# What's the hardest part of managing your healthcare?



## csimone (Sep 18, 2020)

I've spent a long time working in healthcare. I've always been shocked by how complicated it is - even for people who understand the system.

In your opinion, what would you say is the hardest part about it? I expect to pay more for my healthcare as I age, so for me, it's the uncertainty about these costs and making sure I have enough savings.

I'm US-based but welcome responses from any nation


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## Phoenix (Sep 18, 2020)

Finding a good doctor.  The good ones have retired.  Some of the others don't seem to know what they are doing and do not even seem to care that what they do for one of my issues will make another one worse.  It's 25 miles to the closest doctor, 37 miles to some others and 60 miles to more.  Many do not accept new patients, so it's hard to switch.  I walked quietly away from my last doctor and have ten months to find another.  I sent papers to one doctor in July, and they have not gotten back to me.  I haven't pushed it at this time because the air quality has been so bad because of the fires, that I don't want to go to town where it's worse.  Plus, my husband would be sitting in the car waiting for me, and I won't do that to him in all the smoke.


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## hollydolly (Sep 18, 2020)

Phoenix said:


> Finding a good doctor.  The good ones have retired.  Some of the others don't seem to know what they are doing and do not even seem to care that what they do for one of my issues will make another one worse.  It's 25 miles to the closest doctor, 37 miles to some others and 60 miles to more.  Many do not accept new patients, so it's hard to switch.  I walked quietly away from my last doctor and have ten months to find another.  I sent papers to one doctor in July, and they have not gotten back to me.


I know you're in the USA but most of what you've written applies to the uk too unfortunately..


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## Phoenix (Sep 18, 2020)

hollydolly said:


> I know you're in the USA but most of what you've written applies to the uk too unfortunately..


I didn't realize it would be that difficult there.  I'm in a rural setting - on purpose.  So in some ways it my own fault.  The last doctor I really trusted was 30 years ago and about 150 to the north of where I live now.  He was probably 65 at the time.  He was skilled, treated a patient like they had brains and a good man.


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## Aunt Bea (Sep 18, 2020)

Finding a PCP that is comfortable with the fact that at some point I'm going to die.

I get frustrated with all of the various tests, state of the art medications, referrals, etc... that my current PCP is constantly pushing.

My only goal is to stay independent for as long as possible and then slip away as easily as possible without a lot of fuss.


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## Pecos (Sep 18, 2020)

The hardest part is keeping my sense of humor!


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## Butterfly (Sep 18, 2020)

Aunt Bea said:


> Finding a PCP that is comfortable with the fact that at some point I'm going to die.
> 
> I get frustrated with all of the various tests, state of the art medications, referrals, etc... that my current PCP is constantly pushing.
> 
> My only goal is to stay independent for as long as possible and then slip away as easily as possible without a lot of fuss.



My feelings exactly!  I flatly refuse to become one of those people who are constantly having some kind of tests for something or other which they may or may not be able to do anything about even if I had it. A prime example of this is when my mother was in the final stages of cancer which originated in her gall bladder, one of her providers brightly suggested it was time for her pap smear.  I can't post here what I said about that, but suffice it to say she was spared that indignity.

And, there are things that, at my age, I probably wouldn't do anything about anyway, except to opt for palliative care, especially after watching my young niece and the agony some of her supposed treatments caused her before she died.

As to some of those state of the art medications, some of the side effects are worse than that which they are supposed to treat.  No, thanks.


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## Rosemarie (Sep 18, 2020)

Aunt Bea said:


> Finding a PCP that is comfortable with the fact that at some point I'm going to die.
> 
> I get frustrated with all of the various tests, state of the art medications, referrals, etc... that my current PCP is constantly pushing.
> 
> My only goal is to stay independent for as long as possible and then slip away as easily as possible without a lot of fuss.


I keep saying this to my own doctor. I'm more concerned with my quality of life than the length of it.


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## Phoenix (Sep 18, 2020)

Rosemarie said:


> I keep saying this to my own doctor. I'm more concerned with my quality of life than the length of it.


