Trying to find out discounted lab costs from BCBS

[Susan in Tennessee]

I have been having all kinds of fun today trying to find out what I would pay for the suggested set of pre-op/post op labs IF they are requested by my doctor and go through my insurance company, BCBS. I know the cost from Star's company but I prefer to leave no stone unturned so set out to see what I would pay with my deductible NOT being met but receiving the discounted price negotiated between BCBS and LabCorp. Star's price is really good, I think, and I really expect the discounted insurance cost to be similar to her price and I am really trying to find this out for future use more than right now as I feel sure I'll use Star's company right now. But, on down the road, since I will be going to my own doctor for other stuff, I need to know how hard I need to work on educating my doctor to get her to perhaps run tests I will need. IF the cost through her and my insurance is considerably higher than Star's company though, why even bother. So that's why I'm trying to find out these costs.

First I called LabCorp, was told by a gal there that she could give me the test code and their regular price for each test then I'd need to call my insurance company to find out what the discount was. OK. So, I got each code for each test on the sheet I had printed out along with the costs. BTW, total costs from LabCorp for these came to $2,555.00.

Next I called BCBS and explained what I was trying to do. At first BCBS woman tried to tell me there was no way to find out the discounted cost without the actual claim being submitted. I told her, look, the regular cost for the tests in question is over $2,000. I HAVE to know BEFORE I authorize my doctor to run the tests whether I'm going to be able to afford them or not! She was mediumly nice and said she understood my problem and would I wait while she checked on this further. She was gone for a long time, came back and told me the only way it "might" be possible to do this was to do some sort of "dummy claim" and for that I need all the test codes (which I already got from Labcorp this morning) and also diagnosis codes, the NPI for the lab, just as if it was actually being submitted. I got somewhat flustered at this request for the diagnosis codes and told her I would need to work on that some and get back with her. I found the NPI code for Labcorp on an old lab report so I had that and didn't realize it. I knew I had some Diagnosis codes listed on the lab request sheet I had printed out here but I also knew I needed some help to know how to match some of the DX codes up with the tests. For instance, E60 Dietary zinc deficiency code obviously would match up to the Zinc lab test, but some of the others were not nearly as apparent to me when I tried to match all up. So this is what I'm asking for help with, knowing what DX codes to put with each individual lab test. BCBS woman also was saying how some might be preventative, etc. such as in conjunction with a yearly exam. I was thinking to not use preventative codes but I really don't know, what do you think?
Wasn't sure if this post belonged in Insurance or vits and Labs, nothing is ever simple, is it?

 

[CaraOC]

I have been having all kinds of fun today trying to find out what I would pay for the suggested set of pre-op/post op labs IF they are requested by my doctor and go through my insurance company, BCBS. I know the cost from Star's company but I prefer to leave no stone unturned so set out to see what I would pay with my deductible NOT being met but receiving the discounted price negotiated between BCBS and LabCorp. Star's price is really good, I think, and I really expect the discounted insurance cost to be similar to her price and I am really trying to find this out for future use more than right now as I feel sure I'll use Star's company right now. But, on down the road, since I will be going to my own doctor for other stuff, I need to know how hard I need to work on educating my doctor to get her to perhaps run tests I will need. IF the cost through her and my insurance is considerably higher than Star's company though, why even bother. So that's why I'm trying to find out these costs.

First I called LabCorp, was told by a gal there that she could give me the test code and their regular price for each test then I'd need to call my insurance company to find out what the discount was. OK. So, I got each code for each test on the sheet I had printed out along with the costs. BTW, total costs from LabCorp for these came to $2,555.00.

Next I called BCBS and explained what I was trying to do. At first BCBS woman tried to tell me there was no way to find out the discounted cost without the actual claim being submitted. I told her, look, the regular cost for the tests in question is over $2,000. I HAVE to know BEFORE I authorize my doctor to run the tests whether I'm going to be able to afford them or not! She was mediumly nice and said she understood my problem and would I wait while she checked on this further. She was gone for a long time, came back and told me the only way it "might" be possible to do this was to do some sort of "dummy claim" and for that I need all the test codes (which I already got from Labcorp this morning) and also diagnosis codes, the NPI for the lab, just as if it was actually being submitted. I got somewhat flustered at this request for the diagnosis codes and told her I would need to work on that some and get back with her. I found the NPI code for Labcorp on an old lab report so I had that and didn't realize it. I knew I had some Diagnosis codes listed on the lab request sheet I had printed out here but I also knew I needed some help to know how to match some of the DX codes up with the tests. For instance, E60 Dietary zinc deficiency code obviously would match up to the Zinc lab test, but some of the others were not nearly as apparent to me when I tried to match all up. So this is what I'm asking for help with, knowing what DX codes to put with each individual lab test. BCBS woman also was saying how some might be preventative, etc. such as in conjunction with a yearly exam. I was thinking to not use preventative codes but I really don't know, what do you think?
Wasn't sure if this post belonged in Insurance or vits and Labs, nothing is ever simple, is it?

