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Have You Had Medicare Deny Paying For Lab Tests?

  1. #1
    Join Date
    Jun 2014
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    Central California
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    Have You Had Medicare Deny Paying For Lab Tests?

    I just received a bill from a Lab for $577.00 for tests that Medicare would not pay for. The Lab says Medicare denied because the tests were not necessary based on physician's diagnosis.Supplemental insurance will not pay for claims not approved by Medicare.

  2. #2
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    Jan 2014
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    Fresno
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    I don't agree to any lab work or tests until they tell me how much it will cost me in co pays, if anything. I ask when the appt is made and I ask again when I'm there.

  3. #3
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    Quote Originally Posted by CeeCee View Post
    I don't agree to any lab work or tests until they tell me how much it will cost me in co pays, if anything. I ask when the appt is made and I ask again when I'm there.
    I didn't think you were old enough for Medicare CC

  4. #4
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    Jan 2014
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    Fresno
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    Quote Originally Posted by Lon View Post
    I didn't think you were old enough for Medicare CC

    I'm 66.

  5. #5
    Join Date
    Jan 2014
    Location
    So. California
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    7,694
    No.

  6. #6
    Join Date
    Feb 2016
    Location
    Houston, Tx.
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    917
    Lon, have your provider check the coding and resubmit. My friend had the same problem but he was seeing a NP who was doing the coding also and didn't what the hell he was doing. I got concerned a few weeks ago when my doctor was doing so much lab work and my renal specialists was too. I asked the PCP about it and he said with the proper coding there was no reason Medicare would not pay for it. They paid without a problem. Coding specialists are in great demand and some places try to cut corners and do it themselves. A good coding specialist that keeps up with their CE requirements can make a really good living. I know one that works at home for a hospital and they do everything they can to keep her. BTY, my friends claims were resubmitted after I told him about the coding and they were paid without a problem with Medicare. I have never paid for lab work and I don't have a supplement.

  7. #7
    Join Date
    Sep 2017
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    Sacramento, Calif
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    Quote Originally Posted by terry123 View Post
    Lon, have your provider check the coding and resubmit. My friend had the same problem but he was seeing a NP who was doing the coding also and didn't what the hell he was doing. I got concerned a few weeks ago when my doctor was doing so much lab work and my renal specialists was too. I asked the PCP about it and he said with the proper coding there was no reason Medicare would not pay for it. They paid without a problem. Coding specialists are in great demand and some places try to cut corners and do it themselves. A good coding specialist that keeps up with their CE requirements can make a really good living. I know one that works at home for a hospital and they do everything they can to keep her. BTY, my friends claims were resubmitted after I told him about the coding and they were paid without a problem with Medicare. I have never paid for lab work and I don't have a supplement.
    Yes, Lon...this^

    Worked for me, too. In fact, my doctor said, "What? What did I do here? ...Oh. What a dummy I am." He changed one number, and bam! Paid.

  8. #8
    Join Date
    Sep 2014
    Location
    Albuquerque, New Mexico USA
    Posts
    7,861
    Lon, I've never had to pay for lab tests with Medicare, and neither has my sister. Good suggestions above -- DO go back and see if the coding for the tests and the diagnosis is proper. I had a friend who had this problem, and, as Terry above said, it was improper coding.

    I'd also demand an explanation of why the tests were allegedly unnecessary. There's probably some coding glitch somewhere.

  9. #9
    Join Date
    Aug 2016
    Location
    Near Mount Pilot
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    Lon,

    These links may help you determine if the tests should be covered by Medicare.

    https://www.medicare.gov/coverage/diagnostic-tests.html

    https://www.medicare.gov/coverage/is...e-covered.html

    Good luck!

  10. #10
    Join Date
    Feb 2016
    Location
    Georgia
    Posts
    668
    Lon, I have. It was only a little over a hundred so I just paid it.

  11. #11
    Join Date
    May 2013
    Location
    NYS and Florida winters
    Posts
    10,206
    We use to co-pay $20.00 for our lab tests. Now, I see they no longer charge us. There are certain tests that United Healthcare won’t pay if I have the same test within a year. Nuclear stress test is one. Have to wait a year between them.
    Q: Why don’t mummies take time off?
    A: They’re afraid to unwind.

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