Social Security & Medicare Questions

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Social Security & Medicare Questions

Q: I have a history of Osteoporosis and have had bone density tests many times. Now I am told that if I want a bone density test I have to sign a paper acknowledging that Medicare may not pay for it. Is this correct?

A: Medicare Part B benefits were recently expanded to include preventative osteoporosis bone mass tests. The benefit also includes the doctor`s interpretation of the results of this test. You pay 20% of the Medicare approved amount after the $100 yearly Part B deductible. You are eligible for the test if you meet one or more of the following criteria. You are:

A woman being treated for estrogen deficiency and at clinical risk for osteoporosis, based on your medical history and other findings.
A man or woman whose X-rays show previous fractures.
A man or woman on prednisone or steroid-type drugs or who are planning to begin such treatment.
A man or woman diagnosed with primary hyperparathyroidism.
A man or woman being treated with a drug for osteoporosis to see if the therapy is working.

Medicare will only pay for this test if ordered by a physician and will only cover tests every two years (or more frequently if medically necessary).

The form you were asked to sign is routine when there is some uncertainty whether the benefit will be covered. Because this is a relatively new benefit and Medicare coverage rules are often unclear, your doctor may have been overly cautious. Prior to signing such forms in the future, feel free to ask your physician if the test or service you are about to receive is `medically necessary.` Since you are at risk for osteoporosis, chances are your test will meet the definition of `medical necessity` even though you may be receiving it more frequently than biannually.

For more information see www.medicare.gov/health/osteoporosisdetails.asp or call Medicare Toll Free at (800) MEDICARE (800-633-4227).

For more information about osteoporosis, click on the following link to our website:

`Osteoporosis: The Bone Thief``

If you found this question and answer interesting, you may also like to visit the Social Security and Medicare Questions & Answers section on our www.TSCL.org website. Click the following link to go there: (http://www.tscl.org/MedicareandHealthQA.asp)

This article first appeared in Volume 6, Issue 7 of "The Social Security and Medicare Advisor" newsletter (June/2001). To receive future editions of "The Advisor" in its special, free e-mail version, please click here.