Anyone Successfully Billed Medicare For FFC Charges?

Discussion in 'Fibromyalgia Main Forum' started by Mikie, Dec 29, 2005.

  1. Mikie

    Mikie Moderator

    I'm considering going to an FFC and wonder whether Medicare will pay for any part of the treatment and lab work. I know my HMO would not cover it but I could disenroll from it long enough to get treatments from the FFC.

    Seems that my memories about Medicare say that a facility has to be Medicare approved before they will pay.

    Anyone, anyone? Thanks.

    Love, Mikie
  2. justlooking

    justlooking New Member

    Would like to know the answer too..

    Hey Mikie I thought you were our insurance guru LOL!

    Sincerely
    JL
    [This Message was Edited on 12/30/2005]
  3. pawprints

    pawprints New Member

    My experience was the bloodwork was covered at the normal Medicare rate because they used a Medicare approved lab.
    The office visits are not covered.
  4. Mikie

    Mikie Moderator

    That's what I figured. Medicare usually doesn't cover services at non-Medicare approved clinics.

    Medicare HMO's do not have pre-existing conditions. One can go back and forth from Medicare to the HMO's at will with 30 day's notice. There is no open enrollment.

    I'm not a Medicare guru but I used to be an insurance agent who dealt with Medicare insurance.

    I was pretty sure about the coverage with the FFC's, but I was wondering whether anyone had successfully made a Medicare claim for services. It's encouraging to know that at least, a small amount of the costs would be covered. Thanks again.

    Love, Mikie
  5. mbofov

    mbofov Active Member

    Mikie - I think the rules may be changing re being able to switch back and forth from a Medicare HMO to plain Medicare. I recently signed up for Secure Horizons Medicare HMO plan, and the person who signed me up told me that I could cancel it or change to another HMO until this coming June, but that after that there will only be an open enrollment once a year, I think in November.

    It may have to do wtih the new prescription drug plan. The rules say if you don't have one by June, that you have to pay a higher premium for one. So if you're switching from HMO's to Medicare and back, you'd have to keep switching your prescription drug plan too, it's just going to be more complicated I think.

    Mary
  6. pawprints

    pawprints New Member

    Thinking back, I may have had to sign a form stating that I knew the physician/center was not Medicare approved.

    Good luck with whatever decision you make. Would you be thinking of going to the Atlanta center?

    Shana
  7. Mikie

    Mikie Moderator

    Mary, I remember that Medicare has been wanting to make an open enrollment rule for some time, but I had not read that it was going to happen or that the rules had changed. It would make sense with these idiotic Rx plans. If I'm going to do the FFC thing, perhaps I had better get on it. I'll have to check it out. Thanks for the info. I'll call my HMO next week to get some more info. They have yet to send me info on their Rx plan. I'll also check the Medicare website.

    Shana, I would likely go to the Atlanta clinic as it's the closest. My daughter lives in Smyrna just south of Marietta. I am trying to decide whether to move closer to her and her son and husband. I don't want to live in Atlanta but I've been looking in Rome and Athens.

    Love, Mikie



  8. pawprints

    pawprints New Member

    Good luck. I love Athens. I went to college there for my first years.
  9. Mikie

    Mikie Moderator

    Athens is a lovely little town. I grew up in a college town which was about the same size at that time. It has a lot to offer.

    Love, Mikie
  10. hopeful4

    hopeful4 New Member

    Hi Mikie,
    I'm also on Medicare as my primary. The FFC does not take any insurance at all, so Medicare will not cover the office visit (at least that's my understanding of how it works). They will provide you with any necessary paperwork to submit to insurance on your own.

    However, they use Quest Labs. And, fortunately, Medicare does cover these! My first set of labs were the most expensive at close to $2000. Quest Lab took my Medicare card and billed it themselves. I was super happy to find out that Medicare paid the claim, and I owed the lab nothing, not a cent! Ever since, all subsequent labs have been paid for by Medicare.

    I was shocked to see how little Medicare's allowable rates were, and that the lab took them, that was an eye-opener.

    I know you've worked incredibly hard and long to regain your health. I hope that this will help you.

    Best wishes always, and Happy New Year,
    Hopeful4
  11. Mikie

    Mikie Moderator

    Geez, if Medicare would pay the labs, it would sure make it more affordable.

    Love, Mikie