Medicare And Annual Blood Work

I recently got on Medicare, and it's time to have my annual blood work done.  I'm wondering if Medicare covers this.  I know I can call my insurance agency, but don't want to alert them to the purpose of this blood work if it needs to be coded a certain way.  I'm also wondering if I should have my surgeon order the blood work or my PCP due to the coding issue (if there is an issue).  I know the blood work is very expensive, and I can't afford to pay for it without insurance coverage.

I had annual blood work done as part of my yearly physicals before WLS, so I'm not sure why calling your insurance and asking if they cover lab work would be a red flag that signified you had WLS?  I would suggest calling and asking "Hey, I'm about to get my yearly physical and my PCP will probably order some labs - what is covered with my plan?"  Or ask your PCP to order the labs, and then call your insurance once you have the lab codes that your PCP requested.  

Unfortunately, we can't know what your insurance will/won't cover :(

Medicare in general usually covers certain things and doesn't cover certain things regardless of which plan you have.  I just had my annual Medicare Wellness Exam with labs, and it did cover those labs.  Since blood work for bariatric surgery is so different from what would normally be ordered I wondered if they would be covered.  Perhaps my bariatric surgeon's office will know, or at least will be able to tell me how to ask the insurance company, if someone here doesn't know.

Doctors code for malnutrition to get post WLS labs covered. BTW, IF you had WLS in the U.S. your insurance company and Medicare know. 

Thanks AggieMae.  I'll let my PCP know how to code it then if she doesn't already know.  I didn't realize that Medicare would already know I'd had WLS.  That's interesting.

I see your surgery was 10 years ago, so they might not know.

 

 I think you'll find the code under "nutritional deficiencies" or maybe "rule out nutritional deficiencies" 

 

Here is an interesting link your provider (and his/her billing staff)  might find helpful

 

http://bariatrictimes.com/coding-for-laboratory-testing/ 

 

Thanks again.  I'll show her the article on coding.  That was very interesting.

If you have had surgery in the US, more than likely your insurance company knows. From my understanding, they have a bank of info that is shared amongst most major carriers.

However, if you have MEDICARE, it doesn't matter. Pre--existing conditions are covered.

Scott

Under HIPAA, insurance companies cannot share information with each other without your consent.  Your provider can, and does, with your insurance company because we cannot treat people without diagnoses, and often we must justify our billing.  However, there is no master bank of healthcare information all insurance companies can access, to my knowledge.   Any insurance company must get permission to share your records.  If they share it without your request, they are breaking the law.

If you consent or have multiple insurances (as is the case often with Medicare and a secondary insurance), then the secondary insurance has access because you are utilizing their policy.

The hospital I work for changes the administrator of our self pay health care  every year or two. In my case this means that (at least) 14 insurance companies and their subsidiaries have access to at least some of my health care information. So does my location life insurance carrier. HIPAA only works when ALL the players follow the rules and they don't. Who is going to call out one of the biggest lobby groups and major donators to elected officials? Can't ngress? The malignant narcisist currently inhabiting the White House?

 I  know that people have been terminated from employment for violations but has anyone ever been prosicuted beyond a slap on the hand for violating HIPAA?