Medicare question?

[NorasMom]

This has me so confused. I had several of my routine blood tests this morning, and it's the first time they made a point of telling me that Medicare puts limits on how many of which tests I can get each year. It's never been an issue before, and my insurance hasn't changed. I have two separate plans for A/B and C/D.

I'm concerned, because a couple of the ones that are every 3-4 months when I'm relapsing are apparently limited to 2 a year. It wasn't that I'd have a co-pay or pay a percentage for them but that there would be no coverage at all for those tests.

I do have a message in to my insurance company, because there's absolutely nothing in the handbook about this. Have any of you dealt with this? My doctors have always gotten any required pre-approvals, so I've never been denied before.

[leking1]

it sounds like your insurance company may have made some changes in coverage that began with the new year. Hopefully they will get in touch with you soon. Both you and/or your Dr. can appeal any decision they make that is a detriment to your health.

[NorasMom in reply to leking1]

I'm going to have to call them and insist on speaking with a human. I think part of the problem is that my primary and secondary insurances are through the same company, and when you try to communicate with them they only look at one policy.

I tried contacting them after I got home, and the email response told me it was a Medicare issue. Medicare said they could only help if I could give them the 5-digit billing code for each test, which of course I don't have access to. I had a headache and was pulling my hair out at that point, so tomorrow's another day.

[leking1 in reply to NorasMom]

i AGREE. Call and talk with a human, hopefully one based in the US, who speaks English clearly. I hope you got some rest last night. Have a good breakfast, take a deep breath and take charge. We are all with you. Linda

[hairbrain4 in reply to NorasMom]

You can ask your Dr for that code. It's a code that all Drs would use for that test. They use it for billing your insurance or Medicare. Hope you get help soon.

[Fancy59 CommunityAmbassador]

NorasMom, Talk to your doctor again perhaps he can get the coverage pushed through because it is medically necessary with your relapses. It is my experience that the insurance companies try to get out of everything they can and make up these stupid new rules to make us jump through hoops with the hope that we will miss something and they can deny us coverage. They make up the rules and we have no say in them. Sounds like a dictatorship to me but what can we do except to allow them to do it because we're at their mercy to help us pay for our bills. I'm not sure how I got the underlying on this post, but please ignore it. Let me know how it turns out. Remember together we are stronger. Take care . You're partner in insurance frustration! Fancy59.

[Sandydemop in reply to Fancy59]

amen and halleluiah. me too!

[Kitsey]

If you need the code for the tests, you might want to call the lab and ask for the codes for the specific tests. I’m not aware of limitations being imposed on testing. Good luck and please keep us posted. What you learn could be helpful for many.

[bxrmom in reply to Kitsey]

I'm not aware of any limitations either.

[Graip76]

Call the person at your doctor’s office that handles insurance. They deal with such matters all the time. They will have the information and knowledge to solve this matter. Let them work for you! 😉

[bxrmom in reply to Graip76]

Great idea!!

[Jesselespaul]

My IVIG infusions have always been covered by my Retiree HealthSelect Insurance. 3 months ago I got a letter that they will now an exception. When requested they were promptly approved for 1 year. Phew! No doubt means more requests to come. I’m treated at a University specialist MS clinic - they know how to push. My Rituxan is already an exception for a year at a time. Fingers crossed…

[Sandydemop]

you may need a doc to doc call for the labs.

[BlanketTime1]

i've never heard of this, but i get my bloodwork done twice a year, so that could be why. is it at all possible the doctors could handle this like with medications insurance won't normally cover? i take a wonderful sleeping pill called belsomra (fyi people who battle insomnia, i've had insomnia since primary school and this is the only med that's ever worked for me) that insurance won't normally cover. my doctor contacts them to say it's medically necessary for me and i get it at a reduced rate

[itasara]

Noramom, wondering are you retired or still covered by whomever you work for? Medicare and insurance is very complicated-always is. When my husband retired we had to sign up on our own for medicare. Before that we had a joint policy but soon found out medicare only covers us individually. We both chose a BCBS advantage policy with zero payment (except for part B which is a bit pricey-thanks to the govm't.) Anyway so far we haven't had many problems over past several years. If you have a choice next time the date comes up to renew, maybe you can change to something you may want to consider. If you don't get help for tests maybe a different medicare policy with a private company might have more of what you need. Every year I devour the following year information so I know what to expect or if I should change my policy or provider. Talk to your doctor and see if he/she can help out with insurance. Hope it works out for you.