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Question

Can you provide detail on what Medicare covers for lab tests?

Dr. Eric

The Medicare rules for laboratory tests are unlike any of the other Medicare rules. Everyone seems to think that Medicare is a wonderful benefit that pays for all health care, but the reality is VERY different. Medicare has some strict rules on how much they will pay for laboratory tests. Some idiot bureaucrat decided that the way to save money in Medicare was to limit the amount that they pay for each lab test. There is a list, about 400 pages long, that lists all of the lab tests that Medicare will pay for, and how much they will pay. This list is updated each year.

None of the payments has ever gone up.

Basically, Medicare reimbursement to labs is about 50-60% of what the lab normally charges for the test. For many (most) lab tests, this means that the lab will lose money. To compensate the labs (so that they don't go out of business) the mental giants in Washington decided to let the labs bill patients directly for the difference between what Medicare pays, and the actual cost of running the test.

This is why your doctor will present you with a form when he/she orders a laboratory test. The form will look something like this: http://www.cms.hhs.gov/medicare/bni/CMSR131L_June2002.pdf

This is called an "ABN" form, and it outlines how much Medicare does not pay, and how much you will have to pay for the lab tests. It gives you an opportunity to refuse the lab tests, and avoid the charges, but if your doctor ordered the tests, he/she probably thinks they are necessary to make decisions about your care. This leaves you with a decision: "can I afford the tests, or do I wing it and hope the doc guesses right?"

Medicare covers many charges for doctor's fees and hospital expenses, but lab charges are only partially covered. This makes no sense, but it is typical of government programs. Eric's Opinion: Before we start bashing the present administration for this, most of these rules were instituted by the previous administration during the 1990's. If Hillary-care had been enacted, there would be many more examples of these nonsensical loopholes. When government gets involved in health care, the cost goes up, the quality goes down, and innovation is slowed. Health care in America is an excellent example of how a free-market economy can create technological advances. All we have to do is look at a socialized system like those in Europe to see how government will stifle that technology. Virtually no medical advances have been born in Europe over the past three decades.

While it seems that getting government to pay for health care sounds good, remember where government gets its money: from taxpayers like you and me. A health care system in the US that is government-controlled will give us a system that has the compassion of the IRS, with the efficiency of the CIA, and the fiscal responsibility of the military.


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