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Medicare: coverage of XMRV tests

Discussion in 'XMRV Testing, Treatment and Transmission' started by Rrrr, Dec 4, 2009.

  1. Rrrr

    Rrrr Senior Member

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    This thread is to see if medicare ends up covering the XMRV tests (any of them, anywhere)

    please post if you find that medicare does or does not cover your XMRV test, and please state what lab you used, and if you can, what diagnosis your doctor used for the test.

    thx!
  2. dannybex

    dannybex Senior Member

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    My guess is that it will take years...or at least more than one year.

    There are many studies that need to replicate the Mikovits study, confirm the results, and then even if it's determined to be a marker, they might even require more studies to show it actually causes CFS/ME...

    just my two cents. :)

    d,
  3. Rrrr

    Rrrr Senior Member

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    seeking update on medicare

    has no one even tried yet to get medicare to cover their xmrv testing?
  4. Lily

    Lily *Believe*

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    Medicare coverage of XMRV testing.......

    Oh yes, way way too early yet to expect this - so many things will need to be in place first as Danny said. Hang in there.....
  5. fairlight

    fairlight

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    I sent the form

    for Medicare to pay for my xmrv test through VIP.
  6. Rrrr

    Rrrr Senior Member

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    fairlight

    please let us know what the outcome is!!!! thank you.

    rrrr
  7. Tammie

    Tammie Senior Member

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    Woodridge, IL
    I have not tried to get Medicare to cover the test for a few reasons....

    -most likely they will be among the last to cover it, based on their typical coverage history

    -the tests are not really that reliable yet, having blood taken always makes me crash, I am not usually awake & functioning early enough to get to the appt with any ease at all, and we do not really have any treatments if we test positive anyway, so why go thru the stress (physical and emotional) at this point?

    -if I were to get tested and turn out negative for XMRV, I am worried that that will somehow effect my disability payments (like they could use it as "proof" that I am not really sick (even though I am very sick) and then turn around and say that I do not deserve SSDI
  8. Rrrr

    Rrrr Senior Member

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    has anyone gotten tested for xmrv and found medicare was willing to cover the testing? has anyone been turned down from medicare re: paying for the testing?

    rrrr
  9. sleepwalking

    sleepwalking

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    Wild Wild West, US
    Medicare has been billed for my test. I'm awaiting decision. I will post when I hear something.
  10. Rrrr

    Rrrr Senior Member

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    thank you!!! many of us eager await your next post.

    rrrr
  11. OurDayWillCome

    OurDayWillCome

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    I have been checking the VIP site occasionally since they are updating. I want to order the test when they are back up. Decided to check some of the other pages today, and found this:

    Although it does state elsewhere that you may have to pay if Medicare does not.

    http://www.vipdx.com/resources/client_services/
  12. Cloud

    Cloud Guest

    I narrowly missed getting my test done for free as part of the research group back in October. I think they shut that door the same day of my draw (October 11th). Anyhow, I was put into the public paying group, and having MediCare, I asked VIP what would happen for billing. VIP told me that MediCare doesn't normally pay for new tests like that, but they were going to attempt billing anyhow. They even plan to appeal if denied. So, it's been 3+ months since my test and I'm yet to hear anything from VIP.
  13. Rrrr

    Rrrr Senior Member

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    Ross, please keep us posted!

    Meanwhile, I emailed VIP and got this reply:


    -----Original Message-----
    From: Rrrr
    Sent: Wednesday, February 03, 2010 6:56 AM
    To: info@vipdx.com
    Subject: inquiry

    hi,
    a while back when i inquired about if medicare was covering the xmrv
    test, i was told it was too early to tell. can you tell me if, in
    general, patients are having success with this? i know you can not
    guarantee it, but in general, is medicare covering the test?
    _____

    Date: Wed, 03 Feb 2010 10:16:24 -0800
    From: "Marguerite Ross" <Marguerite.Ross@WingfieldNevada.com>
    Subject: RE: inquiry
    Thread-topic: inquiry

    In general, we are seeing a $51.25 reimbursement on the $450 test.

    Marguerite Ross, Director
    Marketing & Client Relations
    VIP Dx / RedLabs
    5625 Fox Ave - Rm 369
    Reno, NV 89506
    775-351-1890
    Fax: 775-682-8517
    www.vipdx.com
  14. Hysterical Woman

    Hysterical Woman Senior Member

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    Hi Rrr,

    Thanks for letting us know. At least that is "something". Hopefully that amount will increase as the tests become less experimental.

    Take care,

    HW
  15. Rrrr

    Rrrr Senior Member

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    more info from VIP



    -----Original Message-----
    From: rrrr
    Sent: Thursday, February 04, 2010 9:36 AM
    To: Marguerite Ross
    Subject: RE: inquiry

    hi again,

    does it stop there, or do you re-submit to see if they will cover
    more of the test?

    best
    rrrr

    Date: Thu, 04 Feb 2010 10:14:24 -0800
    From: "Marguerite Ross" <Marguerite.Ross@WingfieldNevada.com>
    Subject: RE: inquiry
    X-Env-Sender: Marguerite.Ross@WingfieldNevada.com

    That is after appeal and that is their maximum pay out on this test.
    Keep in mind that they also base reimbursement on "medical necessity"
    (is this test necessary based on the diagnosis (diagnosis code) provided
    by your physician.

