Pulmonary Disease and Internal Medicine
Medicare: Dr. Ebenstein "participates" with Medicare, which means that he accepts Medicare's "allowed charge" as full payment. Rules and rates are set by the Congress of the United States. Medicare pays the doctor bills after a $170 annual deductible and, for most services, a 20% copay applies. The patient may wish to carry "medigap" insurance to help with these deductibles and copays. "Medigap" policies are also called "supplement to Medicare." The Congress of the United States still calls the shots.
About Medicare "Advantage" Plans: Patients are frequently confused about these. Be careful. By signing up for a Medicare "Advantage" plan, you are agreeing that Medicare will no longer pay your bills directly. Instead, you have agreed to put a private insurance company in charge of your bills and your care. Medicare pays the insurance company and you have agreed for the insurance company to take charge and to decide what doctors you may see and when and also to decide if and how much these doctors are paid. Sort of like setting the wolf to watch the sheep. There are frequently unpleasant surprises when the patient finds out what is NOT covered. These plans are sometimes called "Medicare Complete" or "PPO" or "HMO" plans. Dr. Ebenstein prefers NOT to work with these plans.
Other plans which ARE accepted include: Most Blue Cross/Blue Shield plans, Oxford, United Healthcare, Pomco, most Aetna plans, Cigna, The New York State Empire Plan, and plans administered by Multiplan. If you are on an insurance plan in which Dr. Ebenstein does not participate, he is still glad to see you, but you are responsible for the doctor bills.
About The Affordable Health Care Act ("Obamacare") plans: The good news: Some people who did not previously have access to health insurance now have that access, but be careful again. The bad news: you get only what you pay for. While some of these plans have low premiums, they may have very high deductibles and copays, limit access to only certain "providers," and pay fees so low that the large majority of doctors in New York State cannot afford to accept them.
Sorry, Medicaid is not accepted. Private doctors in New York State just can't afford to work for those amounts (sometimes as little as 5 or 10 cents on the dollar). Dr. Ebenstein tries to accept as many insurances as possible. It is sad when a valued relationship with a patient must end because of an insurance change that is beyond the patient's control, such as from a change of job or from a decision made by an employer to change insurance plans. Unfortunately, however, a private physician cannot afford to provide good medical care under some plans, which expect 20 minute "complete" physicals and 6 minute follow up visits.
Copyright 2012: Peter Ebenstein, M.D. | Internist New York | All rights reserved.
12 Greenridge Ave. Suite 204, White Plains, NY 10605 914-287-0010
Insurances accepted for your pulmonologist in New York