May 09 Marci's Medicare Answers

Dear Marci, Does Medicare cover screenings for heart disease? Luther Dear Luther, Yes. Medicare covers blood tests every five years to screen for cholesterol, for lipid and triglyceride levels, and for other signs of cardiovascular disease (or indications that you are at high risk for it). Medicare will pay 100 percent of its approved amount for these tests, even before you have met the Part B deductible. The American Heart Association estimates that over 80 million Americans have one or more forms of heart disease, including high blood pressure, coronary heart disease and stroke. Heart disease and stroke are the first and third leading causes of death in the US. Heart screening can save your life and improve your quality of life by treating the condition before it results in more severe health problems. Marci Dear Marci, I received something in the mail called a Medicare Summary Notice. Is this a bill? Sam Dear Sam, No. The Medicare Summary Notice (MSN) is not a bill. When Original Medicare processes a claim for health care services you received, the claim is detailed in a MSN. The MSN is a summary of claims for health care services Medicare processed for you during the previous three months. MSNs are mailed four times a year and contain information about submitted charges, the amount that Medicare paid, and the amount you are responsible for. Understanding your MSN The most important fields on your MSN explain: The total amount your doctor or other provider may bill you. The "You May Be Billed" field indicates the total amount that the provider is allowed to bill you (balance billing). It deducts the amount you already paid. Non-covered charges, if any. The "Non-Covered Charges" field shows the portion of charges for services that are denied or excluded (never covered) by Medicare. A $0.00 in this field means that there were no denied or excluded services. If you disagree with a non-covered charge you can appeal. The MSN will have instructions for how to appeal. Try to save your MSNs for about seven years. You might need them in the future to prove that payment was made if a provider sends you a bill or that services were received if you claimed a medical deduction on your taxes. If you have lost your MSN or you need a duplicate copy, call 800-MEDICARE. Marci Dear Marci, I have Original Medicare. Over the last year I have been feeling more and more depressed, so I started seeing a psychiatrist a few weeks ago. I just received my Medicare Summary Notice and I'm confused. For the first visit, Medicare paid the normal 80 percent of the cost, but after that, it looks like Medicare paid only 50 percent. Doesn't Medicare pay 80 percent for all doctor visits? Lindsay Dear Lindsay, Medicare covers outpatient mental health services differently than it covers other types of doctor services. Medicare will pay 80 percent for your initial outpatient mental health visit so that your doctor can determine your diagnosis. However, Medicare will pay only 50 percent of its approved amount for future visits. The same payment rate applies to other mental health providers that you see as an outpatient, such as psychologists and social workers. There are a few other outpatient mental health services that are covered at 80% by Medicare. These include brief office visits used to monitor or change your prescription and psychological testing to establish a diagnosis. Marci Marci's Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation's largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114. To subscribe tothe free newsletter, "Dear Marci," e-mail:dearmarci@medicarerights.org. To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center's website at www.medicarerights.org.