Have any questions about how to use the community? Check out the Help Discussion.

Need New Neurologist

Dio
Dio Member Posts: 874
250 Likes 250 Care Reactions 500 Comments Third Anniversary
Member

Has anyone sought 2nd or 3rd opinions on dementia diagnosis? Does Medicare (Part A & B only) need a referral for second/third opinions for neurologists treating dementia, more specifically a Lewy Body specialist? I'm not happy with our current one who seems only knowledgeable in Alzheimer's. I tried looking for an answer on the Medicare site, but answers were too ambiguous.

Comments

  • Vitruvius
    Vitruvius Member Posts: 437
    Fifth Anniversary 250 Care Reactions 100 Insightfuls Reactions 100 Likes
    Member

    The first neurologist for my DW was at a major university dementia clinic that only did assessments but did not provide continuing care and suggested, but did not formally refer us, to a local neurologist. We just called and asked if they were accepting new patients, and they were.

    Because of my DW's rare Semantic Dementia the first neurologist also wanted my DW to be seen at another major national university that has specialists in rare dementias to confirm her diagnosis. Both the first and second neurologists referred my DW to the third neurologist. DW had Medicare and a Medicare supplement plan (G), all visits were fully covered.

    I got the impression that the referrals were only necessary to the third neurologist to filter out patients who were not really appropriate. I think Medicare didn't care about the referrals, they only cared about the way each neurologist "coded" the visits. This was true when my DW was given a PET scan which Medicare paid for. Before the scan I wanted to make sure it would be covered as I read that it wasn't for some. The first neurologist was the one who ordered it and told me that it was necessary to "code" it properly as being necessary for a diagnosis or it could be rejected.

  • Dio
    Dio Member Posts: 874
    250 Likes 250 Care Reactions 500 Comments Third Anniversary
    Member

    Thanks for this info. I forgot that the code used in claims is what drives the approval.

  • jfkoc
    jfkoc Member Posts: 4,704
    Legacy Membership 1,000 Likes 2500 Comments 250 Insightfuls Reactions
    Member

    I suggest you google neurologists in your area and read about their specialties and where they trained.

  • JJ401
    JJ401 Member Posts: 385
    Seventh Anniversary 100 Likes 100 Comments 25 Insightfuls Reactions
    Member

    My understanding is that if you have Medicare and a supplement, you can go to any doctor that accepts Medicare. If you opted for a Medicare Advantage plan (the ones that advertise added benefits), they usually care about referrals, your doctor needs to be in Network and you usually need pre approval.

    For PET scans, coding matters. As Medicare only pays for PET scans for a prescribed list of things. Not on the list, they won’t pay.

Commonly Used Abbreviations


DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
Read more