Why?
I received a very nice email from Corey Miller, AvMed’s PR and Communications director in Miami who wrote that “I came across your blog and would like to put you in touch with a member of AvMed’s provider network management team to discuss your concerns.”
I’m assuming that AvMed has a program that searches the WWW for mention of its name.
I thought I laid out my concerns fairly well on the previous blog entry, but I responded to the director’s request with a “by the numbers” email (substantially shorter than this entry). Since AvMed apparently monitors the WWW for references to it, this is my expanded answer to Corey’s offer to discuss my “concerns.”
The Good
I’ve always liked AvMed. I had AvMed coverage in the 80s, long before I came of Medicare age. The company for which I worked had it as its health plan.
When I returned to south Florida I was working and had coverage from the employer. Then my job was eliminated and with that, my health coverage.
When I signed up for Medicare, I checked out several Medicare Advantage providers. AvMed got my business partly based on my past experience with the company and partly because the sales person seemed to know what he was selling.
What I FAILED to check was to see if my Primary Care Provider (PCP) was on AvMed’s list of providers. He was not, and I was forced to find a new PCP. I did, but it was not a happy arrangement. Then, at the beginning of 2011, AvMed took on Dr. Pepe & Associates and my PCP, Dr. Eduardo (Eddy) Perez-Stable was available. I was back in a flash.
What make’s Dr. P-S special? He listens, he’s an excellent diagnostician, and when action is needed, he acts.
Between January of 2011 and October 2013 I’ve had two surgeries: an open Triple A* procedure at Hollywood Memorial Regional and repair of an umbilical hernia that resulted from the Triple A surgery. (The is a 20% to 30% chance of a hernia after the Triple A; I was a 25 percenter.)
Also between January 2011 and October 2013 I made twice-a-year visits to an ophthalmologist; I have developing cataracts in both eyes and my high (albeit controlled) blood sugar has the eye docs checking for diabetes. (So far no signs of diabetes have been found.)
When I was over charged by an AvMed/Delta dentist, AvMed pressured Delta to pressure the dentist to refund the over payment.
When the hospital billed me for 3 days (over my 5 free days), I complained to AvMed and the charge disappeared. (I was discharged during my free days.)
At the same time, being a good AvMed client, I recommended it to a number of people; I know several who did sign up with AvMed and with my PCP.
The “not so good”
When I made my first appointment in 2012 with my then ophthalmologist, Dr. Alan Mendelsohn of Eye Surgeons and Consultants I learned that AvMed had delisted him.
Fortunately, his practice partner, Dr. David Goldberger was listed with AvMed so I could at least stay with the practice.
At the end of 2012, Dr. Goldberger was delisted. I had to find a new ophthalmologist on AvMed’s list.
When calling around, several ophthalmologists told me they wouldn’t know if they would be listed with AvMed until March of 2013.
I found a new ophthalmologist and paid to have my records forwarded to the new practice. The new practice was “OK,” but it was “less comfortable” than Eye Surgeons and Consultants, lacked Sunday appointments (a major convenience), and was substantially farther from my residence. (Driving with dilated eyes in Florida’s sun is no picnic.)
I received a letter from Eye Surgeons and Consultants in September informing me it had been relisted by AvMed. I was delighted.
This month, October, 2013, I received a letter from my PCP’s practice telling me that AvMed had delisted the practice. I had a choice: I could
- (a) Stay with AvMed and find a new PCP or
(b) Sign up with one of the four Medicare Advantage plans that listed Dr. Pepe and Associates.
I also could sign up with a PPO, a Medicare Supplement plan, of go back to "original" Medicare, although the letter failed to mention these options.
Since I see my PCP three or four times-a-year – and I owe my life to his diagnostic skills and ability to listen to the patient - the decision for me was a no brainer: good bye AvMed. Several of the people who followed me to the practice and are Dr. Perez-Stable’s patients also came to the same conclusion.
So
Given my medical history and knowing what lies ahead, AvMed’s delisting of yet another of my physicians has me checking with the four insurers who still list my PCP’s practice. I want to keep my ophthalmologists; they specialize in cataract surgery. I need to keep my vascular surgeon – I have a follow-up with him and a small iliac aneurism that will need attention “someday.” I want to keep access to Hollywood Memorial Health System facilities; the food’s horrible, but the care is great.
Fortunately, the four insurers who list my PCP’s practice all want my business so I am getting some replies to my “do you list” queries. Unfortunately, so far it seems that only AvMed had the desired “line-up.”
Even with its plan changes, I would have stayed with AvMed; I had every intention of renewing until I received the letter from the PCP’s practice.
I simply have too much invested in my PCP to abandon the practice. If I means going with a plan that lacks my specialists, I will reluctantly do that.
I’m fortunate. I have basic computer skills and the time to research my options. I feel for the people who lack the skills and access to the WWW. If I’m frustrated by AvMed’s move, imagine others that lack my mellow disposition.
I’m really sorry that AvMed, for whatever reason – and I am reasonably certain it was not a medical reason – delisted my PCP’s practice.
Will I go back to AvMed if it relists my PCP? Only if it does so before December 1 (the last day to sign up for a Medicare Advantage program is Pearl Harbor day which, any geezer will tell you, is December 7.
I'm not holding my breath that this will happen.
* Triple A: Aortic Abdominal Aneurysm
Iliac aneurism : An aortic aneurysm that extends beyond the aorta into the iliac arteries (the blood vessels that go to the pelvis and legs).
