I am a deadbeat

[ladelfina]

So even though Aetna works for the client, they have a clear delineation of what they will pay and won't.
... You can't buy something and then say you won't pay at the agreed upon cost.

Hmm.. but strangely the OP is being asked to pay beyond the agreed-upon cost in that one normally expects insurance to cover tests that your insurance-connected doc orders. I doubt that this denied test is actually listed anywhere in his insurance docs as being uncovered. So how is he to know beforehand, since he wasn't informed of the cost at the time of "purchase"??. Submitting to the doc's instructions to get the test is not true informed acceptance of any random bill that may come out of that. It's only "clear" to Aetna at the time beancounter Y has to tally up their monthly numbers. most likely; it's not clear to anyone else, nor is it written in stone.

If there's no way of knowing it won't be covered and it's too late to change your "order".. Quest could name any amount at all and you'd say the patient was liable. What if they said the test was $1950, after the fact?

 

[winger]

I'm trying to decide whether to file an appeal with Aetna. Before the blood test, I haven't looked at this policy bulletin. OK, you're right. I hadn't looked at any of the policy bulletins. Am I expected to?

Seems an Aetna approved Dr. or an Aetna approved clinic should have known this.

I'm still willing to pay $102.

From AETNA website dated 9/17/2007:

Aetna considers homocysteine testing experimental and investigational for assessing CHD or stroke risk. Homocysteine testing may be medically necessary for the following indications: 1) evaluating persons with homocystinuria (cystathionine beta synthase deficiency); 2) evaluating persons with coagulation disorders (e.g., unexplained thrombotic disorders such as deep venous thrombosis or pulmonary embolism); 3) for evaluating women with recurrent pregnancy loss (see CPB 348 - Recurrent Pregnancy Loss); and 4) for evaluating persons with borderline vitamin B12 deficiency (see CPB 536 - Vitamin B-12 Therapy ). Homocysteine testing is considered experimental and investigational for all other indications.

 

[ladelfina]

aha! the smoking gun! That seems pretty explicit..

I would try to consult with the doctor who ordered the test and find out more. Is there reason for it being considered experimental? Maybe he/she can make a case that it's not and go to bat for you... Best of luck!!