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Has Medicare Turned You Down? CFSAC Wants Your Story

Discussion in 'Finances, Work, and Disability' started by Mark, May 27, 2013.

  1. Ema

    Ema Senior Member

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    The problem with Obama care is not that it exists...but that it doesn't go far enough towards real reform of our broken insurance and health care system. If anyone should understand why health care should not be tied to employment, it is us! I can't understand why we are not all screaming for a single payer system. It's not perfect but I'd rather support sick people with my tax dollars than make corporate entities richer.

    Ema
    jimells and Valentijn like this.
  2. jimells

    jimells Senior Member

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    northern Maine
    What's an 'ABN'?

    I don't even know exactly how I came to have a commercial relationship with Labcorp. I went to a doctor's office. They told me what their fee would be, drew many tubes of blood, and sent me on my way. Nobody told me exactly what tests were ordered, or from who, or how much it would cost. Now I have the doctor's exam copay plus a notice from Medicare that I can be billed hundreds of dollars for tests. The tests were done in early June. Two months later, I still don't have a bill from Labcorp.

    I don't know which tests were denied, since the description on the Medicare notice is too brief, but it probably was for HHV-6.

    For the appeal, do I need to write a legal-style brief, with references to research, and include the research as exhibits? I don't know how I'll have the strength to do all that; I've been real sick recently.

    The structure of the relationships between patients, the doctors, and the labs is totally unfair to patients, and I wonder how it can even be legal for a doctor to essentially subcontract work to other entities without my permission, and then those entities expect me to pay their invoices. I have a contract with the doctor; I don't have one with three different labs I've never even heard of.

    When I go to the pharmacy to buy drugs, I don't pay the pharmacy for their services and then pay the drug distributors separately. When I take my car to a repair shop, and they have to buy parts, or send a part to a machine shop, there is just one bill from the repair shop. The parts store and the machine shop have to get their money from the repair shop. They don't send me the bill.
  3. jimells

    jimells Senior Member

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    northern Maine
    Oh boy, I received another Medicare notice today. These tests from an entity called "System Coordinated Serv, Boston, MA" were also denied coverage:


    Ferritin (blood protein) level (82728-GA) $43.00
    Iron level (83540-GA) $21.00
    Iron binding capacity (83550-GA) $26.00

    The footnotes for all three tests state:
    "The information provided does not support the need for this service or item"
    "Our records show that you were informed in writing, before receiving the service, that Medicare would not pay."

    I suppose the first footnote is a hint that the proper diagnosis code was not included. The second footnote is just plain wrong, or a lie. I assume this sort of mistake fraud occurs routinely, since there is no reason to believe that the Medicare processing companies are any more honest than the rest of the U.S. financial industry,

    It will be interesting to see if the doctor's office will help me resolve these denials.
    Valentijn likes this.
  4. Ema

    Ema Senior Member

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    ABN is an Advance Beneficiary Notice.

    http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=191

    I totally agree with everything you wrote about how unfair it is.

    I would not worry about the appeal until you are presented with a bill. Sometimes they never come for some equally inexplicable reason...

    Ema
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  5. Ema

    Ema Senior Member

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    That note about being informed in writing is usually signing the ABN. I've only signed these at an actual Labcorp facility. At the doctor's office, they just make me sign the lab sheet.

    I think the doctors office should be your first step but again, I would not sweat about it until you actually receive a bill.

    Ema
  6. Ema

    Ema Senior Member

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    So I have spent this afternoon filling out an official Medicare appeal form in response to a bill (what the heck was LabCorp doing if not appealing officially for the past 6 months!?!). I will let you all know if I have any success with it.

    Ema
  7. Nielk

    Nielk

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    Queens, NY

    Ema, does LabCorp usually accept Medicare?I am not familiar with LabCorp. I use Quest Diagnostics for all my labwork and I don't usualy have a problem with them and Medicare coverage.
  8. Ema

    Ema Senior Member

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    Yes, they do accept Medicare at LabCorp. Generally when you get there, they make a list of all the tests that might be covered if your diagnosis codes are right and all the tests that Medicare definitely doesn't cover. Then they make you sign a paper (ABN) saying you will pay the full retail price if Medicare doesn't reimburse. It makes no sense why you wouldn't be able to pay the Medicare price at least. And then when Medicare declines to pay, they get nasty on you, saying that you signed the paper so PAY UP!

    I did just read something that indicated that an ABN isn't valid if they make you sign it immediately before services are performed. I don't know if anyone has ever tried for that angle though. I presume it would be a hard row.

    I will have to check out Quest. They are always packed and don't take appointments around here though. Maybe because they don't make you fool around with Medicare coverage!

    Ema
  9. taniaaust1

    taniaaust1 Senior Member

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    Sth Australia
    Thou Im in Australia, I'd like to say I won a dispute with a big pathology lab this year.

    They billed me for something I hadnt been warned I was going to be billed for, which I had every reason to believe was going to be covered by medicare.. as it always had been in the past (then crazily they couldnt even tell me what exactly the bill was for, they said it was for something other then what was done). Anyway, I ended up making more then 3 different phone calls to them (one person put me onto another who put me onto another and I ended up back at the first person!!), I wasnt going to pay for something I wasnt warned wasnt covered. In the end they relented (after I used up so much of their time angry at the unfairness of it, blamed the lab for not telling me.. I'd actually been mislead by someone when I'd been trying to find out costs).

    They were very reluctant but ended up saying they would cancel the bill but told me they wouldnt do so ever again (that's fine with me, at least I now know). (they said that after I told them they'd have to take me to court for the money as it was "principle" why I wasnt going to pay it, I told them if it went to court I'd do them for all the time spent on my mobile trying to work out even what bill was for, and also for making my health worst due to stress) They were tough to deal with even thou they themselves had previously given me wrong info when I'd enquired (I'd previously rung them TWICE before I even had the test done just to try to find out about things to do with the test but they still didnt inform me of the fee I thought was covered.

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