DJW Posted September 1, 2015 Report Share Posted September 1, 2015 So the DW has her follow up with her new Medicare Doc after her labs etc. This was not the initial appointment with the Doc but the follow up to that appointment after all the labs results were back. The Doc says your cholesterol is a little high, not over the top high just a little high. They have this test where they take a picture of the heart and they can see if there is any blockage. She says insurance won't pay for it but they the hospital has a flat rate fee of $50.00. My question is if Medicare will not pay for it will our Tricare for Life? I thought that what ever Medicare would not pay for Tricare for Life would? Dennis USA Master Sergeant Ret. Link to comment Share on other sites More sharing options...
nana25k Posted September 1, 2015 Report Share Posted September 1, 2015 If your wife is on Tricare for life then Medicare is the first payer. The remaining bills go to Tricare who then pay. If your are using Dr and hospital that are part of Medicare then they can not by law charge you anything else. I can't imagine any legitimate test that Medicare wouldn't cover unless...and here's the caveat...she does not have a diagnosis to support the test being done. If that's the case then neither Medicare or Tricare are going to pay. An example is that Ron has very normal cholesterol. So even though he does have a heart issue, it is not related to any types of heart disease that cholesterol affects. Therefore Medicare does not pay for an annual cholesterol screening. If we want it done then we pay or he gets it done at VA. So if she can have it done for only $50 and it gives her peace of mind then its selfpay Hope I didn't confuse you. You might ask the Dr billing people if they have a better diagnosis code that would apoy to her and thus cover the cost Ron & LindaClass of 20072000 Monaco Diplomat 2005 Honda Element"Do what you can, with what you have, where you are" Theodore Roosevelt"We can't control the wind, but we can adjust our sail""When man gave up his freedom to roam the earth, he gave up his soul for a conditioned ego that is bound by time and the fear of losing its attachments." Link to comment Share on other sites More sharing options...
nana25k Posted September 1, 2015 Report Share Posted September 1, 2015 Just an added reminder for clarity. Under TLC. If Medicare doesn't approve and pay then neither will Tricare. When it comes to tests its always best to make sure. Also for other issues remember this Medicare only covers a hospital stays of 24 hours or longer. If you are admitted for observation only the clock starts when you are actually admitted. It doesn't count any time spent in the ER Ron & LindaClass of 20072000 Monaco Diplomat 2005 Honda Element"Do what you can, with what you have, where you are" Theodore Roosevelt"We can't control the wind, but we can adjust our sail""When man gave up his freedom to roam the earth, he gave up his soul for a conditioned ego that is bound by time and the fear of losing its attachments." Link to comment Share on other sites More sharing options...
DJW Posted September 2, 2015 Author Report Share Posted September 2, 2015 Thanks Linda that was the type of info I was looking for. It is not a cost factor concern. It will be well worth the $50 to just see a picture of her heart. Dennis USA Master Sergeant Ret. Link to comment Share on other sites More sharing options...
Bobq21 Posted September 2, 2015 Report Share Posted September 2, 2015 Hi, don't understand the part about cholesterol screening not being covered, mine is tested every year during my annual physical along with other blood work. It has always been covered/paid by Medicare/TFLBobQ Bob and Snookie Quinn 2006 F-550 CC Custom Bed 2012 Mobile Suite 38 Rssb3 Fulltiming it!! SKP#96210 30 years Retired USARMY Link to comment Share on other sites More sharing options...
nana25k Posted September 2, 2015 Report Share Posted September 2, 2015 Hi, don't understand the part about cholesterol screening not being covered, mine is tested every year during my annual physical along with other blood work. It has always been covered/paid by Medicare/TFL BobQ It is all about your diagnosis code from your physician. If you have elevated cholesterol or any other diagnosis affected by cholesterol then Medicare will cover it as part of your annual. In Ron's case since none of his diagnosis relate to elevated cholesterol and his is vell in the normal range then Medicare does not cover it. Believe me we have been down this road and ended up paying for it. You always sign a document and the fine print tells you that there may be tests ordered by your physician that are not covered and that you will be financially responsible. Ron & LindaClass of 20072000 Monaco Diplomat 2005 Honda Element"Do what you can, with what you have, where you are" Theodore Roosevelt"We can't control the wind, but we can adjust our sail""When man gave up his freedom to roam the earth, he gave up his soul for a conditioned ego that is bound by time and the fear of losing its attachments." Link to comment Share on other sites More sharing options...
Biker56 Posted September 3, 2015 Report Share Posted September 3, 2015 Medicare pays for the blood work.Supplemental Insurance never has to pay anything on blood work.Medicare has payed for twice a year test for me. Both done from a prescription from the doctor.Some are different test ask for each time.FallComplete Blood Cell Count (Red Cells, White Blood Cell, Platelets)Blood Test, Comprehensive Group Of Blood ChemicalsHemoglobin A1c LevelSpringComplete Blood Cell Count (Red Cells, White Blood Cell, Platelets), Automated TestBlood Test, Comprehensive Group Of Blood ChemicalsManual Urinalysis Test With Examination Using MicroscopeBlood Test, Lipids (Cholesterol And Triglycerides)Urine Microalbumin (Protein) LevelCreatinine Level To Test For Kidney Function Or Muscle InjuryHemoglobin A1c LevelBlood Test, Thyroid Stimulating HormoneProstate Cancer Screening; Prostate Specific Antigen Test (Psa)Creatine Kinase (Cardiac Enzyme) Level Full Time since Oct. 199999 Discovery 34Q DP | ISBDatastorm | VMSpc | Co-Pilot Live | Pressure Pro2014 MKS Twin Turbo V6 365 HP Toad Link to comment Share on other sites More sharing options...
nana25k Posted September 3, 2015 Report Share Posted September 3, 2015 Obviously Biker YOU have a correct diagnosis code for YOUR labs so Medicare pays. My point is that with out a pertinent diagnosis code Medicare would not pay, especially for a routine cholesterol screening after the first one and so neither will Tricare. Other supplements may have different co pay rules. All insurance companies need a reason (medical diagnosis) before they will pay for anything. The first annual screening under Medicare usually pays because its a screening. After that it can be a crap shoot if the ordering physician doesn't code the lab orders correctly Ron & LindaClass of 20072000 Monaco Diplomat 2005 Honda Element"Do what you can, with what you have, where you are" Theodore Roosevelt"We can't control the wind, but we can adjust our sail""When man gave up his freedom to roam the earth, he gave up his soul for a conditioned ego that is bound by time and the fear of losing its attachments." Link to comment Share on other sites More sharing options...
Bobq21 Posted September 9, 2015 Report Share Posted September 9, 2015 Hi, I guess its has become necessary to take your layer along with you to your medical appointments, its nuts what going on!Bobq Bob and Snookie Quinn 2006 F-550 CC Custom Bed 2012 Mobile Suite 38 Rssb3 Fulltiming it!! SKP#96210 30 years Retired USARMY Link to comment Share on other sites More sharing options...
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