Unfortunately that's happening with private insurance also. It's totally crazy. It makes no sense to not pay for preventive stuff. Is there a way to appeal this decision? I have no idea because I'm not yet on medicare.

I don't know either, Scissors. I was thinking about that today.......where and how might one protest? I think the problem is so big that it's overwhelming. It would take a very large group protest to make even a dent. At least that's the way it seems to me.

Perhaps if they would deport some of the illegal aliens instead of giving them Medicaide & foodstamps, medicaide could afford to treat taxpayers.

Glad your are back, Alisande, I am sorry to hear this. Will they still do your breast exams and bone density tests? That is under preventative medicine.

I don't know the answer to that, Ellie, but I can tell you this: I'm not discussing breast exams with Lazypup in the vicinity. LOL

Never mind me...I don't even examine my own.......

I grew up on a dairy farm so every time I see a breast it reminds me of work,,and I run the other way

Medicare is paying dermatologists for skin exams - IF there is justification. Same as for other tests, such as dex scans, etc.

We have traditional Medicare with a Medigap policy to cover what Medicare doesn't pay.
I don't know how those Medicare Advantage policies work. Mother was on one, in NJ, and we took her off and back to Traditional Medicare, because of all the problems with doctors and payments.

Today I got a flu and a pneumonia vaccination free at the pharmacy with my Medicare insurance card. That's preventative.

Medicare is paying dermatologists for skin exams - IF there is justification.

That's true. But unfortunately someone living alone, for instance, with concerns about moles he or she can't see, is not justified in seeking a full-body exam. At least that's how it was explained to me.

I have what you have, Monica. In my case the Medigap policy is Blue Cross/Blue Shield. But as you probably know, if Medicare denies a claim, the Medigap policy won't cover it either.

That's good, Sheilajoyce, and I did the same. But I can't be too impressed with Medicare about that because I used to drop in at our Public Health office and get flu shots for free there, too. :-)

It may be the way the medical person codes the exam. Because DH has had skin cancer, the Dr. checks it every 3 months, unless she finds nothing, then goes to 6 months and now a year, BUT, if DH finds anything he does not like, she checks it right now. So far both MC and BC have paid for everything.

I remember maybe 30 years ago when private insurance would not pay for Pap smears because it was preventative. I had to go to Planned Parenthood or a county public health clinic for my Pap.

I know that Medicare has cut back on some of the services that it previously provided, but it's going to pay for more than my current insurance does when I go on it in a month. I currently pay $650+/month for traditional BC/BS and have copays and $500 BS deductible and a $250 Major Medical deductible. Every time I've had a Flu Shot in my MD's office it cost me $45 min because I haven't met the deductible. I've gotten them at Walmart for the last few yrs. I shouldn't complain because by not meeting the deductibles, it means that I have been fairly healthy, knock wood. I didn't even know that Medicare previously paid for Chiropractic. That's too bad. I haven't had an adjustment in yrs, and feel as if I could really use one.

Medicare does pay for chiropractic...they did for DH this past year. His hip was bothering him, he had pain, and Medicare paid for the adjustment.

I think "justification" may be defined as your personal doctor ordering an exam because of a pre-existing condition or the suspicion of a medical problem.

An example...Medicare only covers one yearly wellness exam. I'm a non medicating diabetic [pre-existing condition] and they pay for blood scans as well as an exam every 6 months.

I have a heart/lung condition and Medicare pays for an annual exam by my cardiologist. I consider his exam to be preventive medicine because he keeps a close eye on my numbers...i.e. cholesterol, etc. Currently...I'm non medicating but if any of my numbers change...I will no longer have this luxury.

I think Medicare is redefining their coverage for the purpose of removing abuse of the system. If one is truly in need of care/examinations...there's a legitimate way to receive the care.

In your case Susan...perhaps Medicare thinks you should have had surgical corrective measures for your scoliosis and that's why they're no longer covering chiropractic therapy. I'm sorry that they've done this to you because I know how painful attacks can be. Perhaps an in depth conversation with your internist could turn this decision around. You can appeal Medicare edicts.

Lazypup....ROTFLMAO!!!

Anne

I guess we can look forward to more of same as the government inserts itself even further into our healthcare delivery system.

Anne, I think Medicare's decisions on the chiropractic all come down to their "event" rule, i.e., if your pain isn't something completely new and different, caused by trauma or some other sudden occurrence, they won't pay for it.

Ironically, one of the new rules is that if Medicare covers a patient's visit they will then insist that the chiropractor set up one or two more appointments to complete the treatment. (Presumably, after that they're done.) This ends up costing Medicare more money than if the patient had come in for a "tune-up" every few months or so.

"I guess we can look forward to more of same as the government inserts itself even further into our healthcare delivery system."

Or you can just pay the bills without Medicare. Would you prefer that?

