Medicare lab denial | Arthritis Information

My doctor ordered lab tests because of the RA. Three were denied: Assay of GGT, Lipid panel, and Assay thyroid stim hormone leaving a large bill. I called Medicare and she said the doctor should send Medicare a Request for redetermination of claim decision with documentation.

Anyone have experience with this?

Jan

This is sad that insurance knows more about your health and what is good for you and what you need than your doctor does. It is all about deny deny deny to save them a few bucks. Do not let this go. The squeaky wheel will get the grease. Call them daily if you have to. The lipid and thyroid NEED to be done for prevention. Not sure about the other. This type of thing makes me mad. Good luck. Thanks, Lorster. THe doctor's manager said she would contact Medicare about it so will see how it goes.

Jan

That must make a doctor so mad to have someone just cancel him out. Hope they can get it straighten it out, Jan.I hate when my health care is dictated by an insurance company.

Jan, actually it happens frequently. I had some tests and treatments denied but I furnished Medicare with a letter of medical necessity from my doctor and all items were paid. Because Medicare hasn't gotten the cut for doc's fees they're going to be even more vigilent about claims and deny more. It's almost as if they're blaming the insured for their own lack of cost control within their organization. Hope you have it straightened out soon. Lindy

LinB2008-07-01 10:56:55Ugh, this stuff makes me so mad when I hear about it. I hope your doc's office can get it taken care of for you.

deb

Jan,

Do you have traditional Medicare, or a Medical Advantage plan or HMO plan? I try to make sense of how our health care system works, but there are so many programs, public and private, its confusing.

Good luck, hope your doctor gets approval for these tests. I read, with all these different plans and their different rules and forms, administrative costs for medical providers, docs and hospitals, is 20-30% of their costs.

I have traditional Medicare, the simplest I think.

Jan

I just cannot imagine Medicare denying a thyroid and lipid screen. Those are needed on all physicals. I wonder if it was an error in the way it was coded. This is the reason you see so many clerical people working in physician's offices now. Remember the old days when the family doctor had one assistant and maybe some one at the front desk?

I am in an HMO for Medicare and it's a nightmare. They are only paying for generic drugs now with a small copay on my part and 30% of others that are prescribed. They questioned my MRI last year but did pay it.
Let's hope our medical coverage gets better in the future.

[QUOTE=ann1026] This is the reason you see so many clerical people working in physician's offices now. Remember the old days when the family doctor had one assistant and maybe some one at the front desk? I think we all are grateful and have benefitted from medical advancements, from drug treatments, medical procedures and surgeries that have improved the quality of our lives and extended our lives. But with an aging population, expensive technologies, etc. we need to come up with a more efficient and effective health care system, cuz costs are increasing. Yes, there are lab and test results, other documents that need to be filed, but I think what is time consuming for many medical providers is dealing with the numerous public and private health insurance programs with their different and changing rules and procedures. There's Medicare, supplements to Medicare (medigap plans), Medicare Advantage, Medicaid, Tricare , the VA, SCHIPS, there's private large group plans, private small group plans, individuals plans, state high risk plans, HMOs, PPOs -- is this an efficient way to spend limited health care dollars? Denial update. Two were approved, Assay of GGT and Assay thyroid stim hormone. Lipid panel denied so will appeal. Might as well. [QUOTE=Jan Lucinda]Denial update. Two were approved, Assay of GGT and Assay thyroid stim hormone. Lipid panel denied so will appeal. Might as well.[/QUOTE]

Hmm... did you recently have a lipid panel done (maybe ordered by another doctor)? Unless you've got some serious lipid problems, perhaps the insurance company won't pay for the test more than once a year.
Sometimes they just bill it wrong. Red tape has rules. It should straighten out eventually. Hopefully without you spending to much time on the phone.Jan - in my previous life with the ex-husband the Chiropractor, we were constantly dealing with denials of coverage because you know, Chiropractors can kill you, j/k, but it was intense. Just do exactly what they say and it will be reviewed and paid. Remember, its the US government, by an out-sourced private company making a killing. Good luck.
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