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What to Do When Medicare Won’t Pay for More Tests

July 22, 2010

“How can Medicare (and how dare Medicare) determine that I’ve had ‘too many tests’?” asks a reader at The Los Angeles Times blog Bucks. “Medicare has informed me that I’ve had ‘sufficient’ tests this year and that they won’t pay for any more.” If you’re caring for an aging parent and this issue comes up, here’s part of what Medicare expert Joe Baker advises in the blog post:

It may be that you received duplicated tests or that you have reached the limit of what Medicare deems medically necessary. In any case, you always have the right to appeal a denial of coverage or payment. If you have Original Medicare, you will see instructions on how to appeal on your Medicare Summary Notice. If you receive Medicare through a private health plan (commonly known as “Medicare Advantage” plans), you must first obtain a written denial from your plan. The denial should include instructions on how to appeal. Whether you have Original Medicare or Medicare Advantage, the key is to demonstrate, through a letter from your doctor, that the tests you received were medically necessary.

Baker’s full answer appears in part two of his recent Medicare questions-and-answers posts at Bucks. In this installment, “Answers About Medicare: Part 2,” he also addresses what to consider when you turn 65 and what to do when you want to see a doctor who doesn’t accept Medicare.

If you have any questions about this post or need help finding senior-care options for a loved one, call 1-866-483-4896 to speak with a care advisor in your area.

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