Medicare coverage for OB/Gyn appointments after transplant....

[jbeany]

Anyone else been down this road yet?  I just got billed for my yearly oil and lube check up from my doc.  Medicare denied the claim, saying they only cover it every other year.  They also noted on my "This is not a bill" that it appears I wasn't aware it wasn't covered, and therefore I was not liable, so don't send the doc any money. ( Well, good, 'cause I haven't really got it right now anyhow.)  The office did go over in excruciating detail how my IUD wasn't covered, and I did pay in full for that, which is dreadfully expensive up front, but well worth it when it lasts for 5 years.  The office said nothing about the standard tests not being covered though.

The other note on my This-is-not-a-bill said that Medicare only pays for the Pap/pelvic screenings unless high risk factors are involved.  I sent copies of the Medicare notice and a note back to the doc's billing office about my immunosuppresants and my increased cancer risk, wondering if they could code the bill differently to account for that.  Has anyone had this covered by Medicare?  Do you know if having a transplant can be used as a high risk factor?  Would that be enough?  Really, I'm not all that keen on skipping every other year, between the immunos and a family history of uterine cancer.

[sullidog]

I don't know but I'd start an appeal

[jbeany]

I'm thinking the doc's office is going to.  I don't have to pay it, so I'm not going to argue with that.  I just would like the codes to tell the the doc's billing department so I can get it done next year, too.

[amanda100wilson]

I am pretty sure that you could be considered high risk if you have had a suspect smear in the past.

[okarol]

We appeal everything.