Personal Consumer Issues • Billed for services I declined

I don't know if it is a federal or state rule, but in my area (S. Calif.), a lab or other service is required to inform you beforehand if something is not covered by your insurance. Then they will give you a form where you acknowledge that and you are willing to pay $xxx. I once signed and Medicare paid for it and I never received a bill. (This doesn't necessarily apply to other services billed to Medicare.)

You are the one who is supposed to know your annual coverage rules, not your service providers, since there are so many plans.

I don't know how a lab could be sure something is covered or not.

Just as with Rx orders, there could be times that a "special request" or "special circumstances" (e.g., specific condition or diagnosis concern) could warrant payment when ordinarily it wouldn't.
In fact, that could happen with many lab tests... just because it was covered last visit doesn't mean it's warranted now. The insurer may not know that (yet?).

It's a nice "rule", it/when it can work!

ETA: We usually have to sign something (for any medical service, lab or not) accepting responsibility for payment IF insurance/etc., doesn't pay.

RM

Medicare rules basically require that if something isn't covered the patient has to sign a specific waiver or else the patient is not responsible, so clearly somewhere in the provider chain someone figures out if something is covered. If providers can figure it out under Medicare, it would seem they can figure it out when otherwise required. https://www.cms.gov/outreach-and-educat ... 006266.pdf

I didn't understand that the concern of the OP here was related to Medicare.
If not, then every insurance group policy, if that's what it is, can be very different from others.

And as mentioned, there are some times when there is a specific need for some test or procedure, and once the physician's office makes that request or documents it, etc., "permission is granted", etc.

It's not always known immediately, and if it's a private insurer, the terms can be rather idiosyncratic, as can be any special requests and approvals.

RM

Statistics: Posted by exodusing — Mon Jun 17, 2024 4:12 am — Replies 44 — Views 4177