Unique Selling Proposition

[somarco]

why would Medicare refuse to pay for lab work?

They don't consider it medically necessary

 

[midwestbroker]

The results are in!

Here are the top 50+ answers from agents on what makes them stand out. I also added some ideas on how to make your own USP (Unique Selling Proposition).

Enjoy:

What makes you stand out as an agent (your USP)? - SMS University

FYI - The report is free to download and there is no personal information required. Simply click the link in the blog post.

 

[somarco]

Thanks for the survey. Good stuff in there. Might have to steal some of those ideas.

 

[j10]

super awesome guide

 

[midwestbroker]

Thank you! I appreciate the kind words.

 

[LostDollar]

My approach to this is different.

I was covered under my wife's group plan (Obamacare) until last year when I enrolled in Medicare. Every year my wellness exam was no charge.

That changed with my Welcome to Medicare exam.

First thing I noticed in the exam room was a sign on the bulletin board that stated "Medicare does not pay for routine lab work".

Doc did the exam and had me sign an ABN form in case Mcare rejected my usual lab work. If not covered my lab work was expected to be $290.

I also mentioned pain in my hip, which prompted an X-ray and a few other tests. That ran $114 (applied towards my deductible).

Setting up a MyMedicare account is something I advise but apparently few actually follow through.

My thought is, rather than just sending them on their way it might be good to give them a guide on what to expect so they don't think everything is free.

How did the lab work charge settle out? Did you wind up having to pay for it?

 

[somarco]

Medicare paid the bill

 

[LostDollar]

Medicare paid the bill

Thank you. I did have a reason for asking.

(I had a post explaining why I asked that was way too long, so I edited it out.)

Basically, after trying as best I knew how, to confirm that the hospital accepts medicare assignment, I was bulldozed into signing an ABN on Thursday.

When hospital customer service called for pre-op questionaire, I asked if the hospital accepted Medicare assignment, and got a yes answer. After a pain filled two week wait for surgery, after check in on day of surgery, an hour and a half before everything was scheduled to happen, I was presented with an ABN for a blood test which they said they needed, had just called on, and Medicare was not going to cover. In addition I thought it was priced pretty high.

I was angry enough to strongly consider saying I did not want the test, but not waking up from surgery and/or more painful waiting and rescheduling transportation were challenges I decided not to cope with.

I hope that Medicare will actually make a decision to cover the test so I don't have to get into arguments with the hospital about it.

 

[somarco]

Medicare approves claims on the basis of medical necessity. If the claim is coded properly (by Medicare standards) it should be paid. If not, they won't. Claim denials by Medicare can always be appealed.

 

[LostDollar]

Thank you.

I hope that when the test goes to Medicare "in context" with all the line items for the surgery, it will be approved. If it's not, I may be asking for some pointers on Medicare coding and appealing.

I do have another "claim set" (different surgeon/facility) for another operation from 4 weeks prior I can use for some comparison purposes if necessary.