-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
Yes, dealing with medicare is a nightmare!
From what I can tell, if your provider (LLMD) has opted out of medicare, you can get your labs paid for only if they have a Unique Physician Identification Number(UPIN). If they don't, the labs will not be covered.
First, contact your LLMD's office and ask them. If the staff doesn't know then ask the doctor himself.
I get some of mine paid for because I have another doctor who has been kind enough to order tests for me and I've had to pay for a number of them out of pocket.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
| IP: Logged |
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
Forgot to mention, if you have the name or any identifying info about the person who yelled at you, call and complain.
It is unfortunate, but I've found that many medicare employees don't know where to get info and rarely know the answers to my questions. Some are nice and try and others are not so nice.
I recently have spent days trying to straighten out a mess that was caused by mis-information that I received from medicare.
If you have the time, it sometimes pays to get on the medicare site and look around. Then when/if you find what you are looking for you can call and verify.
I know it's frustrating but just keep at it and you will eventually get the correct answers.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
| IP: Logged |
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
Thanks Terry,
Sometimes I feel like it is just you and I dealing with this crap. My LLMD didnt even mention that my labs might not be covered.
I guess I just assumed that they had other medicare patients, I guess Im the only one :-(
It makes me somewhat mad they opt out, but they dont know that these labs wont be covered.
They want all these special tests, and another Igenex done at next visit. Guess this is another dr that I cant see. All are mandatory!!
What is a UPIN? Is this something specific to medicare?
I couldnt understand the name of the medicare rep.
thanks again for your help.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
daise
Unregistered
posted
Yes, understanding Medicare is trouble.
For future tests, perhaps you could ask your LLMD about getting a UPIN?
The customer service phone number for Medicare is mostly useless. Ah well ... same-o, same-o for Lymeland people.
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
cantgiveupyet wrote: What is a UPIN? Is this something specific to medicare?
Unique Physician Identification Number(UPIN) I think it's unique to medicare but I don't know for sure.
Yes, good idea daise. Ask your LLMD if they don't have one if they will get a UPIN.
If they have a UPIN then no need to worry about the tests that are normally covered by medicare but I would make sure that you carefully verify it all before getting a lot of tests. As you know, not all tests are covered so you will want to check out which ones are covered before getting them.
Explain to the LLMD what your situation is and see if they will help you come up with some way to manage the testing. Maybe spread it out over many months and only do the stuff that you have to have done initially to start treatment.
Do you have anyone who can order some of the tests for you who is a medicare provider? Check with your local lyme group to see if anyone has a doctor that they see who might see you as a patient and help by monitoring and ordering tests.
I have the original medicare rather than one of the newer policies. It gives me more freedom in who I can see as far as I can tell.
Some reasons that LLMD's opt out of medicare is that medicare pays a very small amount for a doctors appointment and some doctors simply cannot afford to take care of patients like us who often need much longer appointments. Even doctors who have less complex patients opt out because it costs them money.
Another reason is that medicare can and does investigate and try to control a doctor if they don't agree with something and our LLMD's have enough to deal with in trying to stay in business without the government on their backs.
You may need to develop a relationship with another doctor who will help you get the testing. They are out there but can take time to find and develop.
I hope you can stay with this doctor or find a doctor who will work with you to get the help you need.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
| IP: Logged |
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
I will check with my local support group, but I havent heard of anyone in my area that is even on medicare who sees a LLMD.
The first two claims that went thru medicare for my Urologist and a MDL culture, Medicare actually reimbursed the lab more than my Aetna plan would, go figure. It wasnt a complex visit, but I was suprised.
I have standard medicare with a regular medicare supplement.
I will check with my LLMD, hopefully something can be worked out, I had a TON of blood tests done before my insurance ran out, but as you know more is always needed.
I cant even get a straight answer about what IS covered. Labcorp doesnt even know, they said to check webmd to see if the test is FDA approved.
Daise- Im never calling medicare again ever.
I dont think there are many even on LN that are on medicare.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
daise
Unregistered
posted
I have a Medicare Advantage Plan and I like it a lot. Meds are covered better. With Medicare, a PCP is not required. However, my LLMD is paid MORE for his time if I DO HAVE a PCP (Primary Care Doctor) or the equivalent.
Will your meds be paid for? If not your tests then ...
Maybe you need a different LLMD.
My Medicare Advantage Plan also offers free gym for Lyme weightlifting machines. I go to Defined Fitness and I can also use the warm pool to dance-stretch.
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
I decided not to go with the Advantage plan because it was more costly and LLMD's dont take insurance at all in my area.
One does, but he isnt agressive enough. The two llmd dont really agree on treatment, so I cant ask the one to order labs for the other. sigh.
Who knows about my RX, i have a separate plan for those, I really hope the dr prescribing doesnt have to be medicare. I will have to check on this.
What gets me is that they just assume ALL dr take medicare. Even my insurance agent looked at me strange, when I told him my dr didnt take it.
Medicare doesnt explain that non medicare dr's and everything they touch isnt covered.
I tried to contact my support group and the email bounced back.
worst case, i will go back to the non agressive LLMD and try to get them to prescribe what I want.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
quote:I really hope the dr prescribing doesnt have to be medicare. I will have to check on this
I have part D too and they pay for prescriptions with my LLMD who is also opted out of medicare.
That doesn't guarantee that your plan will pay too but it probably will.
edited to add: also, don't forget the $4,000 doughnut hole. I was already there before the 2nd month of the year was up.:-(
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
| IP: Logged |
bettyg
Unregistered
posted
hi cant!
i'm on medicare, my last llmd OPTED OUT OF MEDICARE, and here are my specific details galore about this llmd, testings done, what i paid, etc, and my $4,000 out of pocket expenses for testings/appts, etc. and $1,000 travel expenses out of state.
Bettyg's 4-20-06 new LLMD in Minn. Office visit summary, complete BODY lab results of 15-18 labs nationwide, all info the lab sent back about specific high/low testing, $$ costs involved, and what each test specifically involved what ...
VERY DETAILED! I did this for other newbies who had NEVER had complete body testing like I did! Hoped it would give them guidance what they entail, how costly if OUT OF POCKET PAID like my $ 5000, and which specific labs nationwide are the best for these SPECIFIC lab work. http://tinyurl.com/2hkc6s
IP: Logged |
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
I emailed Igenex and they are saying medicare does pay since they do the testing there and the billing.
who to believe?
its insane. im going to try calling my llmd,
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
![[Smile]](smile.gif)
Printer-friendly view of this topic