Unfortunately for a lot of people who use chiropractors, that profession has a good large number of suspect practitioners. So IMHO there should be some sort of extra certification. Lots of chiropractors can't get approved by any insurance plans; that should tell you something about the efficacy of their treatments.

Yes, the government is Medicare (or vice versa), so one can't separate the two.

A chiropractor once told me about courses that are given to teach members of the profession how to make more money by getting their patients to sign up for endless series of treatments. All chiropractors aren't like this, of course, but stuff like this has tainted the profession.

And yet no group is entirely without its black sheep. A health insurance company once assigned me to a board-certified internist who is now in prison for trading drugs for sex (among other things).

Susan...are you getting this chiropractic info from the 2012 "Medicare & You" booklet? I'm reading mine as we converse and for the life of me...I can't find that info. sigh But...I agree that Medicare isn't particularly fond of chiropractic services...noting the fact that the patient is responsible for "all costs for any other services or tests ordered by the
chiropractor...including X-rays or massage therapy." They're certainly doing everything possible to discourage this particular service. I don't envy you. I hope you can find some other relief from the scoliosis pain.

Anne

First, Alisande I believe if you look on the back of your Medicare EOB you will find the information about APPEALING their denial of coverage. It should be there .... somewhere. Denials are always appealable, usually there are 2 levels of appeal. So, exercise your RIGHT TO APPEAL. Write a letter & explain your situation. If that fails, enlist your chiro to write an appeal for a second review.

Medicare doesn't "think". They have guidelines for coverage. A low level clerk of a computer program screens outs targeted types of claims that have traditionally been abused. That system isn't perfect. But if you don't appeal something that is legitimate, or *possibly* legitimate, they have no way of knowing that they've snagged something in error. The error could even be in how the diagnosis &/or treatment was coded on the bill by the chiro's staff.

Chiro has its place & can be a helpful adjunct for treatment. But it does have quite a history of "hocus-pocus" & of duping people &/or insurance/Medicare. I am aware that there are those "lonely sorts" who ... truth be known... use a chiro visit as somewhat of a social outlet. Why should Medicare or insurance pay for clearly unnecessary treatments. Preventive chiro generally isn't in the same league as preventative in traditional medicine.

I guess we can look forward to more of same as the government inserts itself even further into our healthcare delivery system.
Gibby, I don't understand your statement. At.all. Medicare IS & has ALWAYS been a gov't run healthcare system. I want my tax $ spent as wisely as possible. If there is fraud/abuse, weed it out. And of course, they certainly can't afford to cover absolutely everything on the healthcare menu.

Sushi - I do currently pay for healthcare sans Medicare. My understanding is that I won't have that choice when the time comes - that you're required to take Medicare coverage. AT least that's what my friends who are about to go down that path tell me. They would prefer to keep their private coverage and not have the limitations of Medicare including the fact that some physicians have opted out.

Beeohio - healthcare reform - the government is getting more involved in healthcare for everyone, not just Medicare and Medicaid recipients.

Gibby, you need t do your own research and not rely on what you "hear." You will be very surprised at what you learn. Medicare is a vital part of the health care system, and unless it is dismantled by current politics, it will be there for all of us.

Gibby..and I know i'm speaking frankly.
Think again about not having any medical insurance. Even tho you are in good health now, you could have the kind of year i've had in the past 12 months....tens of thousands of dollars(retail cost, not negotiated cost like private ins or Medicare)on unexpected illnesses and hospitalizations.
Unless you have the liquid resources to pay $70-80,000 to pay hospitals and doctors.
Or you expect to go on Medicade, and let the rest of us pay for your medical care.

Bee, thanks for the tip. I'll keep it in mind, but I should have explained that Medicare didn't just deny my claim--they investigated it. I was one of a number of patients whose files were pulled at random, and my chiro was asked to justify the visit. He wrote a two-page letter describing the condition, the treatment, and the limitations placed on my activities when I'm in pain. Medicare's response was to deny the claim and future claims--unless I presented with something entirely different. (Different from back and/or neck pain? Why else would I go to a chiropractor?)

So I suspect any action on my part at this point would be an exercise in futility. I'll keep the appeal option in mind for future situations, though. I've been advised that my Medigap provider is investigating several of my claims from March, April, and May 2010. This strikes me as somewhat ironic because I've never considered myself a big medical consumer.

It's funny....I almost never think about the scoliosis, which I was born with. I'm a little crooked, but I don't think I appear that way except to the occasional physician's critical eye. I know it causes my hip pain, but haven't related it to my back pain--although I guess I should have. I have widespread joint and muscle pain from other issues, so it all sort of blends together.

Alisande, you might think about going to an Orthopod to define a diagnosis that just might refer you to a Chiro for treatment.

You might also try a 'physical medicine' specialist, Susan. Might massage help?

My own and my DH's limited experience with chiropractors leads me to applaud limitations on insurance coverage for that service.

It did have one, early on?

o j