I had some lab work done for my Nephrologist at 1 PM today. The computer at Lab Corp spit back about a half dozen tests saying that the diagnostic codes entered didn’t support a need for the tests. Lab Corp said they’d bill me $630 for the tests if Medicare denied the claim. I said fine and declined doing the tests in question. I told them that I’ll come back when everyone agrees on what the correct codes are. I then called the doctor’s office and the medical assistant said he’d talk to my doctor and see if they can correct it.
Anyway, by 8 PM this evening the lab results started trickling into my e-mail account, including the 6 tests I declined. I suspect that my doctors office corrected the codes and the 6 tubes of blood they drew from me was sufficient to perform the additional tests. Problem solved with little to no effort from me.
What are the odds I’d have the same experience with a United Health Medicare Advantage plan?
Given that the CFPB dropped cases against five financial institutions, does anyone think the government would hold United Health, or any other insurance company, accountable, for abusive practices?
Labcor has taking over managing lab tests for Providence Medical. They are settling in but it is apparent the employees are a step or two down from those that quit because of lower wages. Medicare or not.
It gets worse. Providence’s Clark County, WA Primary Care Clinics were bought out by Peace Health in January. Peace Health is a Medicare Advantage-only operator, and they booted LabCorp out of the Building. I learned that when I saw a sign on the front door to the clinic directing me to a location a few blocks away for LabCorp. I’m now getting my Primary Care from a Physician Assistant at ZoomCare, which is fine. I’ve still got easy access to specialists for the problems I’ve been diagnosed with – without the nonsense of “preauthorization” and “deny, defend, and depose”.
Just a word of warning…keep an eye on your patient portal to make sure that it really was a clerical error responsible for the initial denial in the first place rather than the addition of a disease you don’t actually have that would then justify the use of/reimbursement for the tests performed. The latter is not unusual.
Edit: …not just a phenom of Medicare’s reimbursement dictates. Most insurance companies don’t reimburse for tests… or treatment procedures, come to that…that aren’t considered “medically necessary”. I suspect a good many screening tests fall into this category.
Two examples of what have demonstrated themselves to have been of medical necessity in the experience of posters here…but are not routinely reimbursed for by Medicare…a Coronary Artery Calcium (even with evident dyslipidemia) and auscultation (a “laying on of stethoscope”) in that wellness check that takes the place of an annual physical in us chronologically enriched Medicare beneficiaries.
I have an Advantage plan from a company that uses United Health Care to handle all the “paperwork behind the curtain”. However, it is an independent company and they are moderately sized. Strictly regional (MN and pcs of surrounding states). Their policy is simple: If a lab/test is covered by Medicare, it is “no charge” to me. They learned that lesson the hard way (LOL !!). Posted it some time ago.
They’re not allowed to do that. If they don’t warn you ahead of time of the possible charge, and give you the opportunity to decline the test, they’re not allowed to bill you for it.
Notify the company their computer is infected and they need to replace all of it (hardware, new & different software, new employees throughout the business including different management, and so on).
I’m a bit the opposite…especially now. Knowing as I do that some tests might be important in diagnosis/decision making even if a third-party payer might decline it, I have made it clear when discussing upcoming bloodwork with my doctor that I was prepared to pay if Medicare did not.
Back when I asked for the more advanced testing to sort my dyslipidemia out, I was well aware that the CAC scan would be on my own dollar…ironic since it was probably THE most useful and eye opening test of the lot…wasn’t so sure about the Apo-b and Lp(a) or the circulating insulin. In fact, I was reasonably sure that, with an A1c routinely around 5.3/5.4 and fasting blood glucose rarely above 95, it wouldn’t be considered “medically necessary”. Seems it was covered.
Since so few patients presumably are willing to do this, and so few physicians bother explaining the rationale of testing, it’s so easy to fall through the cracks left by the limitations of standard testing/standard guidelines if one is non standard.