I agree.  When my mom was in a nursing home I watched the other residents.  Some of their lives were being artificially extended so they could be miserable.  No thanks.  Mom actually liked her time there.  People were very loving to her and she to them.  Tending to her needs took a tole on me, but that was not the issue.  The issue was her quality of life.


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## RedSky4u (Sep 18, 2020)

I don't like being seen by a NP instead of the doctor.


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## Phoenix (Sep 18, 2020)

RedSky4u said:


> I don't like being seen by a NP instead of the doctor.


I don't like that either.


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## Judycat (Sep 18, 2020)

E-script. I've had both the doctor and the pharmacy mess up my prescription renewals. Don't find out until I drive all the way to the pharmacy. Have to call the doctor then and sometimes it's a weekend so have to wait until Monday. Then can only leave a message when I do. Have to call the pharmacy after that to see if the doc got the message and sent in my script. Drives me crazy. Thankfully now, my Part D coverage website reports when my meds have been filled. It didn't for a long time.


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## Kayelle (Sep 18, 2020)

I'm glad to say that our younger GP family Doctor does a really good job managing my health care needs, and I have several. When he wants to send me to a specialist, I always tell him to send me where he would send his own mother. That seems to work well. He could use some help in the odd personality area, but I can deal with that as I think he's smart as a whip.....more than most "whippersnappers".


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## Jules (Sep 19, 2020)

Finding a family doctor if we moved.  

The wait times to see a specialist.  They’re overloaded, especially now that they have to limit their hours for Covid-19 precautions.


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## gennie (Sep 19, 2020)

Patient quality of life will take a back seat if there is a test, procedure or shot that can be billed to Medicare.  It's about $$$


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## Butterfly (Sep 19, 2020)

gennie said:


> Patient quality of life will take a back seat if there is a test, procedure or shot that can be billed to Medicare.  It's about $$$



I strongly disagree.  Medicare reimbursement to docs and hospitals is less than they could get from other insurance  (for people without Medicare).  Medicare pays a set rate for any given thing, regardless of what the doctor or hospital bills.  The doc can bill a zillion dollars for something and Medicare will only pay what it pays.  Docs and hospitals are not getting rich off of Medicare.  Quite the reverse.


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## gennie (Sep 19, 2020)

Butterfly said:


> I strongly disagree.  Medicare reimbursement to docs and hospitals is less than they could get from other insurance  (for people without Medicare).  Medicare pays a set rate for any given thing, regardless of what the doctor or hospital bills.  The doc can bill a zillion dollars for something and Medicare will only pay what it pays.  Docs and hospitals are not getting rich off of Medicare.  Quite the reverse.



I think you misunderstood my post.  It had nothing to do with the amount doctors are paid for what they do.  It was about pushing unnecessary treatment just because Medicare would pay for it.

And I agree.  Many basic care medical practices are under-funded.


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## OneEyedDiva (Sep 19, 2020)

I guess I'm blessed. There is no hard part for me, at least not yet. I never paid for health insurance until I was on Medicare. My work coverage at first was Healthways, somehow it wound up morphing into Aetna HMO.  I have wonderful doctors, including specialists, whom I love. I don't get the obligatory 15 minutes. My PCP spends as much time with me as I need and answers all of my questions. There are no forms for me to fill out and since being on Aetna Open Access Medicare, no referrals are necessary.  My co-pays have been $10 for years...that's for office visits. All my diagnostic testing and labs are free.


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## tbeltrans (Sep 19, 2020)

I feel so grateful for the VA that I go to.  The care is excellent and not at all complicated for me to get around in.  My wife, on the other hand, must deal with the civilian hospitals and clinics.  The main problems that I see are:

1. Insurance companies rule with an iron fist, controlling everything health care professionals do from a financial viewpoint instead of a patient centered focus.  I know it is terribly frustrating for the health care professionals because I hear it from them, especially those who left the civilian side and now work for the VA.  
2. The various clinics and hospitals don't seem to communicate with each other, so there seems to be little or no coordination between them.  With the VA, medical records are intact wherever I go and it is seamless.  The one place my wife has had to go where it is very much like my experience with the VA is the Mayo Clinic. 

Anyway, that is my perspective as I observe my wife's hassles and my lack of hassles when dealing with health issues.

