Tanya Feke - Medicare Essentials: A Physician Insider Explains the Fine Print

Medicare Essentials

A Physician Insider Explains the Fine Print

Tanya Feke, MD

Copyright 2018 Diagnosis Life, LLC

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All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the author except for the use of brief quotations in a book review.

ISBN-13: 978-1-7327593-1-2

First Edition: May 2014

Second Edition: April 2015

Third Edition: September 2016

Fourth Edition: September 2018

Limit of Liability/Disclaimer of Warranty :

While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. You should consult with a professional where appropriate. Neither the publisher nor the author shall be liable for damages arising herefrom.

Dedication

To my mom.

Thank you for always believing in me.

Acknowledgements

I would not be able to write these books without the love and support of my family. A lot of time is invested into this project, and while I always enjoy the opportunity to reach out and support others on their healthcare journey, I often put my own needs aside to do it. Thats where I owe my family the sun and the moon. Thank you so much to my husband Gil and my two children, Gilbert and Charlotte, for always encouraging me. By helping me, you allow me to help others. I love you!

Table of Contents

1 All About Medicare

"We can never insure one-hundred percent of the population against one-hundred percent of the hazards and vicissitudes of life. But we have tried to frame a law which will give some measure of protection to the average citizen and to his family against the loss of a job and against poverty-ridden old age. This law, too, represents a cornerstone in a structure which is being built, but is by no means complete. It is a law that will take care of human needs and at the same time provide for the United States an economic structure of vastly greater soundness."

Franklin D. Roosevelt

Who Am I?

T he first edition of Medicare Essentials: A Physician Insider Explains the Fine Print was released in 2014. A lot has changed since then. Although the Affordable Care Act remains the law of the land, there have been attempts to repeal the law, or at a minimum to decrease its reach. A massive tax cut went into effect that will require cuts to federal spending, Medicare included. There have even been cries to pursue universal health coverage with Medicare for All. The political landscape is ever evolving, and our nation is more divided than ever. All of this has impacted Medicare on a grand scale.

That is why it makes sense for someone who has been in the thick of it all to guide you through the Medicare maze. I am a family physician with years of clinical experience in the exam room and firsthand knowledge about insurers and the Medicare program. It has been an honor to advocate for patients nationwide and to help them make better choices about their health care.

When I made the decision to become a doctor, my goal was to take care of people. After all, a physician cannot survive the grueling training in medical school and residency without that built-in altruism. The years of sacrifice are worth it to make a difference to the lives of the people in my community.

As it turns out, the field of medicine does not necessarily share that philosophy. This was the hardest lesson I learned as a practicing physician. There was always someone pushing me to see more patients, someone urging me to bill for more services, someone adding more administrative tasks to an overflowing list of responsibilities. What this did was leave me with less time to care for my patients. The essence of why I had become a doctor got muddied by the waters of big business.

Make no mistake: medicine can be big business but it does not have to be that way. Medicine cannot and should not be about corporate greed. Peoples lives and wellbeing are at stake. There has to be a way to make lives better. No one will ever snuff that altruism out of me!

While the boards of for-profit hospitals may have a core objective of increasing the wealth of their investors, the U.S. healthcare system at large looks at things from a different perspective. The system aims to reduce costs so that resources can be better allocated for those people who need it. In the case of Medicare, the goal is to stretch those dollars out over as many years as possible before the bank goes bust.

That is where the burden of administrative red tape comes into play. My healthcare colleagues and I have been forced to adapt to increasing rules and regulations from the government, healthcare systems, insurance companies, and more while caring for our patients on the front lines. There is little time to do both, and we are too often pulled away from the bedside to complete unnecessary documentation and jump through hoops just to stay in practice. Our patients do not understand why they are getting less time with their providers and in some cases getting billed more. Healthcare providers are being looked upon as the bad guys while there are forces behind us that our patients may never fully appreciate.

This realization told me I needed to take a closer look at the forces pressuring our healthcare system. Putting clinical practice aside, I dove into a career of utilization review. While that may sound very technical, what it means is essentially this: I review real-life clinical cases and advise hospitals on whether they are appropriately utilizing, and billing for, their services. Instead of consulting with patients, I consult with hospital networks.

The training required for my new role was extensive. What I learned during that transition in my career, however, has been enlightening and even jaw-dropping. There is a whole other world behind that curtain with information I had never been privy to during my medical training. That was the point when I truly understood there was so much that people did not know about Medicare, doctors and patients alike. The trends I witnessed across my clinical career, and subsequently in my consulting career, need to be shared with the people who are affected most Medicare beneficiaries.

In my current work, I consult with hospitals regarding Medicare patients as well as those who have private insurance. Not only do I review the appropriateness of a patients hospital admission, I also fight the good fight to overturn coverage denials by Medicare Advantage and other commercial plans. It has been eye-opening to speak with medical directors nationwide and learn what drives the insurance industry. More to the point, it is rewarding to know that I am able to advocate for patients in ways that will save them money for care they needed.

I founded Diagnosis Life , a health and wellness site at diagnosislife.com, to provide information to those of you trying to lead better, healthier lives. The site offers advice on common health ailments and gives you advice on how to live a more healthful and balanced life. It also takes some of the latest medical studies and cuts them down to size. Translating them from medical jargon to plain old English is good for everyone. After all, some of the doctors I know have a hard time breaking down some of that information for themselves! The goal of the site is to plant a seed that you have the power to make changes that will make you feel good about yourself inside and out.

A book seemed the next inevitable step on my journey to helping people make the most out of the current healthcare system. Medicare Essentials: A Physician Insider Explains the Fine Print was released in May 2014 and quickly became an Amazon best seller. This led me to speaking engagements on radio shows and to public appearances about Medicare. I learned as much from the public as I taught, and I am ever grateful for the growing experience.