MediCare coverage of lab tests

A number of folks (especially diabetics) have expressed concerns that Marshall Lab is saying that routine lab tests are not covered. I have discussed the matter with the Lab Services Director there, and have the following comments to make by way of clarification:

1. MediCare has always, and continues to cover medically needed lab tests.
2. Medically needed with respect to glyco-hemoglobin tests in diabetics (quarterly average blood sugar tests) are:
1. Every 90 days, if stable/well-controlled
2. As often as ordered by doctor if not well-controlled, doctor defines not well-controlled.

So, what's the to-do and what are all those threatening-sounding forms about?

1. Marshall got tired of being burned on lab tests.
2. They got a computer software program that automatically generates a form warning you that MediCare may not pay for a test for any and every test where MediCare defines a time limit.
3. This form is generated for the front-desk people at the lab, who will ask that you sign it whether you are at the time limit or not.
4. This is not meant to say that you will be billed, it is a CYA measure in case MediCare doesn't pay them.
5. The front-desk people have not been educated in the finer points of law and insurance regulations, they are "just following orders".

BOTTOM LINE:

If it concerns you, do "every 3 month" diabetes labs a 90 days or more apart.

If you have been asked to do labs at closer time intervals, don't worry about it. We are careful to complete the paperwork in such a way that it will be covered.