I went to a doctor and he had me get a c-scan. medicare refuses to pay for the test and I am stuck with?

1. Did you sign something that said you would be willing to pay if Medicare did not?

2. Does the doctor you went to accept Medicare? (almost certainly he does or you should have been told)

If the answer to the first question is "no" and to the 2nd question is "yes" then you have NO financial responsibility to pay (assuming you are actually covered by Medicare). As long as you didn't sign something its basically their problem. They needed to make sure they were within Medicare reimbursement parameters before the test and need to do all the appeals to Medicare to try to get payment.

I'm quite surprised they would have tried to squeeze you for the money under those circumstances. If this was at a hospital I'd start by talking to the patient services department. If its just a private office you could contact an attorney who deals with medical issues but that will cost you too and personally I'd just wait it out a bit and see what happens.

You can appeal Medicare's denial. As for a list of what they will and won't pay for... good luck. There is a complicated coding system, so your scan might be covered if they submit the bill with a diagnosis code that Medicare accepts. It might just be a matter of the hospital (or wherever you got the scan) recoding and resubmitting the bill.

Now, finding out what code you need is the tricky part. Nobody is going to tell you, or the hospital, or the doctor that. They keep it a secret until they deny the claim. However, the scan facility ought to have a good idea of what gets them paid and what doesn't.

I'd work on appealing first, before paying anything. It may take persistence and many months to resolve, but you might be able to get Medicare to cover it, if your doc really thought it was necessary.

Good luck.

Both the doctor AND the scan facility should have checked your insurance against Medicare, and TOLD you what portion (in this case 100%) of it you would be responsible for.

Medicare does NOT send this to the PATIENT -- and the doctors have to call and ask.

You need to contact you doctor and have HIM contact Medicare to explain the "Medical Necessity" of the procedure, and how having that scan provided him with important medical information.

AND -- most hospital have "Financial Assistance" programs. They can pass this bill to the Finance Department, and you can pay for it over time, like $50 - $100 a month. Contact the hospital / scan center that performed the work, and ask for Financial Aid Department

I don't think this is a genuine question. Whoever did the scan would know you are covered by a Medicare provider and your primary care doctor would not send you there if they did not accept Medicare. If you really have Medicare, you would know Medicare does not deal with the patient directly and there is no such thing as a list of uncovered services. That would be up to whatever your health plan covers.

Call your doctor and tell them that medicare didn't pay for your CT scan and could they call medicare to get it approved. The will and it usually works. Otherwise, call the facility were you had the CT scan and see if they have financial assistance. You may qualify and not have to pay much at all.

As always, Pangolin's spot-on. Uncle Sam loves to play games like this. The facility and the doctor are also routinely pissed at the Byzantine way the regulations work, and they're so complicated that nobody, and I mean nobody, can possibly understand them all.