Medicare nor Medigap paid for a Vitamin D test

[sengsational]

@athena53, LabCorp made me sign the "Advance Beneficiary Notice" (I guess that's what they called it) when I did my blood draw. They flagged that fact on the MSN, and I was firmly on the hook for the expense. This wasn't a wellness visit, and not a routine health monitoring test. Naively, I thought that, given the test was standard for the diagnosis code, and "worked" with regular insurance, it would work for Medicare. I've had the same test twice since, and the last time they didn't make me sign.

But in your example, I guess the lab has to eat the cost?

I think the moral of the vitamin D and lipid panel story is say "Call the Doctor", when they whip out that form. The doctor can change the diagnosis code. Probably the code is "wellness visit", and that doesn't cut it.

 

[FindingForward]

Interesting they gave you the negotiated rate. If my pre-Medicare insurance (regular ACA policy) rejected a lab, I was charged the fully inflated price, and my single experience where Medicare rejected a lab, I was charged the fully inflated price. When I say "fully inflated", it seems it's roughly 3 to 5 times "street price" (hehe), where street price is what I could get it if I got it directly, without a doctor. I think they're making up for the times when they get stuck holding the bag. That's happened a LOT in the last few years. I see that they "ate" the cost of some lab test and they didn't come after me for it. Gotta make up for those somehow, and I think it's to hit the patient with fully inflated pricing.

Sorry to hear you had to overpay like that. Doesn't seem right. I'm on a HDHP - so 100% out of pocket until I meet deductible. But I always am charged the insurer's negotiated rate with that provider on all services - it's always discounted down from what the provider originally tries to bill. There's just no co-insurance until deductible is met.

 

[pacergal]

CPT code and associated diagnosis codes will determine whether or not labs are covered along with what your insurance plan covers.

 

[audreyh1]

I think some doctors offices are better at handling this than others. Our PCP seems good at it. DH hasn’t had any billing issues with blood draws on Medicare except for 1 year where he did a PSA test slightly less than one year prior. No issues with any of the other routine tests.

 

[MarieIG]

Wow, that was crazy high. I'm not on Medicare yet, but Vit D was included in my blood panel the last few years by my medical oncologist. I was not charged . . .

I recall DS #6 being Vitamin D deficient - and being prescribed high dose vitamin D. I don't recall being charged for his test.

 

[athena53]

@athena53, LabCorp made me sign the "Advance Beneficiary Notice" (I guess that's what they called it) when I did my blood draw. <snip>

But in your example, I guess the lab has to eat the cost?

Yes, they did. Huge sigh of relief. There were a lot more fun things to do with $800.

My doc's office was not good at coding. On an annual exam they billed for "manual breast exam and Pap smear" and Medicare denied it because I'd had a Pap smear the year before. I called and asked them to code the two procedures separately and re-submit. They never did. It was $60 so I paid it and got another doctor, which was a shame because I really liked her. This office would also order blood draws and I'd get to the hospital lab, fasting and grumpy, at 8 AM and they were never able to find her orders in the computer and had to wait till her office opened at 9. Once I specifically requested that they mail me a copy of the orders. They didn't arrive in time.

I'm grateful I can order my own and pay out-of-pocket (I get a bit of a tax break from itemized deductions) and there are no surprise bills.

 

[MichaelB]

I think they're making up for the times when they get stuck holding the bag. That's happened a LOT in the last few years. I see that they "ate" the cost of some lab test and they didn't come after me for it. Gotta make up for those somehow, and I think it's to hit the patient with fully inflated pricing.

I think they’re charging more just because they can, and even if insurance doubled their reimbursement rates they’d still charge those prices for uninsured patients. That’s my experience with LabCorp.

This is why it’s so important to make sure a test or procedure is covered before doing it.