He’s the guy whom pieces of your body get sent off to when you go to the doctor’s office, and he’s got some things he’d like to tell you. Like the secret manual covering which tests Medicare will and won’t cover, your rights under the Health Insurance Portability and Accountability Act, and can you please, please, write legibly and use a standard version of your name when filling out forms…
1) Medicare Sucks
This is pretty widely known, but I do not think many people understand just how little Medicare actually does until they are covered by it. First of all, with only five exceptions (that I know of; more on them later), Medicare will NOT pay for screening tests. Ever. If you are not sick at the time the doctor orders the tests you will have to pay for them some other way, probably out of your own pocket unless you have other insurance.
Even if you are sick there are tests that Medicare refuses to cover. Now, I wish I could tell you what these are, or when Medicare will not pay for the test, but the fact is that I legally cannot. See, we are given this nice booklet that outlines what tests Medicare will not pay for and when it will pay for them. The problem? It is actually against the law for me to show that book to anyone inside the company who does not need to know what is in it or to anyone outside of our company, including doctors.
Now, in the event that you have had a test ordered for you that Medicare will not, or usually does not, pay for you will be asked to sign a paper (called an ABN, or Advanced Beneficiary Notice). If you are shown this ABN do not immediately freak out because it does not mean that Medicare absolutely WILL refuse to cover the cost, and most doctors try to keep tests ordered for patients to the ones they know Medicare will pay for.
The paper is basically a waiver that says you understand that if Medicare does not cover the cost of the tests you could end up paying up to some amount of money. Something you need to know about this: You can refuse to pay for some or even all of the tests and they will not be run. It is not something I suggest, but it is your right to turn down any test (or all of the tests) if you wish. Second, it is your right to receive a copy of this slip of paper and you must be provided with one if you demand it. Finally, if you did not sign an ABN, or if Medicare does not pay for a test and that test is not indicated on the ABN, than it is against the law for any lab to bill you. Period.
As I said previously, Medicare will not pay for tests for the maintenance of your health; they will only pay for tests if you are sick. There is a slight way you can take advantage of this. If a test result comes back with readings that are considered abnormal than that is a test that can be run under Medicare (assuming it is one of the tests Medicare normally covers) without you having to pay (you will still probably be asked to sign an ABN) until the abnormal results go away. Usually doctors do not order unneeded tests, but you might want to ask your doctor the next time he orders a lot of tests if all of them are really necessary, or if it is just a standard procedure to order the whole battery. If it is simply standard procedure ask him to only order the ones he is sure you need.
I previously mentioned that there are five exceptions to the “No Screenings” rule that Medicare has. These are fairly recent because Medicare apparently recently realized that it is less expensive to screen for conditions and treat them early than to try and cure a problem after it is causing obvious illness. Men may have a prostate exam once every year. Women may have a pap smear once every two years. Medicare will also pay for a Lipid Screening or a Thyroid Test once per year. Finally, once every five years Medicare will pay for an Occult Blood (looks for blood in the stool).
2) HIPAA is Not Just Privacy
While a good chunk of HIPAA does pertain to patient privacy, it does have other provisions in there that I do not think are widely known. Most notably, it gives patients access to their own medical records. For example, you can demand a copy of your records and they must be provided to you.
This extends even further, though. If you are having blood drawn for a test, for example, you can ask that a copy of the test results be sent to you. You may even ask that the test be sent to your other physicians if you like. My lab does not charge for this service, but I cannot speak for other labs.
Personally I suggest that patients make it a habit to keep their own medical records on file in a safe place (stressing SAFE, many records have sensitive information). Also make a habit of requesting a copy of any tests run on you. I suggest this mainly because sometimes it can take time for doctors to transfer records to each other, and if you have your own personal copy it can greatly speed up a transition to a new physician so that duplicate tests that are not necessary do not get ordered (also a reason to send test results to different doctors).
3) Phlebotomists Sometimes Mess Up
Phlebotomists are the people who draw blood, but sometimes they make mistakes. While most Phlebotomists are in the business because they care about healthcare, that does not make mistakes any less painful or potentially damaging. Because of this you should be aware of the things you can do to make your visit more pleasant and less likely to have some sort of problem.
