Is pathology not always covered?
I recently had a stool test that revealed I have low pancreatic enzymes. However, I just received a bill for $140 for the stool elastase test. What’s going on? I thought pathology was typically covered by Medicare.
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It’s frustrating to receive unexpected bills, especially when you believe a service should be covered. While Medicare does cover many pathology tests, there are some nuances that can affect coverage, such as the specific type of test, whether the test is deemed medically necessary, or if the lab that performed the test is contracted with Medicare.
In your case, the stool elastase test may not have been covered under your Medicare plan for various reasons, including how it was coded or billed. It’s also possible that the policy for your specific Medicare plan has limitations.
I recommend the following steps:
Check Your Medicare Summary Notice (MSN): This document will detail what was billed, what was covered, and any patient responsibility.
Contact Your Health Care Provider: They might provide clarification on why the test was billed separately and if it was coded correctly.
Reach Out to the Pathology Lab: They can explain the charges and help determine if it was billed incorrectly or if there are options for financial assistance.
Review Your Medicare Plan Details: Making sure that you fully understand what is covered can help avoid surprises in the future.
If you’re still having trouble after these steps, consider contacting the Medicare helpline for further assistance.