Coronary artery calcium scan?
A lipid blood test?
Coronary artery calcium scan?
I just had the calcium scan and it isn’t covered. It cost $120 here in TX. I don’t know why it isn’t covered by Medicare…doc
Have you read something recently that says they don’t pay for those?
I can understand the calcium scan. Even after 20 years their efficacy/usefulness is so-so among the medical establishment.
A lipid test? Maybe they wont pay for it if you have no symptoms and no known heart disease? I had a heart attack 2 years before medicare and since going on MC every time I see my GP they do one. (Also, the 2 times went to the ER for what turned out to be nothing.) Perhaps it has something to do with cholesterol/triglyceride levels being called into question in recent years…? That’s what I’ve been hearing ever since my heart attack that seems to have been caused by nothing to do with anything. That’s what everybody’s been telling me, including two different nurses I’ve seen. They had their own heart attacks.
Why people need these things paid for by a Big Daddy type is strange to me, I will admit. The lipid test is not expensive. Pay for it OR get one of those not-put-a-man-on-the–moon-accurate-but- close-enough home test things. The calcium score test, I believe, is down to about $200.00 and doesn’t need to be done every year, so that’s not all that burdensome. I paid for one myself when they were fairly new. $450. I didn’t think it was all that much.
For a dozen years, I have been generally satisfied with the service from Beaumont Health System in metro Detroit. Last year, Beaumont merged with another system in Grand Rapids. My first concern was how much service will be degraded as a result of the merger.
Last March, the Doc recommended I have an abdominal aorta aneurysm screening, which Medicare will pay 100%, for one screening in a lifetime.
Three weeks later, I received a bill from Beaumont for over $223, net of what Medicare paid. I printed out the information from Medicare’s web site saying that screening is covered 100%, no cost to the patient, and the instructions for how to code it so Medicare will pay cover 100%, and trotted down to the Beaumont clinic where my GP works, and showed him the bill. His first response was “they charge $1500 for that? that’s BS”. And regarding the bill “Don’t pay it”. Then he took the information I brought and went to the head of their billing department.
The billing person came out, said I was right, it had been billed to Medicare wrong, and they would rebill it. I had her put that in writing. That was April 14th.
Several weeks later, the charge for the screening was still on my account. I messaged Beaumont. The billing person from the clinic replied that the rebilling is still in review.
Last week, I received another e-mail from Beaumont, about 30 days after the initial erroneous bill, warning my account is now past due.
I messaged them back they better get this straightened out before their error damages my credit rating and reputation.
As I feared. Management wants to prove the merger was worth the expense, so they apparently have gotten rid of anyone with a brain in their billing and customer service departments.
Correct on the first. Medicare … along with a good many insurances, apparently…don’t cover CAC scans. Yet. Not sure why…certainly a useful tool when it comes to decision making in whether or not to start a statin, say. For but one example…
“A lipid test”. Not sure what you mean by that. Every one of my tests…Total cholesterol, HDL-C, LDL-C, VLDL-C, triglycerides (these are your standard profile) … plus Lp(a) and Apo-b lipoprotein last year (from Peter Attia’s many podcasts on lipidology) all covered.
None of the above tests are super expensive. So I think you must be mistaken unless there’s some super new lipid test out there. I don’t need to look any further beyond the elevated Lp(a) and Apo-b to find out the causative agents for my ASCVD.
I’ve experienced that before. What they do is drag their feet after telling you to not worry about it. Nobody wants their credit rating or reputation to suffer. So, many just opt to send in a check to get it over with. Then, sometimes, they try to collect from the insurance anyway hoping you won’t notice.
Not by people who know what they’re talking about. Quite the reverse. Sure, there are still cholesterol denialists about with their own following and …much like anti-vaxxers … they seem to have a strong presence in the internet echo chamber.
The role of individual lipoprotein particles in initiating atherosclerotic plaques…like Apo-b, for instance…is well understood. Of course, if it’s not measured (and it oftentimes isn’t), then the person with ASCVD won’t know a darn thing about it…or their disease status…if they listen to the cholesterol denialists and statin averse. Until they have their heart attack. Sudden cardiac death is still a common first sign of coronary artery disease, apparently.
