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Shocking Discovery

Monday, April 04, 2016

When I got the mail today, I opened an invoice from the lab where we go for our bloodwork and was shocked to receive an invoice for over $400. It seems that Medicare denied pretty much all of the bloodwork our dr ordered for our annual physical. I could not believe they would not pay to check the cholesterol and triglyceride level on someone taking meds for both and meds for HBP. Then he had never checked my A1C but my fasting blood sugar was on the cusp of me being diabetic the previous visit so this time he wanted to check it to get a better idea of where I was but no, they didn't cover that either. I could understand not wanting to pay for my ferritin level but it too needs checked because my body doesn't always get rid of the iron and at one point it was thought I needed to have blood drawn to lower it. This can be very dangerous if left unchecked and I would think they would rather take care of things and be on top of a problem. It leaves me wondering why I am spending over $300 a month on medicare, a supplement and Part D coverage if nothing is covered anymore.
I did go in and talk to my dr's office manager and she is going to try resubmitting with some different codes but wasn't too confident the outcome would be any different! I will be using a different lab going forward that isn't nearly as expensive. I used them when I didn't have insurance.
So, I guess what I am trying to tell everyone is if you are on Medicare, check with your dr before submitting to a blood test. Know what your lab charges and find out if the test is essential. Everything is changing and it isn't for the better!
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Member Comments About This Blog Post
    Such a thing would be a shock when you have what is considered such good coverage. Not having seen the bill, I am at a loss as to why all was not covered. I hope the resubmitted claim from the doctor made a huge difference in your favor.

    I was surprised at my annual physical early this month, when my doctor wanted me to have two injections & said that my insurance may not cover the cost, so we might be getting a bill. However, since I needed them, I okayed having the bill sent, if they were not covered. When I got home & told my beloved MrV about the possibility of the injections not being covered, he was of a mind that they would be. So far we have not received a bill for either.

    I am with you in that, when we pay heavily for good insurance coverage, it should do what was promised by the insurance salesman. So far ours have paid everything & for that we are grateful to the Lord God Almighty.

    God bless you with a good & fair result concerning that issue!

    1763 days ago
    Wishing you the very best with this. Sure is getting scary with insurance companies now. I will be more aware of testing and if my insurance will cover it!
    1783 days ago
    There must be another code the office can use.
    Sometimes it is such a trick to get the right one.
    1786 days ago
    I hate dealing with insurances!!! It can become a nightmare! emoticon
    1788 days ago
    Sorry to hear this, it's sad you work all these years and then when you need it it won't cover what you need. Hope it gets straightened out soon. emoticon
    1788 days ago
    I was told since I am a few years older than my Husband that I can not get
    Medicare,but yet my Husband has done received his.This whole system has
    totally changed.Something needs to be done especially for Baby Boomers! emoticon Hope it gets worked out for you. emoticon
    1788 days ago
  • no profile photo CD16070360
    I have Humana Part F as my supplement . It covers all of that.
    However, I am facing a problem that to fix would cost $1100 dollars per pill for 3 months. Only Medicare D would cover that, but I do not have that. My wonderful Humana plan does pay for that particular pill. Strange!
    I was thinking about changing to Med. D, but from what you said, I don't think so now.

    Best wishes for your health
    1788 days ago
  • FROSTY99
    Update-talked to dr and office manager this afternoon and they are having Quest resubmit with different codes and hoping they will now pay for the tests. Will keep you posted. However, they told me they have been inundated with nearly 1,000 pages of new rules, codes and other paperwork his office is trying to make sense of. It is no wonder there is so much confusion. I guess no one ever heard of the KISS rule in Washington-Keep it Simple Stupid!
    1788 days ago
  • CHEVY63
    Sorry to hear about this hassle! Hope the office manager can help clear it up.
    1788 days ago
    Have to sign up for Medicare this year. Guess I'd better get all my tests done before my birthday!
    1789 days ago
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