Several days ago a client asked if the newest Ataxia panel test was covered by Medicare and his Medicare supplement policy. The genetic panel tests for certain motor skill deficiencies, usually an adult onset condition. The client asked about coverage because his physician supplied him with a list of questions to ask his health insurance company. Being a new test the physician wasn’t sure whether the test would be covered by a health insurance company.
Sounds fair enough. The doctor wants to make sure he is compensated and the client isn’t put in a tough financial position… tough because the Ataxia panel test costs around $7500!
Medicare is a post-approval health insurance company, that is, the vast majority of medical services do not require pre-approval. Ultimately it is the policyholder that is responsible for the charges if the claim is denied by Medicare. The reality is that patients have many chances to challenge the decision to deny coverage, and many times the claim is paid.
The concern regarding the questionnaire supplied by the doctor is that the form may be used against the patient if and when the bill becomes a point of litigation. Adding insult to injury is the fact that many physicians farm out their billing to another company, giving the physician another reason not to clarify potential medical charges when the procedure is completed.
The vast majority of Medicare patients haven’t a clue what these tests cost. They have no reason to find out either due to the fact that the medical bill is usually paid in full by the government and the private supplemental health insurance company. It is high time that consumers be given the information needed to choose the best course of action, and the cost of a particular procedure needs to be included in this process. Blue Cross and Blue Shield of Arizona is making strides to do such a thing. Recently they have come out with, “Cost Compare,” listing different medical procedures and their costs at different facilities around Arizona. It is shocking to learn that having an MRI done at a hospital is at least $1000 more than having it done at a free-standing medical facility. It reminds me of having a vehicle fixed at either the dealership or a stand-alone repair shop, the difference in price usually being quite a bit.
Michael Higgins
An Arizona health insurance broker.
602.405.8769