Coverage by medical insurance is important for more than just patients—it is also important for those who operate in the health care industry. Businesses that operate in this market often depend on payments from insurance companies to continue operations. Without payment for the services provided, the business may not receive the funds it needs to operate.
Medicare coverage denied: Business goes under
A sixteen-year-old medical diagnostic company provides an example. The company sold a blood test used to diagnose heart disease. The test was covered by one of the largest health insurance providers in the country: Medicare.
Although Medicare covered the blood test for six years, it recently rescinded coverage. The federal agency states the recent decision to deny coverage was the result of new data that allegedly finds the blood tests are unnecessary.
Take away lesson: Take Medicare coverage denials seriously
The medical diagnostic company had a lucrative business. It previously sold the blood test and realized millions of dollars in covered claims from Medicare. The business reportedly sold over $50 million worth of blood tests in 2016 and 2017 alone. However, since the agency has decided to deny coverage, the business has announced it is closing operations.
Medicare coverage is not a given. Even businesses with years of established coverage can find themselves facing a denial.
Options after a denial: Consider an appeal
Those who receive payment from Medicare can appeal denied coverage. An attorney experienced in Medicare overpayment and denial appeals can review your case and discuss available options.