Connect
Is a dexa every 2 years enough?
My doctor suggested that a Dexa scan every 2 years is what he uses to monitor Evinity then followed by reclast
I asked about blood turnover markers to see if meds are working along the way
He said he doesn’t use those
Time for a new doctor????
Like
Helpful
HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
Connect
Do you know how to check if your insurance company defines those tests as “medically necessary” for your condition? Usually, there is an electronic tool on the insurance portal that allows patients to evaluate the cost (co pays and/or whether certain tests and/or procedures are covered). Just out of curiosity, has your new dr confirmed that he or she believes those tests are medically necessary?
Medicare has a list of conditions they will accept as “medically necessary” for bone density scans more frequently than bi-annually. i remember once my dr forgot to write medically necessary and why on the script and the hospital wouldn’t schedule the scan until my doctor corrected my rx—i understand—i wanted the cost covered by insurance and the hospital wanted to ensure they would be paid
-
Like -
Helpful -
Hug
1 Reaction@elisabeth007 The tests were the first things he and I talked about. Yes, he believes they are medically necessary and my impression is that all of his OP patients get the order for them.
As a former Medicare fraud investigator, i feel I have been well informed about what medical necessity means. As far as i know, it’s the insurance company that decides, Not the Medical provider.
If i were in your situation I would email or text my insurance company and ask: 1. if the insurance company covers those tests 2. If so, under what circumstance's your insurance company covers those tests
I checked a few hours ago on the Medicare website for when they cover bone density scans more frequently than once every two years. There was a very specific and detailed list of the specific occasions/circumstance's.
-
Like -
Helpful -
Hug
2 ReactionsThe question i would be concerned about is: who bears the financial burden of paying for the tests. Many patients don’t mind paying a few hundred dollars for tests that insurance doesn’t cover.
-
Like -
Helpful -
Hug
1 Reactionfor the first time, i have a claim that needs to be appealed on Medicare and the directions i’m reading seem to say i’m the one who needs to write the appeal
My experience was that Recast worked well for me because there was such an improvement in my DEXA scores. i have an extremely knowledgable endocrinologist. He has more patients than time permits and there is a sign up about the natl shortage of endo’s. i would be afraid that i would need to find a new dr if i demanded my dr wrote my ins company pressuring them to pay for a test he didn’t even order. Hopefully, you have less of a physician shortage than we do in Florida
@elisabeth007, I'm not clear on why one would expect payment on for a test the MD didn't order. Under those circumstances, I think you'd be on your own.
@elisabeth007, could be! I called Medicare when wondering if bone marker testing would be covered and was told that they would be if the MD would indicate they are medically necessary. Maybe I was given false information.
This is probably the link you mentioned?
https://www.medicare.gov/coverage/bone-mass-measurements
-
Like -
Helpful -
Hug
1 Reactioni have found that its best to get such information in writing. Do you know how to use the text function of Medicare. i would suggest being very specific and naming the specific tests and asking what the specific documentation from your dr needs to say.
-
Like -
Helpful -
Hug
1 Reaction