Tony


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## Ruthanne (Sep 19, 2020)

What bothers me the most is constantly getting referrals to see other doctors and they may not be in my area and it's hard to get to them so I just don't go to  all of the specialists.  And I feel like I Aunt Bea does I'd rather have quality of life for the time I'm here and then just go quietly.


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## tbeltrans (Sep 19, 2020)

Ruthanne said:


> What bothers me the most is constantly getting referrals to see other doctors and they may not be in my area and it's hard to get to them so I just don't go to  all of the specialists.  And I feel like I Aunt Bea does I'd rather have quality of life for the time I'm here and then just go quietly.



I agree with the idea of quality of life and just quietly go.  I don't care so much about quantity of life as I do about quality of life.  I also don't want to be a burden on those around me by living long with Alzheimer's or stroke or any of that.  When I can't take care of myself any longer, I wish to be gone entirely.

Tony


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## Ruthanne (Sep 19, 2020)

tbeltrans said:


> I agree with the idea of quality of life and just quietly go.  I don't care so much about quantity of life as I do about quality of life.  I also don't want to be a burden on those around me by living long with Alzheimer's or stroke or any of that.  When I can't take care of myself any longer, I wish to be gone entirely.
> 
> Tony


I hear you.


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## Fyrefox (Sep 20, 2020)

Reducing out-of-pocket costs is the hardest part of managing my health care.  I used to get lab work done at my doctor's office until they were absorbed by a larger conglomerate, costs for lab work more than doubled, and my insurance balked at covering the increase.  Now I travel to a private independent lab which largely accepts what insurance will pay, and tells you up front your maximum out-of-pocket costs.  It pays to know and shop around on costs before you're hit with them...


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## Aneeda72 (Sep 21, 2020)

Aunt Bea said:


> Finding a PCP that is comfortable with the fact that at some point I'm going to die.
> 
> I get frustrated with all of the various tests, state of the art medications, referrals, etc... that my current PCP is constantly pushing.
> 
> My only goal is to stay independent for as long as possible and then slip away as easily as possible without a lot of fuss.


Exactly, I now refuse a lot of testing.  It annoys her, my doctor, but she tolerates it and me


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## Aneeda72 (Sep 21, 2020)

RedSky4u said:


> I don't like being seen by a NP instead of the doctor.


Really?  I like them if they are knowledgeable but some are not.  I don’t like the “dumb” ones.


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## Aneeda72 (Sep 21, 2020)

Kayelle said:


> I'm glad to say that our younger GP family Doctor does a really good job managing my health care needs, and I have several. When he wants to send me to a specialist, I always tell him to send me where he would send his own mother. That seems to work well. He could use some help in the odd personality area, but I can deal with that as I think he's smart as a whip.....more than most "whippersnappers".


Depends on if he likes him mom.


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## Don M. (Sep 21, 2020)

The "hardest" part of managing my healthcare, at my age, is trying Not to do anything stupid that will send me to the doctor.  That, and eating properly and getting plenty of exercise to keep this old body in reasonably good shape.  We have a good doctor, about 12 miles away, and a decent hospital about 40 miles away, so we try to just go there for routine exams, etc.  My biggest problem seems to be my teeth....starting to reach their "end of life"....I can see the day coming when I need dentures.


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## OneEyedDiva (Sep 21, 2020)

tbeltrans said:


> I feel so grateful for the VA that I go to.  The care is excellent and not at all complicated for me to get around in.  My wife, on the other hand, must deal with the civilian hospitals and clinics.  The main problems that I see are:
> 
> 1. Insurance companies rule with an iron fist, controlling everything health care professionals do from a financial viewpoint instead of a patient centered focus.  I know it is terribly frustrating for the health care professionals because I hear it from them, especially those who left the civilian side and now work for the VA.
> 2. The various clinics and hospitals don't seem to communicate with each other, so there seems to be little or no coordination between them.  With the VA, medical records are intact wherever I go and it is seamless.  The one place my wife has had to go where it is very much like my experience with the VA is the Mayo Clinic.
> ...


