Medicare question

[Ambereyes]

MIL went to cardiologist for BP problems yesterday, he ordered a thyroid blood test. When she went to get it the nurse asked her if she had had the test in the last 3 months she said no why, nurse said new medicare guidelines state that they cannot pay for some blood work but every three months. Nurse told MIL that if she had previously had the test she would have to pay for it herself..

Also all kinds of new question involved before treatment. Some of them sounded kinda strange, like they were trying to find out if she could use other avenues to pay for her treatment.

Any one else have this kind of thing happen?

[Hollowdweller]

Not sure about medicare, but where I work we are not allowed to schedule any testing that has been done within the past year unless the medical evidence suggests that there has been some recent change in the persons condition.


This is from MS but looks like it addresses your question:

http://www.library.umc.edu/Medicare/medi-thyroid.html

[Ambereyes]

Hmm, interesting MIL has several of the indicators for the test. Since the doc ordered it as needed in her problem I assume he would know. There has been a recent change in her condition, she had to go to the ER for her BP a week ago. She has also had valve replacement in 1999. BP had run in the normal range until about a month ago and now is getting into the danger zone.

I have to take her to other doc for her macular (sp) degeneration later today, they always due several scans wonder if that will be restricted too, as this is a once a month treatment.

Thanks for the info

[Txsteader]

Originally Posted by Hollowdweller

Not sure about medicare, but where I work we are not allowed to schedule any testing that has been done within the past year unless the medical evidence suggests that there has been some recent change in the persons condition.

I can certainly see the logic in that. No doubt there's a lot of waste in the system.

[my3boys]

Not on Medicare, but I have thyroid issues and I believe my private insurance will only pay for blood work to check my levels every 3months, although I don't need it that often. I think the exception is someone who has been recently diagnosed. They can and should have their levels checked more often until their meds are adjusted and their levels stabilized. I think I was checked at 6 weeks, 6 weeks again, then 3 months, 6 months, and after that a year. Of course that will vary according to the situation.

[Old Vet]

Originally Posted by Ambereyes

MIL went to cardiologist for BP problems yesterday, he ordered a thyroid blood test. When she went to get it the nurse asked her if she had had the test in the last 3 months she said no why, nurse said new medicare guidelines state that they cannot pay for some blood work but every three months. Nurse told MIL that if she had previously had the test she would have to pay for it herself..

Also all kinds of new question involved before treatment. Some of them sounded kinda strange, like they were trying to find out if she could use other avenues to pay for her treatment.

Any one else have this kind of thing happen?

Of coures they would if Medicare were to pay for the test she they would pay much less than she would. Have you ever looked at what medicare payes and what they are billed? Every 3 months you will get a summery of that from Medicare.

[Ambereyes]

Yeah, it is pretty shocking to say the least. We got through her treatment (macular degeneration), she has to fill out a whole new packet of info first of the year..

[Danaus29]

All insurance companies are trying to find out if people have other insurance they can use. You should have seen all the letters I got last year when I broke my foot. (I really wanted to fill it out saying I want to sue the state of Ohio because it was their mole that dug the tunnel that I stepped into. Didn't do it because I figured then my ins would deny my claim)