I think you should just go get the surgery and worry about the labs later!!!!

 

[DSRIGGS]

Susan I have to agree with Cara. They will make sure you are in good shape lab wise when you get your surgery and after wards. If you are worried about two common things that are low sometimes before suregery, just take some iron and Dry vitamin D now and eat things high in vitamins (while you fully absorb) . Because for $2,500 it isn't worth getting labs before surgery and frankly for $500 it isn't worth it either. There isn't anything much else you are going to find and it all changes after surgery anyway. The hospital will make sure you are fine. To me you will be throwing away money.

 

[Susan in Tennessee]

@CaraOC I knew you'd say that! . @DSRIGGS i appreciate both your opinions even though I don't agree with all of it. Didn't Clematis say Esquerra doesn't do preop labs, so I doubt he does post op labs, but I'll wait to hear this from the ones who've been there. Cara, what say you? Maybe I'm being slightly obsessive on this matter but I just think it's crazy to NOT know how I stand and try to bolster low levels now since its so much harder to do after. Guess I go by ounce of prevention worth pound of cure.

Don't worry, I won't be paying $2,500 for labs now, or later! But, I still need to get the answers to my questions on diagnosis codes and what a set of labs will cost through my dr/insurance company because I will be getting labs on a regular basis and will need to know if my dr along with bcbs is feasible or if I'll need to stick with DirectLab (Stars company).

 

[CaraOC]

@CaraOC I knew you'd say that! . @DSRIGGS i appreciate both your opinions even though I don't agree with all of it. Didn't Clematis say Esquerra doesn't do preop labs, so I doubt he does post op labs, but I'll wait to hear this from the ones who've been there. Cara, what say you? Maybe I'm being slightly obsessive on this matter but I just think it's crazy to NOT know how I stand and try to bolster low levels now since its so much harder to do after. Guess I go by ounce of prevention worth pound of cure.

Don't worry, I won't be paying $2,500 for labs now, or later! But, I still need to get the answers to my questions on diagnosis codes and what a set of labs will cost through my dr/insurance company because I will be getting labs on a regular basis and will need to know if my dr along with bcbs is feasible or if I'll need to stick with DirectLab (Stars company).

Esquerra does do pre op labs. A full panel is drawn the day prior to surgery. You also have an EKG and a chest X-ray. I think you can certainly take your vitamins prior to surgery just to get ahead though. But once again just bite the bullet and get under the knife!!

 

[Susan in Tennessee]

Thanks, Irish lass!

 

[Clematis]

I wouldn't pay for pre-op labs. BTW, Esquerra's pre-op labs are of the sort one gets at an annual physical... not the labs DSers get to measure vitamins.

 

[hilary1617]

I can't comment on costs or codes, but if you want to self-test nutrient levels pre-op and will be subject to out-of-pocket costs, It may be useful to narrowing the list to a subset of nutrients which are commonly deficient in general population, or are hard to absorb for DSers . E.g. Vitamins A,D,E, K2, B12, calcium (really PTH), magnesium, iron. Probably not worth paying for testing things like selenium, copper, etc. where deficiencies are uncommon.

 

[DSRIGGS]

I get my labs done at a very large hospital system and even so they send A, E & K to Mayo so I am sure they are expensive. I don't know because my labs cost $0. Honestly I think the only thing to reasonably expect might be low would be D or Iron, so there is no sense testing when you can take a 50k D3 twice a week and an iron supplement. If anything is going to be low when in hospital they will give you an infusion.

Just my two cents but I would save that money for after surgery testing when it is crucial and also save money for supplements. Chances of anything other than d, iron or h&h be low are pretty slim.

 

[Susan in Tennessee]

I can't comment on costs or codes, but if you want to self-test nutrient levels pre-op and will be subject to out-of-pocket costs, It may be useful to narrowing the list to a subset of nutrients which are commonly deficient in general population, or are hard to absorb for DSers . E.g. Vitamins A,D,E, K2, B12, calcium (really PTH), magnesium, iron. Probably not worth paying for testing things like selenium, copper, etc. where deficiencies are uncommon.

Yes, this sounds like a good idea. It has been my D and B12 showing low in the past.