discussion of fee-for-service vs. prepaid medical care. In a well-run Medicare Advantage program, it pays to employ care managers to coordinate everything from home-going instructions, to follow-up home visits for safety and compliance with treatment programs. Pharmacists become an integral part of the team. None of these services can be billed for in the traditional fee-for-service model, thus, in general, they do not happen.

However, a very big advantage was not mentioned. In traditional fee-for-service Medicare, the fun really begins when the patient gets home. I am not talking about the patient and family trying to figure out the medical part of the equation, but the billing part. Example: a trip to the emergency department with subsequent surgery – separate bills begin to arrive by the dozens. The hospital, the ER doctors, the radiologist, the anesthesiologist and the surgeon, to name a few, bill separately. Medicare and supplemental insurance statements pile up faster than junk mail.

In my Medicare Advantage program, I pay my copay at the time of service. I get a receipt right then. That is it! Simple. Better care, cost-effective and no billing hassles. Your friendly representatives in Washington want to cut back funding for a program that works. Oh well, what else is new?

Robert LeFevre, M.D., Modesto

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