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I am scheduled for an outpatient stress test on Monday and want to know what I have to pay. I have an advantage Medicare plan but they just tell me I will pay 20% of what Medicare allows and they don't know what that is. ??? Called the OP dept of the hospital to get an answer, but its a voice mail, so I might not get any info there either. Anyone here had one of these tests where they inject you with dye and you run on a treadmill? Just thinking I should cancel it. Don't want to be stuck with a big bill that is unnecessary.
Depending upon how your doctor bills it, there could be no charge to some charge. If s/he bills it as routine it will be one charge. Diagnostic is another. If you have Medicare Advantage why would you be paying 20% of Medicare's allowable fee? That's not right. Unless the provider of service isn't on your Advantage plan. Did you get this information from someone from your Advantage plan or from the provider?
It's pretty difficult to tell how much the test will be prior to taking it. There are different variations of the test and until they give it to you, the insurance payer won't know what it will be. What one person pays may not be what another person pays. It all depends upon the type of stress test and your location in the country.
OK so the copay was only $20.42. It involved a nurse putting in an IV, radioactive solution, pictures with a HUGE overhead camera (twice), a treadmill test with Bp, EKG monitor, more dye, more pictures, and a cardiologist present, in case I croaked on the treadmill.
Seems like the copay was so insignificant for what they did. I don't understand who determines these payments.
Of course, the test turned out to be abnormal and I am waiting to see the doc to find out why.
OK so the copay was only $20.42. It involved a nurse putting in an IV, radioactive solution, pictures with a HUGE overhead camera (twice), a treadmill test with Bp, EKG monitor, more dye, more pictures, and a cardiologist present, in case I croaked on the treadmill.
Seems like the copay was so insignificant for what they did. I don't understand who determines these payments.
Of course, the test turned out to be abnormal and I am waiting to see the doc to find out why.
Insurance companies (and Medicare) have priced preventative care in a way that it's affordable for people to go--free or very low cost. Your stress test, while involved, costs a heck of a lot less than a day in the ICU after you had a heart attack. They want to catch potential problems early so you don't end up in the ICU. Even having bypass before a heart attack is more affordable because of advanced treatments now, people rarely stay in the hospital after a bypass for more than a few days but if you have a major heart attack, you could end up in the hospital for weeks--or worse a stroke and end up in a nursing home permanently.
A lot depends on someone sitting at a desk looking at the diagnostic code that the doctor's insurance clerk used.
If the insurance clerk goofs and uses the code for something that doesn't need a stress test, Medicare won't pay a dime.
As someone who was an "insurance clerk" for over 20 years I can tell you that I have never seen this happen. There is a much greater chance that the doctor will put down the wrong code or someone in his or her staff will. The claims adjuster has no way of knowing what the correct code should be in that case.
Since the advent of computers, there is even less chance of the insurance clerks getting it wrong as long as the doctor's staff supplies them with the correct coding.
Here is a tip. Many doctors are lazy when it comes to giving the correct code. My pulmonologist is very diligent about this. She will go over the codes with me when ordering pulmonary function tests and other complicated exams. So I see what she is ordering.
There is no reason whatsoever that a patient cannot ask the doctor how a procedure will be coded. But too many people as patients don't want to take that responsibility.
The Key is not the Procedure Code, but the Code for the Diagnosis. I doubt that most doctor are familiar with those codes. It's not that they are lazy, but that they have more to remember. That's why they hire clerks. (Minervah isn't the only one here with a background from working in medical practices)
The Key is not the Procedure Code, but the Code for the Diagnosis. I doubt that most doctor are familiar with those codes. It's not that they are lazy, but that they have more to remember. That's why they hire clerks. (Minervah isn't the only one here with a background from working in medical practices)
True, but only the doctors can say what the diagnosis code is because they are the ones doing the medical records. They can't just tell their clerks that they did so and so on a patient and have the clerk put down what the code might be.
When I said lazy I was referring to the fact that they don't bother to look the codes up. They don't have to remember them.
You go in for your first mammogram and it is "preventative" and should be coded as such. Say they see something on that film and they want another one. That next one is no longer preventative but it is now diagnostic...but they are still both mammograms. Sorry but I don't want my doctors concerned with these little details about is that code 2041A ore 2041B. If something doesn't look right when I get my explanation of benefits, one simple phone call to the dr's office and they send in the right code. In my 30+ years of handling my own medical bills, I think I have had to call for a coding issue maybe 3 or 4 times. Not a big deal to me I guess.
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