Wednesday, September 4, 2019

Insurance.... again

If I could pay one lump sum and then get all the tests my doctors think I need, I would be a happy girl.

Unfortunately, that is not the case.  TBG and I have Medicare, because we are old, and an AARP supplement plan because we understand that Medicare doesn't cover everything. 

But, really - calling a PSA Screening Not a Medically Necessary Service seems somewhat ridiculous.  Just ask Fast Eddie, whose life was saved by a biopsy when his PSA raced to 9 between checks. 

And how about my final Pelvic/Breast Exam?  Apparently this is also Not a Medically Necessary Service.  Neither the scheduler nor the billing officer at the practice told me that Medicare didn't think I needed to see my retiring gynecologist once I turned 65. 

The amounts are not huge; after the Adjust Medicare reduction the two total just under $60.  But that's not the point.  Screenings save lives, or so I've been led to believe over the course of 67 years of  Public Service Announcements.  Catching disease early and starting treatment before total disaster ensues has always been the point; it's why I go to the dentist and the doctor on a regular basis, even though I'm remarkably healthy.

I called AARP/United Healthcare and the lovely woman said that they follow Medicare's guidelines.  If I have a problem, I have to talk to Medicare.

Talk to Medicare.  That's actually what she said.  As if Medicare has a point person to explain its intricacies to a little old lady in Arizona.  As if calling did not send me to a never-ending voice mail loop, where my wait time was considerable.

And why is there a Medicare Adjustment on the physician's bill if Medicare doesn't think this is a necessary service?  I'm glad to save the somewhat more than 50% they've deducted from what ends up in the Patient Responsibility column, but the reasoning behind it escapes me.

As I thought about exploring this further, about figuring out the whys and wherefores of medical billing, I caught myself.  I laughed.  I remembered what My Cousin the Fireman, the CFO at a variety of major hospitals around the country over his career, told me when I asked about this issue.  "Oh, please.  Don't go there.  Those numbers don't mean anything at all."

Sigh.

10 comments:

  1. You can appeal the denials; it is not that arduous.
    But before that, I would call Medicare. I had to do it yesterday and it went quickly and well.
    Maybe it was because I called early in the morning, on the Tuesday after a holiday Monday.
    Don't just pay without a fight, no matter how small the amounts are.

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  2. The comment above was me, Laura. I don't know why the system has me as "Unknown." I tried to comment using my name, as usual. Aargh.

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  3. Did you get the Medicare & You 2019 book? Check out p. 33 for you (the time frame might be the problem there) and p. 44 for TBG which clearly states Medicare covers the PSA test.

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  4. Each clinic might be different for what they approve or do not. I have never minded paying some extra considering how cheap everything is in comparison to what it would be without Medicare. I am though one of those who wants the least tests possible. When I went in for my wellness visit in August, the doctor said i should get a bone density test. I said but it was fine last one. He gave me that look-- 10 years ago. So, I agreed and did have it. We have paid for things that weren't okayed by insurance but this last visit, I paid nothing for any of it (unless I get a delayed bill lol). They did not do a Vit. D test this time and I've been thinking about having that done on my own maybe next time I am in Tucson. We had something else this year that United wanted-- a visiting health nurse. I didn't want that either but finally figured I might as well give in to it. We had it our last time in Tucson. Interesting but they were supposed to send the results from it to our doctor. He never got anything from it. Not exactly a finely tuned concept.

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  5. A visiting nurse??? Without following up. Hmmmmmmm
    a/b

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    1. It's a program that United has probably for over a certain age. I kept putting them off. The visit though was fine and she could check certain things. It was never intended to be instead of seeing the doctor but odd that it didn't go to him as they said it would. IF they ask again, I'll mention that. The woman who did it said she was an RN who had worked in ER and the stress got to her. She liked the home visits, which for someone who couldn't get out would maybe be a good idea. We enjoyed our visit with her but it did take over an hour. They gave us two insulated cups for the car as a reward lol

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