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I got an end of year notice from Medicare for my October well exam, that the visit to dr. was covered, but a comprehensive blood test was not covered. Apparently the blood test also included Hep C, and that is not covered, either.
If a service isn't covered, that means my Medigap plan won't pay for it, either, doesn't it?
I've never heard of a standard blood profile not being covered as part of a well exam. Is this normal?
(I also think it's odd to have a Hep C test. I don't think I've had one of those before, because there's no reason for it. I'm in excellent health w/no reason to think I have any med condition.)
A standard blood profile is covered once every 5 years if I recall. Mine was covered in my "Welcome to Medicare" appointment earlier this year, but I hadn't had one for 6 years prior to that appointment. Not planning on getting one next year at my "annual wellness" exam because it won't be covered and there wasn't anything in my recent blood work that warranted concern.
I can't answer your question about medicare, but a one time hep c test is now recommended for all baby boomers (born 1945-1965) by the CDC.
My doctor also tested me during a routine annual exam for hep c without asking me if I needed the test. I donate blood 4 times a year and have been tested dozens of times over the past 10 years for hep c by the blood bank. I already knew I was hep c negative.
I got an end of year notice from Medicare for my October well exam, that the visit to dr. was covered, but a comprehensive blood test was not covered. Apparently the blood test also included Hep C, and that is not covered, either.
If a service isn't covered, that means my Medigap plan won't pay for it, either, doesn't it?
I've never heard of a standard blood profile not being covered as part of a well exam. Is this normal?
(I also think it's odd to have a Hep C test. I don't think I've had one of those before, because there's no reason for it. I'm in excellent health w/no reason to think I have any med condition.)
Based on what I'm reading on the Wellness Visit page, lab tests should be covered under Part B. However, reading further down the page, one could infer doctor should have set up a screening schedule and had the tests done separate and apart from the Wellness Visit - although that would appear to be contradicted by the following which appears on the Wellness Visit page:
Quote:
However, you may have to pay coinsurance, and the Part B deductible may apply if:
Your doctor or other health care provider performs additional tests or services during the same visit.
These additional tests or services aren't covered under the preventive benefits.
Of what use is a Wellness Visit if doc cannot order routine tests to ascertain wellness?
That said, as stated upthread, unless you had the same tests done a year ago at your last visit - in which case they probably wouldn't be covered so soon - I think you should dispute this nonpayment with Medicare. Those tests are clearly covered under Preventive. Wellness Visit page does not say lab tests done at time of Wellness Visit would not be covered.
Last edited by Ariadne22; 12-23-2019 at 01:20 PM..
The Medicare "Wellness Visit" only consists of the following. Blood work is not included.
Quote:
* A review of your medical and family history.
* Developing or updating a list of current providers and prescriptions.
* Height, weight, blood pressure, and other routine measurements.
* Detection of any cognitive impairment.
* Personalized health advice.
* A list of risk factors and treatment options for you.
* A screening schedule (like a checklist) for appropriate preventive services.
A comprehensive blood test is not covered by Medicare if you are healthy. Depending on the actual tests performed, certain components may be covered under Medicare's preventative benefit. Many people do have the comprehensive blood test covered because it was coded as a diagnostic lab service. Covered diagnostic lab services are exempt from the Part B deductible and coinsurance so it gives the appearance of being preventative.
A comprehensive blood test is not covered by Medicare if you are healthy. Depending on the actual tests performed, certain components may be covered under Medicare's preventative benefit. Many people do have the comprehensive blood test covered because it was coded as a diagnostic lab service. Covered diagnostic lab services are exempt from the Part B deductible and coinsurance so it gives the appearance of being preventative.
Aaaand.... just to complicate the whole conversation further, I went for my Welcome To Medicare visit after much reading and trying to understand what it would cover and what it wouldn't, and my doc (same primary doc I've had for years) coded it as a Welcome to Medicare visit, referred me for bone density test, mammogram, and a routine blood panel (HDL, LDL, triglycerides, C-reactive protein)... and none of it cost me anything. All covered. So go figure.
I did find, as I posted in this thread a bit above, that Medicare will cover a limited routine blood panel as part of their preventative services once every 5 years.
A lot may depend on how well your doctor understands the Medicare coverage rules, and how to code the services. Also if you've had the same doc for long time, they may know, for example, that you hadn't had a blood test for over 5 years prior and would know they could order one with your Medicare annual wellness visit and it would be covered, or they'd know you have had one more recently and not order it for you without giving you a heads up that it won't be covered.
I love my doc but am dropping her because her staff doesn't know how to code and doesn't respond to appeals for incorrect coding. Mt first visit post-Medicrae I had $800 worth of bloodwork rejected as "not medically necessary" That included the a1c (I had fasting glucose that runs around 110) and the lipids panel (my total cholesterol is always well over 200 so the components are important). I was off the hook only because the lab forgot to have me sign an Advanced Beneficiary Notice waiver acknowledging my potential liability.
I now use RequestaTest.com. You go on-line, select a LabCorp or Quest lab near you, select the tests you want (the ones I get are generally under $100 total) and they send the order to the lab. Easy-easy and results are on-line in a day or so. No BS. They'll even fax them to your doctor. I have no idea if Medicare covers- haven't even submitted a claim.
Based on what I'm reading on the Wellness Visit page, lab tests should be covered under Part B. However, reading further down the page, one could infer doctor should have set up a screening schedule and had the tests done separate and apart from the Wellness Visit - although that would appear to be contradicted by the following which appears on the Wellness Visit page:
Medicare preventive benefits do include Hep C screening:
Of what use is a Wellness Visit if doc cannot order routine tests to ascertain wellness?
That said, as stated upthread, unless you had the same tests done a year ago at your last visit - in which case they probably wouldn't be covered so soon - I think you should dispute this nonpayment with Medicare. Those tests are clearly covered under Preventive. Wellness Visit page does not say lab tests done at time of Wellness Visit would not be covered.
I had standard blood work done in 2017. But not as a Medicare patient. And not Hep C, as far as I know. Maybe it was there, and I didn't know it, but I gave my Medicare dr a copy of my 2017 blood work, so he would've seen if there had been a Hep C test taken before.
The 2017 lab work was not done under Medicare, so it seems natural to me that any dr would want to do a standard blood profile upon entering a new health care system. This was my first Medicare general dr. exam. (I had an eye exam earlier this year, which went to my Part B deductible.)
I plan to get blood work done every year, but I can get it much cheaper on my own at a lab & just pay out of pocket. I wish I'd known.
Maybe I need a new dr.
Last edited by bpollen; 12-24-2019 at 02:28 PM..
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