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Valued Social Butterfly
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Re: medical procedure

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@Lostsoul62 wrote:

I have Medicare A and B and I would like to get an endoscopy which cost between $1,500 to $10,000 so I ask how much out of pocket would I pay. Well no one know the answer. So I'm suppose to get a medical procedure without know how much I have to pay?


Can't give you an answer until one important fact is disclosed:

 

How do you get your Medicare benefits?

- are you using the traditional or original program with or without a Medigap (Medicare supplemental plan)?        OR

- are you getting your benefits via a Medicare Advantage plan?

 

Telling us that you have Medicare Part A and Part B does not tell us how you are getting your benefits to this coverage, since different entities are responsible for this coverage (negotiation of price, network coverage, etc) depending upon how you are getting your benefits, that makes a big difference.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: medical procedure

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Hi, Lostsoul62,

 

 

According to CMS (see the link below), endoscopies are covered when reasonable and necessary. According to the Medicare website (below), they are covered when your doctor orders them (which meets the definition of "reasonable and necessary." The Medicare website also states that you pay 20% for "covered diagnostic non-laboratory tests and X-rays" done in your doctor's office or an independent testing facility, so unless you have a Medicare supplement, you would likely be responsible for that portion. I hope this helps.

 

https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?CALId=171&CalName=Coding+Gui...

 

https://www.medicare.gov/coverage/diagnostic-tests.html

 

 

 

Medicare, Life, Annuities
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Info Seeker
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medical procedure

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I have Medicare A and B and I would like to get an endoscopy which cost between $1,500 to $10,000 so I ask how much out of pocket would I pay. Well no one know the answer. So I'm suppose to get a medical procedure without know how much I have to pay?

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