- Thread starter
- #31
Medicare Number Before Card Arrives
- Thread starter somarco
- Start date
- 29,488
I don't do MAPD, so I prefer Med Supp/FE/DVH/Cancer.
- 29,488
It's been a while and I can't remember. I just recently went for a blood test for diabetes. Before they took my blood they put an ABN in front of me so they'd know how much blood to take. They said that Medicare would cover the diabetes blood test, but not General Health Panel($1,225), the LIPID Panel($330) or the PSA Screening($315) = $1,870. I told them if Medicare's not covering it, then I must not need it too badly, and I passed. That would've been my weed money.
- 6,457
It's been a while and I can't remember. I just recently went for a blood test for diabetes. Before they took my blood they put an ABN in front of me so they'd know how much blood to take. They said that Medicare would cover the diabetes blood test, but not General Health Panel($1,225), the LIPID Panel($330) or the PSA Screening($315) = $1,870. I told them if Medicare's not covering it, then I must not need it too badly, and I passed. That would've been my weed money.
(Side note to following: I tend to have strong feelings about PSA since I think it helped to save my life.)
They may have been out of line on the PSA, depending on when you had your last one.
See 2018 Medicare and You, P53 for allowed PSA under preventive services.
If you have not already done so, create a MyMedicare account.
Login.
Click MyHealth tab.
Click preventive services on drop down menu
or scroll down to preventive services in displayed information and click:
View all Preventive Services
Scroll down to Preventive Services notification box.
Click the plus box to expand.
PSA eligibility is included in the list.
I assume the secret to getting this done at no charge would be twofold:
A) not signing an ABN.
B) the provider properly coding the test.
I would highly recommend keeping a chain of PSA readings going in your medical file.
- 29,488
I called Medicare and they aid that unless the test was connected to a condition I already had, it wouldn't be covered. I tried reasoning with them...but they weren't reasonable.
- 6,457
I called Medicare and they aid that unless the test was connected to a condition I already had, it wouldn't be covered. I tried reasoning with them...but they weren't reasonable.
I'm sorry goillini, that you are having to put up with that.
That sounds so WAY wrong but I have no idea how to help.
ld
Last edited:
- Thread starter
- #37
Medicare may have missed the mark in their response .. .
Medicare paid for my PSA and lipid panel. Also Comprehensive Metabolic Panel.
Total billed $539, Medicare paid $106. I owed nothing.
Can't say why my Medicare covered the PSA and lipid but yours did not. Had to be the way doc coded the claim.
No family history of prostate cancer. Lipids slightly elevated but not requiring medication.
Medicare will not cover a "fishing expedition" but will cover the tests if you have a specific diagnosis or symptoms, family history, etc.
Screening blood tests determine a patient’s cholesterol and other blood lipid levels, and may indicate whether he or she is at high risk for cardiovascular disease. Citing the risks and health care costs associated with heart disease, Congress established the cardiovascular blood test screening benefit as part of the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003. Coverage is provided as a Medicare Part B benefit. The beneficiary pays nothing for the blood test; there is no coinsurance, copayment, or deductible.
To meet benefit requirements under the MMA, all of the following conditions must be met:
The screening must be “for the purpose of early detection of cardiovascular disease,” according to the Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Healthcare Professionals (www.cms.gov/mlnproducts/downloads/psguid.pdf). CMS recommends all eligible beneficiaries to take advantage of the coverage.
The patient must be asymptomatic. The beneficiary “must have no apparent signs or symptoms of cardiovascular disease,” the Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Healthcare Professionals explains.
Eight Requirements Satisfy Medicare Blood Test Screening Benefit - AAPC Knowledge Center
https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/se0436.pdf
https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNProducts/downloads/WorldHeartDay.pdf
- 29,488
I'll have to run it past my Doctor to see if he can code it differently. I guess I looked at those tests as a fishing expedition.
- Thread starter
- #39
This site (just found it when looking for answers to your comments) seems to outline the criteria for getting labs paid.
Eight Requirements Satisfy Medicare Blood Test Screening Benefit - AAPC Knowledge Center
My doc has done lab tests 2 or 3x since I went on Medicare. Gave me the ABN, which I signed. Never paid anything OOP.
There are also discounted labs.
Affordable Blood Tests - No Doctor Visit- Most US Cities | Discounted Labs
PSA $43
Lipid panel $32
CMP $32
Eight Requirements Satisfy Medicare Blood Test Screening Benefit - AAPC Knowledge Center
My doc has done lab tests 2 or 3x since I went on Medicare. Gave me the ABN, which I signed. Never paid anything OOP.
There are also discounted labs.
Affordable Blood Tests - No Doctor Visit- Most US Cities | Discounted Labs
PSA $43
Lipid panel $32
CMP $32
- 6,457
I know there is some controversy over the effectiveness of the PSA test, but it is definitely more than a fishing expedition.
At the time I started doing it, the family doc that recommended it was on the teaching staff at a local hospital. And I believe he probably saved my life.
For me, it was ultimately a significant change in "the RATE of change" in my PSA series that led the doctors to do more detailed tests for cancer.
At the time I started doing it, the family doc that recommended it was on the teaching staff at a local hospital. And I believe he probably saved my life.
For me, it was ultimately a significant change in "the RATE of change" in my PSA series that led the doctors to do more detailed tests for cancer.
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