One of my best friends, now deceased, told me how happy he was with his VA care here in N.J.  I tried to get my husband to go soley to VA care but his doctor, who none of the family thought competent, including me, was his friend. I thought I heard someone mention that wives could get care at VA centers under their husbands' plans (??)


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## csimone (Sep 21, 2020)

Fyrefox said:


> Reducing out-of-pocket costs is the hardest part of managing my health care.  I used to get lab work done at my doctor's office until they were absorbed by a larger conglomerate, costs for lab work more than doubled, and my insurance balked at covering the increase.  Now I travel to a private independent lab which largely accepts what insurance will pay, and tells you up front your maximum out-of-pocket costs.  It pays to know and shop around on costs before you're hit with them...


completely agree! people don't know that they have options when it comes to their healthcare. but really it's just like choosing where you eat... you should have transparency into costs


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## csimone (Sep 21, 2020)

OneEyedDiva said:


> One of my best friends, now deceased, told me how happy he was with his VA care here in N.J.  I tried to get my husband to go soley to VA care but his doctor, who none of the family thought competent, including me, was his friend. I thought I heard someone mention that wives could get care at VA centers under their husbands' plans (??)


have you inquired about the health plan and if you're covered under the benefits? there are certainly cases where the benefits are extended to the spouse


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## csimone (Sep 21, 2020)

Phoenix said:


> Finding a good doctor.  The good ones have retired.  Some of the others don't seem to know what they are doing and do not even seem to care that what they do for one of my issues will make another one worse.  It's 25 miles to the closest doctor, 37 miles to some others and 60 miles to more.  Many do not accept new patients, so it's hard to switch.  I walked quietly away from my last doctor and have ten months to find another.  I sent papers to one doctor in July, and they have not gotten back to me.  I haven't pushed it at this time because the air quality has been so bad because of the fires, that I don't want to go to town where it's worse.  Plus, my husband would be sitting in the car waiting for me, and I won't do that to him in all the smoke.


what type of qualifications or speciality areas are you looking for in your doctor? I see from your other reply that you live in a rural area. Are you open to telehealth for routine checkins?


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## tbeltrans (Sep 21, 2020)

OneEyedDiva said:


> One of my best friends, now deceased, told me how happy he was with his VA care here in N.J.  I tried to get my husband to go soley to VA care but his doctor, who none of the family thought competent, including me, was his friend. I thought I heard someone mention that wives could get care at VA centers under their husbands' plans (??)



As far as I know, only the veteran gets care at a VA facility.  Also, they have a rating system.  It was several years ago that I went through the application process, so I don't recall the details, but it is a priority system based on disability level.  Vets who don't have a disability rating can go to the VA, but will pay a fee for the services.  It is very affordable compared to civilian medical services and there is a substantial discount for financial hardship determination (i.e. income below a certain level depending on where you live).  However, as I understand it, if Congress ever decides to roll back on the VA budget, these are the folks who would no longer be eligible for VA services.  

Those with a disability rating would not be affected (as I currently understand it) and don't pay for services at the VA except those with less than a certain disability level do pay a fee for medications.  I pay very small fee for medication since I don't have a full 100% disability rating, but not for any services.  To me, this seems a fair system.   One thing I am really pleased with is that us Vietnam veterans are treated very well at the VA (at least that has been my experience) - very different from how civilians treated us when we came home all those years ago.  The weird thing is that I always thought of the WWII vets as the old guys around the VA, but we are in that role now. 

I have a younger brother with a 100% disability rating and I know his family is covered under a military insurance plan, but are not eligible for the VA services he gets.  He retired from the Marines, so I don't really know how their insurances work.  I was in the Army, and I don't know about family insurance since I was not a lifer. 

Despite the fact that the VA is my primary care, I still had to sign up for Medicare.  My supplement costs almost nothing since I really don't need it, but it is good to have something just in case.  I also think this is fair, since we all need to support Medicare.  Besides, it is nice to know that if I ever did end up in a civilian hospital due to an emergency situation, I have that coverage.

