Just the other day I went to my doctor’s office to get a PSA (Prostate Specific Antigen) blood test ordered by my urologist knowing Medicare would pay 100% of the cost for the blood work. (As a side note, Medicare only pays 80 percent for the digital exam.)
When I arrived, the nurse said in addition to the PSA, I will do a complete test for cholesterol, lipid and triglyceride levels. I told her to only test the PSA blood levels or Medicare would not pay the 80% for the lipid profile screening until September.
Why September and not now? Unless the patient has hypertriglyceridemia (excessive amounts of fat in the blood), Medicare only pays every 12 months for this type of lipid profile blood testing. I was one month short of my 12 month window.
If the technologist would have proceeded to do the lipid testing, I would have been stuck with the bill.
After the PSA test was finished, I marched down to my doctor’s office assistant to confirm the next appointments. She said, “You’ll meet with the physician assistant on September 6th to conduct your annual “wellness visit” paid for by Medicare at 100 percent. Then you’ll go to the lab for the lipid profile blood work paid by Medicare at 80 percent.”
She wasn’t done yet. “Remember, you will then meet with your doctor two days later on September 8th to conduct a complete annual physical which Medicare will pay 80 percent of the assigned amount.”
Wow! Talk about confusing.
Here’s my Medicare coach tip: You need to be your own quarterback and take charge of your scheduled appointments to know what you are eligible for and when Medicare pays.
Go to MyMedicare.gov and register to get direct access to your preventive health information-24 hours a day, every day. You can track your preventive services, get a 2-year calendar of the Medicare covered tests and screenings you’re eligible for, and print a personalized “on-the-go” report to take to your next doctor’s appointment.
That’s what I plan to do next time.