I had a lipid profile in early April and my supplemental insurance paid for whatever Medicare didn’t cover on Part B…doc
Can’t help but wonder what a lawsuit for reputational damage would bring? I do have everything documented: it is free from Medicare, their billing person agrees they billed it wrong. I also printed out my clean credit history from Experion and my FICO score, as of late April, so there would be no doubt the damage done was entirely due to them.
That would be the co-pays only, though. Your supplemental doesn’t cover anything that’s not a Part-B covered service, so whatever your lipid panel involved everything on there must’ve been covered by Medicare.
Just remembered that, in addition to requesting Lp(a) and Apo-b be added to the Usual Suspects on my lipid panel, I also asked for circulating insulin. I really wanted to exhaust all possibilities of this “mildly elevated LDL-C” putting me at risk of ASCVD. Again, no reason to suspect any metabolic dysfunction/insulin resistance from clinical signs and previous metabolic panels…but you don’t know until you check. Insulin resistance can be the canary in the coal mine. Turned out to be nicely low with a calculated HOMA-IR (by dh, so I trust it) of 1.28.
Mention this because, once again, it’s an example of a test being covered by Medicare … in spite of there being no superficial reason for checking.
My cardiologist ordered the scan after tracking a-fib and cholesterol levels.
My oncologist ordered the lipid test, as a follow up, post bone marrow transplant for subsequent systemic issues due to graft vs host disease.
Medical care, ordered by doctors, should be covered by insurance. (aka, Big Daddy)
And if doctors order unnecessary tests, maybe take it up with the doctor, not the patient?
The system is a shambles. If you want to appeal, a third party, Novitas, is there to offer more resistance.
So, what you’re saying is Medicare doesn’t pay for these things EVEN WITH the doctor’s perfectly good medical reason for wanting them? If that’s the case then I can say I guess I misunderstood the focus of the original post.
Sounds like electronic wire fraud to me. As it seems organized and is electronic wire fraud, it might fall under the RICO act. A nice group law suit with disclosure attempting to prove organized crime
should be interesting.
It depends on what diagnostic code your doctor entered to justify the test. I’ve had at least 2 chloresterol tests since I started Medicare and my lipids are fine. No problem with Medicare covering the test.
I’ve had about a half dozen of those warnings saying that a test isn’t covered and that Quest will bill me $400 for a $60 test if I have Quest do it anyway. I always decline the test. If my doctor really needs it, I can come back when they’re sure they’ve entered the right diagnostic code to justify the test.
You need to keep your medical professionals on a short leash.
Caution is advised in a situation like this. An insurance company might decline a test that your doctor thinks is crucial in the event of a diagnostic conundrum where a set of unusual signs/symptoms are present but not conclusive … tests to "rule out … ", for example. An erroneous diagnosis to justify a test wouldn’t be a good idea to have in your medical history.
In fact, when I requested my Lp(a), Apo-b and insulin as add ons, I was well aware of the potential for this (I regularly get earache from the husband on just this topic) and actually mentioned to my new PCP that, if necessary, I would pay out of pocket (like she’d warned me re: the CAC scan) For whatever reason…and when all this was going on… my lipid profile per standard (and somewhat outdated parameters) was “only” borderline high and nothing about me screamed metabolic syndrome.
Medicare tells you up front if something isn’t covered with an Advance Benefit Notification (ABN). A for-profit insurer won’t tell you up front if something is covered without a lot of time wasted on the phone with them. And even then, they could tell you the wrong thing and it still wouldn’t be covered.
Now that I’m on Medicare, I don’t have to worry about medical underwriting and what kind of diagnosis is on my medical record. I’m fine with my doctor doing whatever he has to, to make sure I’m not screwed financially.
I’m a bit more circumspect in this regard. I want my documented medical history to be spot on accurate…or as close as possible. The obvious reason being that I (like everyone else) can’t be 100% certain of what might befall me in the coming years. In the hopefully unlikely event that someone who doesn’t know me or my medical conditions needs to make a speedy decision, I want that decision to be based on an accurate set of facts.
As a provider for many years, Medicare doesn’t pay for a lot of things. But I wound up doing them anyway because it was the right thing to do for the patient.
Good for you. Did it make a significant difference to your income? My husband has always followed this doctrine…but, then again, he could “afford” to since he has always worked with a pre negotiated salary.
I, on the other hand, never did (well, hardly ever) In private practice, pretty much the only source of income to pay for everything that had a dollar cost from the moment the patient pulled into the parking lot was down to me.