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NOTE: I created this info
page (Jan. 2016) with generous help from James Pusavat, a
MEDLAB-L
subscriber from the USA.
QUESTION:
Do U.S. transfusion services bill patients for lab tests and blood
products such as the following, which may or may not be covered by public
insurance such as Medicaid (for the poor) or Medicare (for the
elderly), assuming they qualify,
or have employment-based private insurance?
Where does 'Obamacare' (Affordable
Care Act) fit?
Type and screen
Antibody identification
Antigen-negative red cells
Transfusion with multiple blood products
Transfusion with special blood products such as
irradiated red cells
ANSWERS
U.S. transfusion services may bill patients for lab tests
and blood
products IF is it NOT covered by Medicare AND the
patient has signed the
Advance Beneficiary Notice (ABN) PRIOR to providing
the services. It is
consider fraud if the service provider asks the patient to sign
ABN after the
services have been completed or denied by Medicare.
More details.
Advance Beneficiary Notice (ABN)
Medicare Waiver/Advance Beneficiary Notice (ABN): Frequently
asked questions
What are Medicaid and Medicare?
The components of Medicare /
Medicaid
Affordable Care Act (Obamacare) does not pay for medical services
directly, it helps
lower and some middle income families pay for health
insurance through
subsidies based income, age, and family size.
The Affordable Care Act actually refers to two separate
pieces of
legislation — the Patient Protection and Affordable Care Act
(P.L. 111-148)
and the Health Care and Education Reconciliation Act of 2010
(P.L. 111-152)
— that, together expand Medicaid coverage to millions of
low-income
Americans and makes numerous improvements to both Medicaid
and the
Children's Health Insurance Program (CHIP).
"Medicaid and the
Children’s Health Insurance Program (CHIP)
provide free
or low-cost health coverage to millions of Americans,
including some
low-income people, families and children, pregnant women,
the elderly, and
people with disabilities. Some states have expanded their
Medicaid programs
to cover all people below certain income levels."
The Affordable Care Act,
Section by Section
All 10 Titles of the Affordable Care
Act, with
amendments to the law called for by the reconciliation
process. Click on
each Title to see a brief outline and then read the law
section by section.
FURTHER READING
A quick guide to the
Health Insurance Marketplace
Consumer Reports
How to use your health insurance /
High deductibles, provider networks, and FSAs
What's the difference between a deductible and an
out-of-pocket limit? /You need to know to make a smart plan choice
Health insurance deductible and out-of-pocket costs made
simple /
How to understand the difference
That CT scan costs how much?
/ Health-care prices are all over the map, even within your
plan’s network
Hazardous health plans
/ Coverage gaps can leave you in big trouble
Junk health insurance
/
Stingy plans may be worse than none at all
6 ways to avoid having a health insurance claim denied
/
You pay for insurance. Make sure it pays your medical bills.
Avoid Medical Bill Sticker Shock
Sample private health insurance plan
Employee Health Benefit Contributions
Summary of Benefits –
Comparison Chart
Twitter: @bogeywheels
/ @transfusionnews
Blog:
Musings on Transfusion Medicine
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