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Old 10-27-2006, 07:16 PM   #1
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Medicare rules for bone density test.

After a complete check-up, my internist wanted me to have a bone density done. I had told him that the rheumatologist's office had done a "Dexa Scan" in his office last year. I checked into the radiology dept., and the first question from the tech was "Have you had a bone density before?" When I said yes, she warned my that Medicare might not pay the $200 for this test, since it had not been longer than 2 years ago. We called Medicare and of course it was "Medicare covers a bone density once every 24 months, unless medically necessary for one sooner". Needless to say, I left without having it done. I am so grateful for that intelligent tech! I think all doctors should be aware of that rule and tell the patient. Has anyone on this board had to pay for the test out of pocket?? Squirrly

 
Old 10-27-2006, 08:25 PM   #2
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Re: Medicare rules for bone density test.

Quote:
Originally Posted by squirrly
After a complete check-up, my internist wanted me to have a bone density done. I had told him that the rheumatologist's office had done a "Dexa Scan" in his office last year. I checked into the radiology dept., and the first question from the tech was "Have you had a bone density before?" When I said yes, she warned my that Medicare might not pay the $200 for this test, since it had not been longer than 2 years ago. We called Medicare and of course it was "Medicare covers a bone density once every 24 months, unless medically necessary for one sooner". Needless to say, I left without having it done. I am so grateful for that intelligent tech! I think all doctors should be aware of that rule and tell the patient. Has anyone on this board had to pay for the test out of pocket?? Squirrly
Hi Suirrly: I have yet to meet a doc that didn't know about the 24 mo rule on dexa scans, so I've never had that problem with such a lack of knowledge. If you go through your medicare handbook, you can figure out what the time limits are on all med procedures. In my case I had a second scan done in 12 months, but I didn't have to pay for it because the doc wrote a letter saying that it was medically necessary. I'm glad the tech caught it, in your case, but there really is 'no excuse' for a doc not knowing this, since the vast majority of them deal with medicare on a daily basis. If you thoroughly read the handbook, this type of thing should never happen again, because YOU will know what the rule is and not have to rely on docs that, in your case, sound very uninformed. Really sorry this happened to you! But you can prevent it from happening again by reading the book, even though I know how confusing that medicare handbook can be

I've always believe they must have hired someone to write that book to make it purposely confusing, when that isn't necessary. Once you get used to reading it it will seem less confusing and you'll know all the rules like how often you can get mamo's, pap, chest x-rays, blood transfusions, lab test's etc, etc. You can also call 1800 Medicare and they will explain any questions you have. Never make the mistake that "all" docs know more than you do, after you've thoroughly read that handbook, you'll have the upper hand. Per your question about paying for it out of pocket, I considered it and would have, if it hadn't been deemed medically necessary by medicare; but the price I was quoted was about $75.00 cheaper than yours, but that price would depend on each individual lab. In my case it was crucial to find out if I needed to go on Forteo, and I couldn't wait another year while my t-score plummeted.

Good Luck, and I sure hope this doesn't happen again. Read, Read, Read

Last edited by DesertBloom; 10-29-2006 at 10:54 AM.

 
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Old 10-28-2006, 07:08 PM   #3
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Re: Medicare rules for bone density test.

Thanks, Desert Bloom. I just had received the 2007 Medicare Handbook the other day. I just checked it, and in there it is called "Bone Mass Measurement". I also checked last year's billing statements, and the Rheumatologist's office had charged $225 for the dexascan. I had planned not to return to him, since I can't take all his meds anyway, and my scores were not that far off normal. I will tell my internist that I wish to wait until my 24 months are up next May. Most of my pain is osteoarthritis in fingers, hands, and hips. He simply wanted a new screening, and also ordered lab to rule out rheumatoid arthritis, and do the pain med check. So, I'm not worried about waiting until May for a new "bone density", as this radiology dept. calls it. Squirrly

 
Old 10-29-2006, 08:34 AM   #4
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Re: Medicare rules for bone density test.

I was aware of the 24 month Medicare ruling but I was willing to pay the cost myself just to get some ANSWERS whether my Forteo treatment was working or not.

In my mid-Michigan area the hospital charges $220. A local Rheumay charges $175 and a brand new state of the art imaging facility w/the only digital DEXA scanner in this part of the state (at that time) charges $180. My Endo told me after 10 months on Forteo he didn't think I would have to pay for the scan. I was willing to wait 12 months, but not 24. He ordered it at 10 months and must have specified it was medically necessary as I didn't have to pay for it tho I willingly would have.

Now you guys have me wondering about my PAP smear which I used to get and have paid for every year until Medicare. Since I have a post-menopausal ovarian cyst we are watching I wonder if my gyn specified the PAP was medically necessary .... or would it be? for a post menopausal ovarian cyst??? 7 cm in size.

I'm already saving them one pelvic/transvaginal ultrasound a year by having one done annually as part of the U of K Ovarian Cancer Screening Trial.

Last edited by CrohnieToo; 10-29-2006 at 08:37 AM.

 
Old 10-29-2006, 11:44 AM   #5
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Re: Medicare rules for bone density test.

Quote:
Originally Posted by CrohnieToo
I was aware of the 24 month Medicare ruling but I was willing to pay the cost myself just to get some ANSWERS whether my Forteo treatment was working or not.

In my mid-Michigan area the hospital charges $220. A local Rheumay charges $175 and a brand new state of the art imaging facility w/the only digital DEXA scanner in this part of the state (at that time) charges $180. My Endo told me after 10 months on Forteo he didn't think I would have to pay for the scan. I was willing to wait 12 months, but not 24. He ordered it at 10 months and must have specified it was medically necessary as I didn't have to pay for it tho I willingly would have.

Now you guys have me wondering about my PAP smear which I used to get and have paid for every year until Medicare. Since I have a post-menopausal ovarian cyst we are watching I wonder if my gyn specified the PAP was medically necessary .... or would it be? for a post menopausal ovarian cyst??? 7 cm in size.

I'm already saving them one pelvic/transvaginal ultrasound a year by having one done annually as part of the U of K Ovarian Cancer Screening Trial.
Hi ChronieToo: I couldn't find my Medicare Handbook, but I "think" paps are covered every 12 mos just like mamo's but I would look it up just in case. TEXT ADDED: I just found that answer in the Medicare book, and they pay every 12 mos for high risk patients, and every 24 mos for low risk patients.

Also, there is a blood/urine test that can be done to see if the Forteo is working and it's called a Urine NTX test (n-telopeptide). I'm not sure what the test measures for, other than collagen type 1 levels, but it will tell your doc whether there is bone turnover or not. I had this done at 4 mos after starting Forteo and it showed new bone growth. I would imagine I will have this test again, while I'm waiting for the 24 mos to elaspe on my dexa scan.

Last edited by DesertBloom; 10-29-2006 at 11:59 AM.

 
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