Quote:
Originally Posted by APovi
MEDICARE Fact or Fiction?
Is there is no way for a patient to know, in advance, if a 'treatment/prescription/therapy' is/will be covered by their Health Insurance?
Our friend got an unexpected invoice, so I called them for her.
I was told by the doctor, Medicare and the insurer that they cannot tell a patient, in advance, if a proposed medical expense is covered.
Apparently your medical provider submits an invoice to Medicare.
They decide which items they will pay.
Your insurer will only pay those charges which exceed what Medicare paid..
What we didn't realize is that, if Medicare says 'We don't cover that at all.' then your Supplemental Insurance doesn't either.
So, even with the best 'F' Supplement you're stuck with an unexpected expense!
Oh well!
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The above info is not the norm. Are you sure you are talking Medicare and not Medicare Advantage? Does the Provider accept the Medicare payment schedule? Are you talking about Medical needs as opposed to elective procedures?
There are certain conditions that most providers are aware exist. As an example, consider cataract surgery. Medicare will not pay for the surgery until the cataract reaches a certain maturity. If the provider believes there is a compelling reason to perform prior to that maturity, then a request and justification must be provided.
One simple recent example. My GP requested a blood test prior to a physical. His subscription for the blood test was sent to LabCorp. While getting the blood withdrawn for the requested test, I was presented a form to sign by LabCorp stating that one of the tests may not be paid by Medicare. I opted to get the test assuming it was necessary. Sure enough Medicare did not pay. Long story short, the GP request did not use the proper Medicare Billing code. The correction process is not fun, but it indicates what can happen if the provider is not adept with the billing code system.