Will Medicare cover tests?
Maxine, I spent a long time on the phone with medicare trying to discover this. After being transferred from one person to another for a while and waiting a long time, someone finally came on the line and told me that medicare never, ever says ahead of time what will be covered and what will not. She said you have to have the test and bill medicare. Then, when they receive the bill, they will decide if your test is "medically necessary". If they decide it is, they pay. If they decide it is not, they do not pay. Note: I am referring to original medicare. I do not know what medicare advantage plans do.
If Medicare pays anything toward this test, I doubt that it will pay the entire cost of the test. I've contacted VIP DX on this issue, but their answer is not clear at all to me. As I understand, if a lab or doctor is a Medicare participating provider, they have to accept Medicare's assignment, or in some states are allowed to charge 15% over the assignment amount. VIP DX says that they have a Medicare provider number, but they are not a "preferred" provider. I don't know what that means. They say that they are a fee-for-service provider. As a courtesy they will bill Medicare and secondary insurance, but cannot guarantee that Medicare will pay anything, and that the patient is responsible for any and all portions not paid by Medicare.
I don't understand how VIP Dx can have a Medicare provider number, and not abide by Medicare's rules of assignment or the 15% over assignment, if allowed.
So I think if you decide to take this test, that you better be prepared to pay the full bill. I'm in the same boat, i.e. I have Medicare and can't afford the tests if VIP Dx will not accept Medicare assignment.
I think it's unconscionable for labs that specialize in ME/CFS tests and doctors who specialize in ME/CFS research who will not accept Medicare assignment. They are basically turning their backs on the most severely disabled ME/CFS patients who are on Medicare and struggling to survive on near poverty level social security disability benefits.