Monday, 30 July 2012
The Medicare BluesBy Kathleen Noble of The Dassler Diaries
It's finally over. My year-long battle over a $364 laboratory bill that had been denied by Medicare (and therefore not covered either by my supplemental plan) is over - and I lost. The bill to Lab Corp got paid - but by me, not Medicare.
I had one of the same two tests again this January - six months later - and Medicare paid the bill without blinking an eye. I have a chronic Vitamin D deficiency (yeah, right, here in sunny Arizona) and my doctor tested me to see if it was improving because of a supplement I was taking.
My purpose in writing about this admittedly boring topic is to help you avoid going through what I went through. Even if you are not on Medicare, my story may help you deal with denials from Medicaid or your own insurance company.
If you choose not to read any further, here are the two things I learned from losing this battle:
First, ALWAYS ask your doctor for a printout of your medical record from an appointment before you leave the office. Keep the records in a place where you can easily find them. Your doctor's office may have a system of storing your medical records online, if you need them from past appointments. Find out if they do or ask them for past copies, if needed.
Second, if services are denied by your insurance company or Medicare, file an appeal as soon as possible. The directions are simple and are sent along with the letter explaining why the charges were denied.
INCLUDE A COPY OF YOUR MEDICAL RECORD FROM THE DATE OF SERVICE AND A LETTER OF EXPLANATION FROM YOU. An upper level manager from Medicare actually told me that nearly all lab tests are denied when first submitted to them if they are labeled as "routine tests."
You must file an appeal within 120 days from the date of the denial letter, so do it soon.
I thought that an appeal was the last and final route to take in reversing my Medicare denial. I spent many hours leaving messages for my doctor or the clinic manager, talking to them, writing them notes, calling Medicare and Lab Corp, collecting and mailing paperwork, etc. and was told by both a Medicare employee and my doctor that the problem was a simple "coding issue."
I thought that my doctor could simply resubmit her bill with the correct code and - bingo! - problem solved! This was not the case.
I eventually filed an appeal but it was past the 120-day limit and was denied. No amount of explanation would make Medicare reverse its decision on my appeal.
I was not notified at all of the second denial until someone called me today – more than a year from the date of service - to explain the details and tell me what to do if this happens again.
I could have filed a third appeal if today's call had come earlier but the 60-day limit for the next appeal had already come and gone by the time I got the call.
I kept telling myself that it was not the money but the principle of the thing. I needed these tests, my doctor prescribed them and Medicare wouldn't pay them.
It turned out that Lab Corp did not have a written explanation from my doctor as to why the tests needed to be done and that she had used a medical code that was not the correct one.
My doctor told me that she used the same code that she always had used! I really like my doctor and have no intention of switching to someone new. It is too late now to get a refund from Lab Corp or Medicare for the $364 I spent.
And yes, it's not about the money, but my husband and I are attending a family reunion in the northwest next week and that refund check would really have come in handy!
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