I just received a statement from Medicare indicating that they denied payment for one of the blood tests that my primary care doctor ordered. However, that statement also said that I am not responsible for paying for it if the lab did not advise me that it wasn’t covered by insurance.
Has this situation ever happened to anyone else.
Without getting too personal, was the blood test “necessary”, even though the doctor ordered it? I’ve seem documentaries where an 85 year old woman who was dying of cancer was given a PAP test…pretty much to pad Medicare.
From what I see they cover “medically necessary” blood tests, but not tests like cholesterol. But the doctor has to specify that it’s medically necessary.
Very few blood tests are covered by Medicare. If I remember the language properly, they have to be medically necessary. That usually means something specific to diagnose a problem or monitor a previously identified problem. I speak from experience after getting the bill. The doc did tell me that had I let him know he would have rebilled with a different code.
What were they checking ?
And yes it common. I had my vitamin d checked and they tried to deny it.
I wrote them a letter explains why, citing literature and sign it MD. They approved it.
I know why my doctor ordered it and it was necessary
@kcflyer - It was a blood test for thyroid level and I have no idea why the doctor ordered it. I don’t have any symptoms of a thyroid problem and the result for that test was normal. This was the first time I went to this primary care practice and their “routine blood tests” included a few that I never had before, such as this one.
Thyroid is typically checked for weight gain, complaints of cold intolerance, weight loss, etc
@Wintermute - I don’t have any of those issues but that blood test may have been ordered because I mentioned to that doctor that I was having a difficult time adjusting to the death of my husband.
Not through Medicare, but after my recent hospital stay, i got a notice that the stay wasn’t covered. I suspect someone just failed to use the right code. It was quickly resolved.
I had an allergist order too many tests as well
Sometimes it’s done during the annual physical.
Remember it should be difficult to adjust to the death of a spouse. That means they were part of your life