First of all, they should ask you to verify your information. Several times. Actually look at it and make sure it is all completely right. Name spelled correctly, address correct, sex, and everything else. When things get busy sometimes the staff does not check the paperwork as closely as they should because they are trying to get everyone through quickly. Sometimes paperwork just gets mixed up as well. If you cannot read the information yourself for some reason than ask to have it read to you.
When they wipe your arm with alcohol ask them to wait for 30 seconds or so before they stick you, since if it is still wet the needle will sting more. You should also probably tell them up front if you want to be warned when the stick is coming. Inform the Phlebotomist if you have taken blood thinkers or aspirin in the past 24 hours if they do not ask you since this will increase your chances of bleeding after blood is drawn or developing a bad bruise.
Sometimes they will ask you to hold the gauze for them after blood has been drawn. It does not take a lot of pressure, just as much as you would use if you were taking your pulse. Do not bend your arm for a couple minutes because that can cause bruising under your skin! You can elevate the arm above your head to help stop the bleeding if you like. Most people stop bleeding in less than 15 seconds. Ask the Phlebotomist to check to make sure you have stopped bleeding if you are old or know you have bleeding issues. Also if you have a purse, do not carry it on the arm that you had blood taken from.
4) What Fasting Is
While we are on the topic of drawing blood I figured that it would be prudent to touch on what “Fasting” means since many people misunderstand. There are a lot of tests that require a patient fast, and if the fasting is done wrong than it will effect the results.
If you are told to fast you may not eat anything. You also may not drink coffee or soda or juice or sports drinks, even if they are “diet” drinks. You may not chew gum even if it is sugar free. You may not smoke. Any of these will throw off the results and make it more likely you will need to have the test retaken. Avoid all of these activities until after the test.
You may, however, drink water. In fact, it is strongly recommended that you be well hydrated when you come in to get blood drawn because it makes it much easier to hit the veins. When you are dehydrated sometimes it can make your veins collapse down so that they are harder to find and hit. If you are dehydrated enough you may be asked to come back another day, although usually you will be provided with several glasses of water to drink before blood is drawn.
Diabetic people who are fasting for a blood test should probably have a snack with them to eat immediately after they leave. It is also prudent to notify the staff that you are diabetic so that they know and can get you through more quickly. It is recommended that diabetic people eat a breakfast as soon as possible after their sample is drawn if they were required to fast.
5) Social Security Number
One thing that I will say is that it is much easier to track patient history and make sure tests are assigned to the correct patient history if we have a SSN to work with. I bring this up because with identity theft on the rise the whole idea of putting your SSN on almost any form is a little risky; however on the other hand the lab is much less likely to have your results sent to the wrong patient if you provide it.
If you are uncomfortable with giving over your SSN that is your right, but there are several things you can do to make it easier for a Reference Laboratory to keep track of who is who. First of all, always fill out your name exactly the same and write as legibly as you can (print, not cursive please). This means you should be consistent about providing your middle initial or not, try not to switch back and forth. If for some reason you feel you have messed up please feel free to ask for another form! We have hundreds of them and would rather throw one into the shredder than have something with corrections all over it.
Have you recently moved? Consider having a copy of your previous address with you with a note to inform the lab techs that you have moved. Address is one way to verify that you are who we think you are, and when it changes that can sometimes cause confusion (standard procedure is to create a completely new patient profile if there is any doubt). Ask your doctor to attach the note with the lab order.
Provide your birth day please. Again, this is not required information but it helps to verify who you are. At my lab we must be able to verify 3 separate types of information in order to say that we have the correct patient (unless the SSN does not match). If we cannot match 3 types of information to your history than we cannot confidently say that the history is yours and will have to create a new patient history.
In essence, provide as much information as you can if you choose to not provide your SSN. Even if you do provide the SSN it will help us if you provide additional information like your birthday and address because company policy usually requires that SSN be the last thing we check in order to help protect the patient.