Medicare Proposes Restrictions on Vitamin D Testing
In my last blog posted here on OsteoporosisConnection.com, I discussed the need for vitamin D testing for those who want to have their vitamin D storage levels checked and how you would go about having that done.
Most insurance companies pay for this test, but some Medicare providers recently proposed a change in coverage details on this and identified which patients would qualify for this test. Unfortunately, most Medicare beneficiaries won't be covered, for this test, if this most recent proposed change in coverage occurs.
As Medicare beneficiaries age, many develop vitamin D insufficiency due to their lack of sun exposure, their inability to synthesize UVB light, and problems with dietary intake of the few food items that contain vitamin D, beyond the fortified foods that are available.
At present, many physicians perform this test if you have osteopenia, osteoporosis, or a malabsorption problem with certain minerals and vitamins. If you have one of these disorders you wouldn't qualify for the test, if the proposed changes occur. Some Medicare providers state that those who do qualify are patients with kidney disorders, osteomalacia, rickets or hypercalcemia. Since most of us don't have one of these disorders, what are Medicare insured individuals suppose to do, to find out if they are at risk for a vitamin D disorder?
According to Dr David Mehr, M.D, professor and director of the University of Missouri-Columbia School of Medicine: "The diagnosis of osteomalacia can't be made until after doing a vitamin D level." If the proposed restrictions go through, and you need to have osteomalacia or one of the other disorders to qualify for the test, how do you check for this if a diagnosis can't be reached until your physician tests your vitamin D level to establish osteomalacia?
Hopefully this proposed change will meet with rigorous resistance from health care providers since this test is crucial for predicting those who may be at risk for falls, lower extremity weakness and fractures. If your vitamin D levels are insufficient, your health care provider needs to know this and prescribe the necessary amount of vitamin D to protect you from the various health related D deficient disorders.
Physicians routinely check vitamin D levels, in their patients, with osteoporosis because of the negative affect that low D has on the treatments with bisphosphonates. If physicians are no longer allowed to check these individuals, with osteoporosis, won't this possible change have a blunting affect on bisphosphonate treatment? If patients have inadequate levels of vitamin D, bisphosphonate treatments - like Fosamax®, Actonel®, Boniva® and Reclast® - won't work to their full potential.
This is just one more example of the crisis in health care and how it will affect Medicare beneficiaries, if we don't advocate for ourselves and others to find an alternate solution.