Has Medicare Turned You Down? CFSAC Wants Your Story

[Ema]

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]

I have basically decided not to ever sign an ABN at Labcorp if they say they won't cover tests because I don't know how to win an appeal.

PS It looks like that was for the HHV6 test.

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.

 

[jimells]

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.

 

[Ema]

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.

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

 

[Ema]

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.

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

 

[Ema]

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

 

[Nielk]

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

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.

 

[Ema]

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.

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

 

[taniaaust1]

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.

 

[Horizon]

This is very frustrating because I thought Medicare was gonna be the awesome insurance policy that would cover everything and I wouldnt have to worry. I am quickly learning it's not the fantastic. My private insurance covered so many tests that I am glad I got done before getting on Medicare. That being said, some things they would not cover Medicare will so I guess it is just a matter of what tests but I hope I don't end up with a lot of surprise bills.

 

[Vincent]

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!



Ema

It makes sense because those without power (poor and the uninsured) subsidize those with power (assets,insurance). This is true in all facets of medical and dental care in the United States.

 

[*GG*]

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

Oh, is that why I am getting bills from Quest now, for hundreds of dollars. My Obamacare insurance is Harvard Pilgrim out of MA. I don't get bills for anything else, and of course I have to pay out of pocket to see my specialist. Hopefully I will have my old insurance back soon, when my disability gets approved.

GG