Being (possibly) billed for lab tests at Marshall

When you go to lab to get blood tests done and you are asked to sign a paper you are NOT being told that you WILL be billed.

Marshall recently bought new billing computer software that automatically prints out a form called an Advance Beneficiary Notice (ABN) whenever a doctor orders a test that has a limit on how often it might be done or has often been not reimbursed to Marshall.

This form tells you that:

1. Your doctor feels you need this test.
2. If your insurance, for some reason, refuses to pay Marshall for doing the test, Marshall may bill you for it.

Problem is, Marshall's billing people are not involved in tell you about this or helping to determine whether or not you actually will get a bill or not. The lab people are just being asked to have you sign the paper whenever the computer prints one out.

You won't get a bill for:

1. annual screening tests done at least a year after the last one
2. diabetic glycohemoglobin tests (HbA1c) at any frequency at all for out of control diabetes
3. tests often ordered for screening but ordered for non-screening purposes, such as a mammogram for an abnormal screening mammogram, or a PSA test for an enlarged prostate.
   

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.