A question about ethics

[Time2]

After some elevated while blood cell counts I had a bone marrow biopsy.
The biopsy was sent to a genomics laboratory for analysis.
The service was not approved by Medicare, I don't know why, as it seems as though the 10 page report was key to understanding my diagnosis. The medicare statement also says, "If the laboratory knew Medicare would not pay for this item, and didn't tell you in writing before providing it, you may be owed a refund."
I'm a bit perplexed, I have not been billed, I have not paid anything. I was actually out of the loop, the cancer doc took the biopsy and that is as far as I was in the loop, they sent it somewhere (to the genomics lab) and had it tested, they had my name but I doubt the had any further info on me, as no more identifying info is on the report.

The lab only charged $233.00 dollars for the testing that covered a lot of genetic information. (Hey, I'm a Male!) I know the biopsy was probably put in a machine and it spit all the data out, but a person still read that data and came to, if not a conclusion at least a narrowing of possibilities.

Will the Genomic Lab follow up to and try to get Medicare to pay? Or is that something I should do? It's now 5 months after the testing, and just received my Medicare Summary Notice.

Would you pay a bill that you have no legal responsibility for.

I think I might, they did what was ask of them, I think they should get paid.

 

[aja8888]

Are you on a Medicare Advantage plan?

Straight Medicare?

Do you have a Supplemental insurance plan?

Ask the lab submit the bill to Medicare again. Make sure they have your Medicare number.

Strange that you have not received a bill after 5 months.

 

[target2019]

Something like this happened to me early in my diagnosis. I was in surgery, and the report came later. It was inconclusive, so essentially the biopsy and test were inconclusive and worthless.

The lab billed me once or twice, but then said it was a mistake. I assume the hospital eventually ate the cost, as nothing further came out of that with regard to payments.

The hospital or doctor was supposed to use an approved medicare provider, and did not. Their insurance specialist(s) are supposed to clear all of the red tape and let me know ahead of time if we're experimenting.

 

[pb4uski]

Was this in 2022? The $233 that you were charged happens to be the same amount as the 2022 Medicare Part B deductible. Coincidence? I don't really believe in coincidences.

What does the Medicare EOB say? Had you already met your 2022 Part B deductible?

If you have MA or Medigap that you bought through Boomer Benefits then they may be able to help you figure it out. Give them a call

 

[Time2]

Are you on a Medicare Advantage plan?

Straight Medicare?

Do you have a Supplemental insurance plan?

Ask the lab submit the bill to Medicare again. Make sure they have your Medicare number.

Strange that you have not received a bill after 5 months.

Straight Medicare plus a Supplemental plan.

 

[Time2]

Was this in 2022? The $233 that you were charged happens to be the same amount as the 2022 Medicare Part B deductible. Coincidence? I don't really believe in coincidences.

What does the Medicare EOB say? Had you already met your 2022 Part B deductible?

If you have MA or Medigap that you bought through Boomer Benefits then they may be able to help you figure it out. Give them a call

I find this, when searching EOB.

"You only receive an EOB if you have Medicare Advantage or Part D. An EOB is not the same as a Medicare Summary Notice."


I don't have Medicare Advantage, I have a supplemental plan.
Good question on the $233, I'm not sure what I paid last year.

 

[street]

My thought is if you haven't meet deductible you may have to pay that bill. Wait for a bill and go from there is what I would do.

 

[target2019]

I find this, when searching EOB.

"You only receive an EOB if you have Medicare Advantage or Part D. An EOB is not the same as a Medicare Summary Notice."


I don't have Medicare Advantage, I have a supplemental plan.
Good question on the $233, I'm not sure what I paid last year.

$233 really sounds like a Part B deductible.

 

[Aerides]

Would you pay a bill that you have no legal responsibility for.

I think I might, they did what was ask of them, I think they should get paid.

In 2021 we had to call 911 for DH (no doubt needed, they were doing triage in the driveway - he's fine now).

The county ER/FD billed it wrong. We appealed, they resubmitted, months of back and forth and frustration. The county even told us they don't even go to collections, it's essentially an honor system to pay when insurance doesn't.

They didn't. We did. It was about the same amount as your situation.

 

[OldShooter]

... Will the Genomic Lab follow up to and try to get Medicare to pay? Or is that something I should do? It's now 5 months after the testing, and just received my Medicare Summary Notice. ...

My policy is this: I do not wake sleeping bears.

 

[Jerry1]

Would you pay a bill that you have no legal responsibility for.

No. And, I’d feel very comfortable using the clause that states they must notify you that Medicare will not pay against them. You might have done something different had you known in advance that your insurance would not pay. For example, many healthcare providers will substantially discount direct patient pay situation. You may have negotiated a better rate or you may have looked for another option to figure out your situation.

The lab knows that their services are not payable by Medicare and they know the rules of Medicare (this isn’t their first rodeo). If they had any ethics, they would have informed you. They don’t and you shouldn’t worry about your ethics. Enforcing the terms of an agreement (Medicare Regulations) is completely ethical on your part.

 

[Texas Proud]

Nope, I will not pay a bill that I had nothing to do with... nor one that I do not legally owe...

 

[pacergal]

If you did not sign an ABN (advanced notice of noncoverage), the lab can not bill you for the service.
At least that was the medicare rules when I was working and EPIC would highlight in red to have client sign one when the lab orders were placed.