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Update re: Medicare Denying Genetic Testing Claim

Posted by trki @trki, Mar 26 11:38am

I went back today to look at the medicare summary which had the genetic testing denial.

What I had not noticed before was:
Maximum you may be billed: $0.00

And A, B, C and D notes

D= "You didn't know this service isn"t covered so you don't have to pay"

So good news? Or will we still need to wrangle with Invitae?

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Mentor
Laurie, Volunteer Mentor | @roch | Mar 27 6:53am

@trki
I have had similar Medicare explanation of benefits statement where it is not covered, but I was not required to pay because the clinic that did test failed to have me sign a Medicare waiver/Advance Beneficiary Notice (ABN). It was not for genetic testing, but for certain blood tests.

If your not familiar with ABN, it is a written notice that a clinic must have you sign before receiving certain services notifying you Medicare may deny payment for that specific procedure or treatment.

It is my understanding if you did not sign a ABN before test, you are not required to pay.

Did you sign or agree to anything with Invitae that you were responsible for payment if insurance does not pay? If they bill you, they need to prove you were notified and signed / agree to cover uninsured costs.

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1 reply
trki | @trki | Mar 27 8:18am
In reply to @roch "@trki I have had similar Medicare explanation of benefits statement where it is not covered, but..." + (show)
@roch

@trki
I have had similar Medicare explanation of benefits statement where it is not covered, but I was not required to pay because the clinic that did test failed to have me sign a Medicare waiver/Advance Beneficiary Notice (ABN). It was not for genetic testing, but for certain blood tests.

If your not familiar with ABN, it is a written notice that a clinic must have you sign before receiving certain services notifying you Medicare may deny payment for that specific procedure or treatment.

It is my understanding if you did not sign a ABN before test, you are not required to pay.

Did you sign or agree to anything with Invitae that you were responsible for payment if insurance does not pay? If they bill you, they need to prove you were notified and signed / agree to cover uninsured costs.

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Thanks for your feedback.

No, I don’t think he needed to sign anything… I’ll double check with him though

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