do them all again?

[brooklyngirl]

Hey guys!
So I'm due for blood work this week (the last one was 3 months ago) and I wanted to know if I need to repeat everything or if I should just ask to have the things that were low and borderline low checked? The reason I ask is because with my new insurance I had to pay $460 for my last set of labs. I never had to do that before, everything was always just a copay, and money is super tight right now

 

[Spiky Bugger]

Just because I'm in the mood for a fight...do you know WHY you had to pay so much? If a diagnosis code was wrong or missing, you have to pay for stuff you shouldn't have to pay for.

Call and tell your insurance to explain the charges they did not cover on each test.


ETA...people get lazy and code for "routine labs," when WE need the tests because we have malabsorption and other stuff.

 

[southernlady]

Just because I'm in the mood for a fight...do you know WHY you had to pay so much? If a diagnosis code was wrong or missing, you have to pay for stuff you shouldn't have to pay for.

Call and tell your insurance to explain the charges they did not cover on each test.


ETA...people get lazy and code for "routine labs," when WE need the tests because we have malabsorption and other stuff.

Actually she used the same PCP I do and same lab sheet. Mine was coded the same way and my insurance paid for everything.

 

[Terri]

My first thought was the same as Spiky. I am interested to see what everyone says.

 

[Sheanie]

Ah, then they are kicking them back as "not a covered benefit"? That's what mine did with just the K test. I had to pay $460 for just that one alone. It won't be covered, ever, is what BCBS has told me. I appealed and sent it to Review, all to no end.

 

[Spiky Bugger]

Ah, then they are kicking them back as "not a covered benefit"? That's what mine did with just the K test. I had to pay $460 for just that one alone. It won't be covered, ever, is what BCBS has told me. I appealed and sent it to Review, all to no end.

Does that mean that no matter what the diagnosis, they exclude testing K? Because my old insurance tried to not test stuff related to a surgery they didn't want to cover. Deal is, they don't need to know WHY I malabsorb...or WHY I lost a lot of weight...or WHY anything else. I do...and I need testing. And they paid when I resubmitted with different codes.

 

[newanatomy]

If I were in your position, I would just do the ones that were out of range. You can run a full set in a few months.

 

[Sheanie]

Does that mean that no matter what the diagnosis, they exclude testing K? Because my old insurance tried to not test stuff related to a surgery they didn't want to cover. Deal is, they don't need to know WHY I malabsorb...or WHY I lost a lot of weight...or WHY anything else. I do...and I need testing. And they paid when I resubmitted with different codes.

Yup, that's exactly what they said on appeal, too. Not a covered benefit, no matter what. Never a covered benefit under my plan, which is the best you can buy currently. I argued eloquently and well, they even complimented me on a well-worded intelligent letter. But it will never be covered, they said.

Years ago, though, I remember when they excluded both sons' epilepsy. Wouldn't pay for anything on our new insurance related to it. Then the law changed, BCBS didn't inform us, and I found out about it 2 years later. I submitted everything we paid for in those two years: Anti-seizure meds, labs, doctors appts, MRI's, CAT scans, brain wave studies, ER visits and everything. They paid it all retroactively. They weren't happy about it, but they paid it.

So I will re-test my K in afew years, if I feel like it. Who knows what **won't** be covered by then. In the meantime, I get almost $2K of labs done once a year and only pay $149. But we pay our own insurance premiums, so I know for a fact they make out like bandits in the long run.

 

[brooklyngirl]

Ok, so when I got charged (the lab here made me give my credit card and sign a form that said I acknowledge they would charge my card for anthing not covered by insurance) I called blue cross blue shield and they said they only pay 70% and the other 30% comes out of my deductible. I thought that sucked, but made sense according to what's printed right on the front of my card. Should I question them any further?

 

[Spiky Bugger]

I made myself laugh because I suddenly realized I didn't know if you meant Potassium or Vitamin K.

I've never used them, but others have and were pleased.
https://www.directlabs.com/mobile/OrderTests/ViewTests/tabid/16543/language/en-US/Default.aspx
https://www.directlabs.com/mobile/OrderTests/ViewTests/tabid/16543/language/en-US/Default.aspx

 

[Spiky Bugger]

Ok, so when I got charged (the lab here made me give my credit card and sign a form that said I acknowledge they would charge my card for anthing not covered by insurance) I called blue cross blue shield and they said they only pay 70% and the other 30% comes out of my deductible. I thought that sucked, but made sense according to what's printed right on the front of my card. Should I question them any further?

I think that routine sounds familiar and fairly standard. If it conforms with what your card says, it is likely the benefit you get.

 

[brooklyngirl]

Ok, so now that that's cleared up, back to my original question.... Do I need to repeat everything or just the things that were out of range?

 

[southernlady]

Ok, so now that that's cleared up, back to my original question.... Do I need to repeat everything or just the things that were out of range?

Just get the ones out of range this time then. And any others that maybe were still normal but very low?

 

[Elizabeth N.]

I'd want the ones that were near the bottom/top of normal as well as the out of range ones. For example, if D was low and PTH was within a few points of top of range, I'd want PTH done, too. If ferritin was low and iron was within range, I'd want a full iron panel.

 

[hilary1617]

Are you near to reaching your deductible and/or out-of-pocket maximum? Where you stand relative to these limits can drastically impact the portion of the bill that is the "patient's responsibility".