Medicare prior authorization for tests?

Question

I'm 78 and recently became very ill.  I made it to an urgent care center and they decided I needed to be hospitalized.  I spent 4 days in a hospital during which time several doctors ordered a barrage of tests including CT scans and PET scans.
I am now home recovering and beginning to think about all the expenses I have run up and wondering if Medicare will cover them with my getting prior approval.

Danielle D · Accepted Answer

Straight Medicare (part A) covers 80% of your hospital bill. If you have something like Security Blue (or other medicare HMO) they will likely pay at a higher rate. There should be no further expense to you. The tests done during an inpatient stay do not usually require specific prior-authorization, and if they did - it would be the responsibility of the hospital to obtain that authorization BEFORE providing the testing, or to make sure you understand that it is not covered and giving you the option of electing to proceed or decline the test based on that information.

mildred f · Answer

Overall, your bills will be covered 50-60%.  The rest is out of pocket.  So did you buy any gap insurance?

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Medicare prior authorization for tests?

2 Answers