    Marguerite Ross, Director
    Marketing & Client Relations
    VIP Dx / RedLabs
    5625 Fox Ave - Rm 369
    Reno, NV 89506
    775-351-1890
    Fax: 775-682-8517

    www.vipdx.com
  16. Cloud

    Cloud Guest

    Good point on the medical necessity. But, it's kinda hard to prove medical mecessity for a new test that looks for a bug that is yet to be shown to cause illness or any other problems. But if it can be justified, I will surely be one who gets that recognition because my doc is a wizard with these insurance issues. I sure hope they are able to make it happen for all of us. VIP have gone above and beyond with these kinds of issues since I have been connected with them as RedLabs. They go beyond most labs. I really appreciate what they do for us.


    I thought the cost of the full xmrv PCR/Culture tests was over $600.00. I'll let ya'll know what happens with my billing.





    TE=Rrrr;42674]more info from VIP



    -----Original Message-----
    From: rrrr
    Sent: Thursday, February 04, 2010 9:36 AM
    To: Marguerite Ross
    Subject: RE: inquiry

    hi again,

    does it stop there, or do you re-submit to see if they will cover
    more of the test?

    best
    rrrr

    Date: Thu, 04 Feb 2010 10:14:24 -0800
    From: "Marguerite Ross" <Marguerite.Ross@WingfieldNevada.com>
    Subject: RE: inquiry
    X-Env-Sender: Marguerite.Ross@WingfieldNevada.com

    That is after appeal and that is their maximum pay out on this test.
    Keep in mind that they also base reimbursement on "medical necessity"
    (is this test necessary based on the diagnosis (diagnosis code) provided
    by your physician.

    Marguerite Ross, Director
    Marketing & Client Relations
    VIP Dx / RedLabs
    5625 Fox Ave - Rm 369
    Reno, NV 89506
    775-351-1890
    Fax: 775-682-8517

    www.vipdx.com[/QUOTE]
  17. Lily

    Lily *Believe*

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    I'm sure one of you out there knows something about medical billing that can provide more details.....but, blood tests are submitted using CPT and/or HCPCS codes aren't they? And when there is no code for a specific test then the appropriate "unspecified code", (or codes) is used. If all of the other coding is correct then the computer will allow the claim to fly through and pay the standard amount allowed for the unspecified code or codes, which is probably the 51.25 for Medicare atm.

    An appeal would get a human to look at the claim. So Medicare is either paying the unspecified code amount, or they have decided to allow $51.25 for XMRV testing (which I doubt).

    At least Medicare is paying something. It'll be interesting to see the explanation of benefits to see what coding was used and what was paid or denied. I suppose you could ask VIP what billing codes are used.

    I guess no one who's been tested has submitted the super bill that VIP provides to their insurance company yet? I would expect parts of it to be reimbursed, especially if they are using unspecified codes. In my case whatever is reimbursed would be at the out-of-network rate (which would be practically nothing) and would all go toward my out-of-network deductible.

    Still think it will be a while before there is a standard test that will be reimbursed. A lot has to happen.
  18. Rrrr

    Rrrr Senior Member

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    hi all,

    is there any new news in terms of medicare covering more for this xmrv testing besides the $51 (out of a $450 bill)? cloud, do you have any new news? anyone have any?

    cloud wrote: "I narrowly missed getting my test done for free as part of the research group back in October. I think they shut that door the same day of my draw (October 11th). Anyhow, I was put into the public paying group, and having MediCare, I asked VIP what would happen for billing. VIP told me that MediCare doesn't normally pay for new tests like that, but they were going to attempt billing anyhow. They even plan to appeal if denied. So, it's been 3+ months since my test and I'm yet to hear anything from VIP."

    best,
    r
  19. Rrrr

    Rrrr Senior Member

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    okay, i just called VIP and talked to jessica who answered the phone, who has been there only a few months. she thinks this is the current situation (she thinks!):

    lots and lots of patients are getting the test done and submitting the bill to medicare via VIP. medicare is still only paying $51 (for the $450 test that is a virus culture that takes 3 weeks -- the antibody test is still in development, she says). they will set up a payment plan with you if you can't afford the rest right away.

    she thinks medicare is paying the $51, period. and she does not think they are paying more upon an appeal to medicare for more.

    by and large, the diagnostic codes she is seeing coming thru her office are:

    780.71 Chronic Fatigue Syndrome
    780.79 malaise and fatigue

    I will also email Marguerite Ross again, too, just in case jessica got it wrong. she is at:

    Marguerite Ross, Director
    Marketing & Client Relations
    VIP Dx / RedLabs
    5625 Fox Ave - Rm 369
    Reno, NV 89506
    775-351-1890
    Fax: 775-682-8517
    <Marguerite.Ross@WingfieldNevada.com>

    - R
  20. Hope123

    Hope123 Senior Member

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    I suspect that it will be a while (perhaps long, hopefully not) before Medicare covers XMRV testing. There would need to be several studies showing causality and perhaps treatment availability before they cover it. As an example, it took the recent healthcare legislation to pass before Medicare covered long-proven preventive measures for the elderly.

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