Preparing for Your Visit
Because some tests require advance preparation, it is important to understand exactly what is required so testing is not compromised or needs to be repeated.
Diagnostic tests are designed to provide a comprehensive evaluation of a patient’s condition and to help caregivers devise a treatment plan best suited for the patient’s needs.
Because some tests require advance preparation, it is important to understand exactly what is required so testing is not compromised or needs to be repeated. For more detailed information on diagnostic tests, click here.
To request copies of outpatient test results for you or to be sent to any other person, please click here to print the “Authorization for Use or Disclosure of Protected Health Information” form. Complete the two-sided form, sign and bring with you to the Hospital or to any of the off-site facilities on the day of your test.
The time a patient spends with his or her physician can sometimes seem very short, so it is important that a patient is well prepared ahead of the visit to ensure that the doctor has a firm understanding of the patient’s condition and the patient has all of his or her questions answered. Click here for more information on how patients can make the most of their time with their doctors.
Before undergoing a surgical procedure, a patient’s doctor will issue important instructions, ranging from what foods and liquids can or cannot be consumed prior to surgery to guidelines to follow at home after surgery. Click here for more information on preparing for a surgical procedure.
Important Information for Medicare Patients Concerning Outpatient Testing and Services
Below are insurance rules and regulations that St. Clair Hospital must follow in conjunction with our goal of providing quality and accessible health care.
What is Medical Necessity?
Medicare covers only those services which are reasonable and necessary for your treatment. Medicare requires all providers, like St. Clair Hospital, to report information regarding the patient diagnosis when seeking payment so they can determine whether the test or service ordered was medically necessary.
What is ABN?
An ABN is an Advanced Beneficiary Notice. The purpose of the ABN is to give you advance notice that Medicare may not pay for your test or service. The ABN tells you which test or service is in question, why denial is likely, and informs you that you will be financially responsible if Medicare denies payment. When it is required, you will be asked to sign the ABN before the testing is performed.
What Options do I Have?
If St. Clair Hospital issues an ABN to you, you will have to decide if you want the services that may not be paid for by Medicare, and then you will have two options:
- You may sign the ABN and have the test performed. You will then be billed for the test if Medicare does not pay.
- You may choose not to receive the test by checking the “no” box on the ABN then signing where indicated. We will provide you with a copy of the form, which lists the test that was not performed, so you can review it with your doctors.
Will signing the ABN affect Medicare’s Decision to Pay?
No. Medicare considers a number of factors in determining whether the test or service is considered medically necessary. The fact that you have signed an ABN agreeing to pay for the test or service does not affect Medicare’s decision regarding payment.
If Medicare Will Not Pay, Does This Mean I Do Not Need It?
No. Your doctor bases decisions about testing or services on a wide range of factors including your personal medical history, any medications you may be taking, and generally accepted medical practices. There may be times when your doctor feels a test is necessary even though Medicare will not pay for it.
Will I Receive a Bill?
After we perform the test, we will bill Medicare. If Medicare denies the claim, however, you will be billed. Please not that it may take Medicare several months to respond to a request for payment. You may contact Medicare to appeal the denial if you think it was wrong.
Will Supplemental Insurance Pay for the Test if Medicare Refuses?
If you have a supplemental insurance policy, it may or may not pay for tests not covered by Medicare. You will have to call your insurance company for clarification.
If you have additional questions, please contact:
- Your physician or other health care provider at the time of service.
- St. Clair Hospital’s Patient Registration Department at 412.942.8152
- Medicare at 1-800-MEDICARE or 1-800-633-4227.