Tony


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## OneEyedDiva (Sep 21, 2020)

tbeltrans said:


> As far as I know, only the veteran gets care at a VA facility.  Also, they have a rating system.  It was several years ago that I went through the application process, so I don't recall the details, but it is a priority system based on disability level.  Vets who don't have a disability rating can go to the VA, but will pay a fee for the services.  It is very affordable compared to civilian medical services and there is a substantial discount for financial hardship determination (i.e. income below a certain level depending on where you live).  However, as I understand it, if Congress ever decides to roll back on the VA budget, these are the folks who would no longer be eligible for VA services.
> 
> Those with a disability rating would not be affected (as I currently understand it) and don't pay for services at the VA except those with less than a certain disability level do pay a fee for medications.  I pay very small fee for medication since I don't have a full 100% disability rating, but not for any services.  To me, this seems a fair system.   One thing I am really pleased with is that us Vietnam veterans are treated very well at the VA (at least that has been my experience) - very different from how civilians treated us when we came home all those years ago.  The weird thing is that I always thought of the WWII vets as the old guys around the VA, but we are in that role now.
> 
> ...


Thank you for this information. I'm glad to read that the Vietnam vets are treated well. They and all vets deserve to be.


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## OneEyedDiva (Sep 21, 2020)

csimone said:


> have you inquired about the health plan and if you're covered under the benefits? there are certainly cases where the benefits are extended to the spouse


If you read my first reply to this thread you'll see that I have great retiree health benefits and don't need any other coverage.


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## Pecos (Sep 21, 2020)

tbeltrans said:


> As far as I know, only the veteran gets care at a VA facility.  Also, they have a rating system.  It was several years ago that I went through the application process, so I don't recall the details, but it is a priority system based on disability level.  Vets who don't have a disability rating can go to the VA, but will pay a fee for the services.  It is very affordable compared to civilian medical services and there is a substantial discount for financial hardship determination (i.e. income below a certain level depending on where you live).  However, as I understand it, if Congress ever decides to roll back on the VA budget, these are the folks who would no longer be eligible for VA services.
> 
> Those with a disability rating would not be affected (as I currently understand it) and don't pay for services at the VA except those with less than a certain disability level do pay a fee for medications.  I pay very small fee for medication since I don't have a full 100% disability rating, but not for any services.  To me, this seems a fair system.   One thing I am really pleased with is that us Vietnam veterans are treated very well at the VA (at least that has been my experience) - very different from how civilians treated us when we came home all those years ago.  The weird thing is that I always thought of the WWII vets as the old guys around the VA, but we are in that role now.
> 
> ...


If your younger brother is retired from the Marines, then he is probably using Tricare For Life like I am. It has worked very well for me after I turned 65. Prior to turning 65 and being eligible for Medicare, I used the local Military Hospital. 

When I turned 65, the Military Hospital booted me out the door and I had to go on Medicare with Tricare picking up the remaining costs. I still got my medications from the Military Hospital until the virus came along. Now I get them via express scripts and that works pretty well.


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## csimone (Sep 21, 2020)

tbeltrans said:


> I agree with the idea of quality of life and just quietly go.  I don't care so much about quantity of life as I do about quality of life.  I also don't want to be a burden on those around me by living long with Alzheimer's or stroke or any of that.  When I can't take care of myself any longer, I wish to be gone entirely.
> 
> Tony


Have you set up advance care directives that state this? This will ensure these wishes are respected in the event you are faced with a condition where you aren't able to advocate for yourself


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## tbeltrans (Sep 21, 2020)

csimone said:


> Have you set up advance care directives that state this? This will ensure these wishes are respected in the event you are faced with a condition where you aren't able to advocate for yourself



Yes, we have all of that done as far as the law permits, which is essentially "do not resuscitate".  We also have our cremation all paid for.

Tony


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## tbeltrans (Sep 21, 2020)

Pecos said:


> If your younger brother is retired from the Marines, then he is probably using Tricare For Life like I am. It has worked very well for me after I turned 65. Prior to turning 65 and being eligible for Medicare, I used the local Military Hospital.
> 
> When I turned 65, the Military Hospital booted me out the door and I had to go on Medicare with Tricare picking up the remaining costs. I still got my medications from the Military Hospital until the virus came along. Now I get them via express scripts and that works pretty well.



Tricare sounds familiar, so that is probably what his family has.

Tony


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