Is it illegal for licensed insurance agents to process cancer screening test?

[Northeast Agent]

Past couple of years? Really? Medicare only started approving the DNA Hereditary Medically Cancer Screenings March 2018.

I know an agent who was affiliated with a company out of FL who claimed to be doing this for "years." And her "upline" was a nurse practitioner who claimed to be doing 20 + swabs weekly at health fairs. This may have been part of the whole scam, to get people to enroll thinking they were going to make big $$$.

Of course, they also said they had three attorneys on staff, and a former CMS employee/expert who said it was all kosher...

 

[somarco]

3 generations of different types make the test a medical necessity.

Medicare, for example, defines medically necessary as: “Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.”

Medical necessity refers to a decision by your health plan that your treatment, test, or procedure is necessary for your health or to treat a diagnosed medical problem.
Medical Necessity Definition in Health Insurance


The Social Security Act defines "medically necessary" in terms of what Medicare will pay for: "No Medicare payment may be made for any expenses which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."
Medical Necessity and the Law - FindLaw

Medical necessity is further defined at the state level . . .

Medicare defines "medical necessity" as services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

The following is an example of a State Statute (California) on medical necessity:

Cal Wel & Inst Code § 14059.5. "Medically necessary" or "medical necessity"

A service is "medically necessary" or a "medical necessity" when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.
Medical Necessity Law and Legal Definition | USLegal, Inc.

 

[Northeast Agent]

I have heard conflicting information on this and would like to know what everyone here thinks.

Not sure if you're trollling, but feel free to read this long thread. And there's a second similar one.

Knock yourself out!

 

[somarco]

Those girls got some moves

Do they have a Gangnam Style video? Or Robert Palmer "Simply Irresistable"?

 

[somarco]

This will eventually rival the "Anyone Going to the Dayum NAAAAA Conference" and the "Bacon is for Losers" thread.

Perhaps I have missed it, but one of the dangers in promoting this "free" DNA test is tantamount to telling a client their (legitimate but maybe not necessary) claim will be paid.

If a client asks if "this" or "that" is covered I NEVER say "yes". The answer is "could be" or "might be". Depends on how the claim is coded and the documentation.

I don't care how much money is in it for the agent, but I can think of easier ways to make money legitimately than this.

 

[goillini52]

Do they have a Gangnam Style video? Or Robert Palmer "Simply Irresistable"?

They've probably got 100's of videos, so I wouldn't be surprized if they did. Are you saying that you find the Gordon Girls "Simply Irresistable Bob?

 

[somarco]

Are you saying that you find the Gordon Girls "Simply Irresistable Bob?

Let's see.

This


or the Gordie Girls?

Oh yeah. Tough choice . . .

NOT!

 

[Sc2018]

The screenings are for medicare pateints, age 65 and up kostly..not the types to get 500k life insurance policy.

 

[Sc2018]

Unless one is too agressive and manipulative, the testing for now is fine. How else will anybody know about these tests, i went to my famiky dr..she never heard of testing.

 

[goillini52]

Let's see.

This


or the Gordie Girls?

Oh yeah. Tough choice . . .

NOT!

I just caught a nice Easter buzzz and was "rocking out" to some more Gordon Girls dance videos. I thought that it only fitting to share these with the Forum. Really makes me want to put all my contracts with the Gordon Girls. They seem really cool. I wonder if they smoke pot.