Reply With QuoteAlthough not surprising, these moves are depressing.
Notified two weeks ago that under provisions allowed in Obamacare - Medicare and medicaid will no longer pay for routine screenings for prostate cancer. Also routine bone density scan will no longer be covered. So much for affordable access............
Peace
Hppy
Although not surprising, these moves are depressing.
To hppygr8ful: please, please, please, if you have come across such information, list the source. There is an ample supply of mis-leading information circulating online and as a nurse, I think it responsible and wise to verify sources of information BEFORE putting that information out for people to see.
If you go to http://www.medicare.gov/Publications/Pubs/pdf/10110.pdf you will find that these services ARE covered and coverage has INCREASED since January 2011.
See page 16 for Prostate screening and page 19 for Bone Density screenings.
Peace to you too!
I don't think my previous reply was posted properly, so I'm an going to try again.
Please verify the source of your information - "Medicare and medicaid will no longer pay for routine screenings for prostate cancer. Also routine bone density scan will no longer be covered. So much for affordable access"
There is so much mis-information circulating on the internet, one should verify anything before posting. As well, when you post such information, it would be more creditable if you would post the source of the information.
Posting that "Obamacare" (Proper name - Patient Protection and Affordable Care Act) is no longer paying for Prostate Screenings and Bone Density tests is not true.
Please refer to pages 16 and 19 at http://www.medicare.gov/Publications/Pubs/pdf/10110.pdf You will see that payment has actually increased for Bone Density scans as of January 2011.
I am curious as to where you got the information that such services are no longer covered...
I can't give you the exact source due to patient confidentiality but I have been receiving denial letters for these tests for medicare and medicaid for some time along with test used to screen for risk factors for heart attack and CVA (...ie.. Cholesterol, lipids etc.....) Medicare will only be paying for these tests after a heart attck or CVA has occurred or once every 5 years instead of yearly. I just received a letter for two of my disabled clients on medicaire which stated that their recent Bone density screenings were not covered and they each owed a payment of over $300.00 each. Mind you this is for routine screenings - if they have already had a fracture then it's covered 100%. In ither words the new system is designed to treat existing illness not for prevention.
Hppy
Last edited by hppygr8ful; 02-20-2012 at 05:51 PM.
Originally Posted by PamB
I didn't say the screening would not be covered at all but that "routine" screenings would not be covered.
Also note that the publication you site was for 2011 not 2012. Expect to see many changes as we enter the "Brave New World" of healthcare reform which takes full effect in 2014.
The cited publication sates
PSA's covered yearly for men over age 50 that's a full ten years later than the previous guidline to start screening at age 40.
Bone density screenings are only covered if deemed "medically necessary" no longer routine.
Cardiovascular Screening covered every 5 years instead of yearly.
Cervical Cancer screening every three years instead or yearly.
Obama himself was quoted as saying "why pay for a bunch of tests when a pain pill might do the trick."
Of course political hot buttons like mamograms and HIV testing still covered yearly.
This all taken from the publication cited. Plus there is all kinds of qualifying language in the publication with regard to these tests being covered as deemed medically necessary (By whom?) or if your Doctor excepts assignment (meaning very few since many physicians have claimed they will either retire or stop practicing medicine in the next ten years due to declining reimbursement rates)
As a nurse who cares for some of the most vulnerable patients (developmentally disabled adults), I feel it is important to educate people on the lies being sold to the American people with regard to healtcare reform.
Rates for health insurance continue to climb 15 to 35% this year alone for most people and if you don't purchase insurance by 2014 you will face criminal penalties.
Peace
Hppy
Last edited by hppygr8ful; 02-21-2012 at 02:33 PM.
I looked up the Cardio Panel and you are right, they will only pay once every five years, unless someone suffers MI or CVA.
As for the bone scans - if you are at risk for osteoporosis, have hyperparathyroid disease, if you take steroids, if you have vertebral abnormalities, this scan is covered once every 24 months and more if medically necessary. (not sure what meets the term "medically necessary")
I agree that the health care reform is far from perfect, and I hate the fact that we still have for-profit insurance companies running the show. Personally I think the problem is a result of the way our entire health care system is set up.
As a nurse I got sick of what I was seeing. Last April I lost my job so I started a medical tourism services agency, IHT World. If someone needs (for example) a knee replacement, the total average cost in the USA is around $38,000 and that doesn't count outpatient physical therapy. I have a client that is saving her money to go to a Joint Commission international accredited hospital in Costa Rica. She and her husband can get her knee replaced for about $19,000 and that includes air travel and accommodations for two AND 10 days of outpatient physical therapy. This price also includes medical tourism insurance to cover her in the event a complication would develop.
My question is, why is health care in the USA so darn expensive compared to the rest of the world? When a hospital abroad earns JCI accreditation that means American quality care. You just don't pay American prices.
I would like to know more about this medical tourism! Did you see where there is a new super-strain resistant bacteria (make MRSA and VRE look like the common cold) that is being found in folks who are having surgeries abroad? Most of this is coming for South American and Far East countries
Healthcare in the US is so darned expensive because of the very high rates paid by practitioners for malpractice insurance and the refusal of the government (both sides) to enact comprehensive tort reform. How do you think John Edwards made all his money - by bringing law suits against OB/GYN physicians for so-called mal-practice. Did you know that you can sue your ob/gyn for malpractice up to the age of majority (18 ) of the child he/she delivered. So if you kid doesn't pass his/her SAT's sue the Dr. for your baby having anoxia during childbirth! It's the American way. Most countries control health care costs two ways -one by rationing health care (very common in Canada and England) and two by not allowing people to sue their doctors who are for the most part mid level government employees. In Canada and England you can't bring a suit against the government either.
Hppy
I believe I posted something some time ago about the VRE etc from foreign countries (SW Asia, I believe). Am too tired to do a search myself.
Remember, Canada is part of England; Queen Elizabeth is the Gov., for the most part. Regardless, I know from a pen pal that the wait time for some surgeries is pathetic, and the patient can get much worse while waiting.
I had read a story about 2 weeks ago, where people from I want to say Saudi Arabia go to India for 'getting back to pre-pregnancy looks'---sagging skin fixed, etc.
Well I just spent my morning going through the new book of billing codes to see how I can get Medicare to cover the lab tests for my disabled clients. I want to find codes that actually apply so that we won't later be accused of comitting fraud. This is such a nightmare! It's only going to get worse. I envy you all in the hospital setting on this - you don't have to worry about wether the test is going to be paid for. But I do because my Clients only get to keep $35.00 a month (the rest goes for their food, transportation and housing) for Personal and Incidental expenses and uncovered medical costs have to come out of that .
Oh and then I get the dentists who just pull all their teeth so they don't have to see them again.
Some days I just want to cry.
Hppy
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