Medicare Denial of PSa Test

[Don_1213]

Imagine my surprise when a recent Medicare statement showed they denied coverage for a PSa test, stating that it hadn't been a year since the last one.

I've never seen this before., And I didn't pay since it was a denied coverage, Quest had to eat the cost - it's as if Quest did something wrong. I know on the prescription form for the test (done as part of a large battery of blood tests I get every 6 months by my GP) it specially called out "prostate cancer" as one of my diagnosed maladies.

Anyone else had this experience? I'm temped to call Quest and see what they think. I can imagine a scenario where they only would do the test if I guaranteed they'd get paid. I'd rather not have that happen.

The statement has a small form to file a protest, with no details of how to file one - or what documentation is needed, they just say to attach documentation to the form.

Duh... really rather annoying since I'm probably going to start TRT* shortly, and the intent is to start it with monthly PSa tests to make sure the T doesn't wake anything up.

*TRT is even more likely based on the results of a study I referred to in another post..

[mrscruffy]

Happened to me just 2 weeks ago. MO ordered different scans that showed all good. Same reason given

[MoonRocket]

Seriously, how expensive is a PSA test? If you get one every 3 months ...maybe $320 a year...but one is paid for so $240 a year. Let's face, medicare cuts are coming in one form or another....reality bites.

[Don_1213 in reply to MoonRocket]

In the case of TRT it will start out with a PSA test every 2 weeks. If in several months the numbers don't change it will be reduced to a PSA test monthly. I'm not sure when the tests will back off to every 3 months (possibly never) - but they would start to add up (Quest bills Medicare $162 per test - Medicare used to pay about $7.)

I just spent about 30 minutes in a chat session with Cheryl from Medicare, where I learned she couldn't see what I can see, she could see things I couldn't see on line, which indicated to her that Medicare reversed that decision and paid the PSA test claim.

I found the original prescription from my MD for the test - and it's all in the coding. Whoever wrote it up at his office used the code for an "Annual PSA Screening Test" for someone who was at risk of PSA. That doesn't cover tests for someone who has been diagnosed with PCa. I explained this to Cheryl and she couldn 't see that information, so she thanked me and ended the chat.

In the future I guess I'll have to request the prescriptions for bloodwork and then go to a coding website and determine if the codes given for the tests will be allowed by Medicare.

It had absoluely nothing to do on "medicare cuts" - it ended up being a coding error.

[MoonRocket in reply to Don_1213]

In that case you're embarking on an unapproved treatment. Why would medicare pay for your PSA test? That would be a misuse of taxpayers dollars, No?

[Don_1213 in reply to MoonRocket]

And your treatment: healthunlocked.com/advanced... - "standard of care"?

No? Are you paying out of pocket for all the PSA tests?

[MoonRocket in reply to Don_1213]

I am SOC. I also have a high deductible health plan and I'm only doing 4 PSA tests a year.

[Mgtd in reply to Don_1213]

I pay for the ones the Dr does not prescribe. I do that between the 6 month ones. Cost is $40. Money well spent in my mind. That is $80 a year.

[Worked_the_World]

I want to monitor my PSA closely. My Oncologist is helpful and orders adequate tests. However, I have paid for a couple of my own as well. The cost is $69.00 at Labcorp. It is simple. Sign-in as a patient, order the test, show up at the appointment, and receive the results the next day.

I would not let some bureaucratic denial prevent me from following my PSA closely.

[6357axbz]

Over 7 years living with PCA I have never had to pay for any of my labs (which always included PSA). Medicare, Florida Blue Supplemental Plan F and Blue Medicare Rx (PDP) part D drug plan. There were times when my MO ordered monthly PSA labs. Mostly, like now, it’s every three months.

[NanoMRI]

Based on my experiences self-direct and self-pay via RequestATest/LabCorp is some of the best money spent and return on investment I have realized over the last ten years. Since my RP nearly nine years ago I prefer to be an elitist show off so I test bi-monthlyish with the 'top-of-the-line' more expensive ultrasenstive PSA test, using different labs across many states as I travel in my RV.

Helping support phlebotomists across the West is my motto!

[j-o-h-n in reply to NanoMRI]

Of course............ they can get blood out of a stone......(or even if you're stoned).

Good Luck, Good Health and Good Humor.

j-o-h-n