Have You Had Medicare Deny Paying For Lab Tests?

L

Lon

Well-known Member
Location
Central California
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.
 

CeeCee said:
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.
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I didn't think you were old enough for Medicare CC
 

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.
 
terry123 said:
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.
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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.
 
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.
 
Plan C and D

Lon said:
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.
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That is just proof in the pudding why I stopped my senior advantange. Go on You Tube and look at the videos telling us not to get Part C. It's just another way for insurance comanies to get richer. When something comes up they will say they don't cover it.

As far as Part D- I use Good Rx for everything and I take meds on a daily basis. I pay dirt cheap for meds.

I don't a vast amount of research on this topic.
 
I asked my doctor about this one time as he had ordered extensive thyroid blood tests and I was afraid my Humana Medicare plan would not pay. He said that usually the problem is the coding of lab claims. He said as long as the doctor said it was necessary and the coder billed the claim correctly, Medicare should pay. Everyone of mine were paid in full. I worked Medicare collections for 15 years in a hospital before I retired. When I had a lab claim denied which was seldom, I went straight to the coder who would submit a corrected claim and it would pay. Good coders are in demand and get paid great salaries. A practice or doctor cannot stay in business without a top notch one. Medicare coding is very tedious and demanding with all of their rules, etc. An elderly friend of mine had his lab work denied for the same explanation. I went online, checked the EOB, called his doctors coder, had her correct her coding and all claims plaid in full. He has regular Medicare and did not pay a cent.
 
My Medicare advantage plan pays for all my lab tests, x-rays, etc. Neither my sister nor I (we both have the same plan) have ever had any problem with it. She has had some of the more big deal tests, mine have been just routine stuff.
 

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