Cost of blood tests question

[Texas Proud]

So, DW went to the Dr for her free annual exam under Obamacare...


Dr had her do blood tests... no problem... but said that they were included in the free exam...


Now I get a bill from Labcorp for those tests.



My question is are they actually part of the free services provided under the ACA? I have looked and can not find anything saying they are but since doc said so I do not want to pay if I do not have to.

 

[EastWest Gal]

Some are, some aren't. Testing for diabetes (fasting glucose, hemoglobin A1C) and lipid screening are covered. Doctors don't seem to be up to speed about any of this. They consider a urinalysis and a complete metabolic profile as part of preventive services, but they aren't. Why not? Because the benefit is so low it doesn't justify routine screening. Healthcare.gov has a list.

https://www.healthcare.gov/preventive-care-adults/

 

[Yipper]

Just did this for myself under an ACA plan last month. These tests were fully covered...

- CBC Platelet
- CMP Comprehensive Metabolic Panel
- Hemoglobin A1C
- PSA
- TSH

All covered 100% and my understanding is at least for this plan it's covered annually.

 

[FLSUnFIRE]

My doc orders some not covered so I get a bill for the those from Quest. Also billing code matters. If diagnosed with anything then it is a treatment code (same test) and not preventative and you have to pay. My annual is partially check up and partially "treatment" because of prexisting conditions (nothing significant -my labs are steady but it's monitoring so there you go). Its silly but it is what it is.

 

[EastWest Gal]

My doc orders some not covered so I get a bill for the those from Quest. Also billing code matters. If diagnosed with anything then it is a treatment code (same test) and not preventative and you have to pay. My annual is partially check up and partially "treatment" because of prexisting conditions (nothing significant -my labs are steady but it's monitoring so there you go). Its silly but it is what it is.

Good point. The billing code may be playing a role in you getting charged for the labs. I've never had a CBC or CMP covered, and it's not listed at healthcare.gov.

 

[Surewhitey]

I had this problem forever with my prior GP. He retired and my new GP apparently knows something he didn't and I didn't get a follow up bill for bloodwork. It was my only irritation with our annual exam.

 

[Texas Proud]

So, who do you complain too?


Called labcorp and they did nothing... will go to Dr if that works but I have been in this dark area before where each blames the other for the error...

 

[MichaelB]

So, who do you complain too?


Called labcorp and they did nothing... will go to Dr if that works but I have been in this dark area before where each blames the other for the error...

Do you have the insurers statement of benefits where it shows the billing codes used? That eill tell you if the issue is with LabCorp or your Dr’s coding.

When I had BCBS in Fl LabCorp billing was always an issue.

 

[Aerides]

I typically get a bill from quest for my annual blood work, but it's always in the 50-75 range so I don't really think about it.

 

[RetMD21]

Some are, some aren't. Testing for diabetes (fasting glucose, hemoglobin A1C) and lipid screening are covered. Doctors don't seem to be up to speed about any of this. They consider a urinalysis and a complete metabolic profile as part of preventive services, but they aren't. Why not? Because the benefit is so low it doesn't justify routine screening. Healthcare.gov has a list.

https://www.healthcare.gov/preventive-care-adults/

I wonder if some docs are mis-coding to get labs covered

 

[Texas Proud]

Do you have the insurers statement of benefits where it shows the billing codes used? That eill tell you if the issue is with LabCorp or your Dr’s coding.

When I had BCBS in Fl LabCorp billing was always an issue.

Good point... I have not yet received it but will look online... but I still need to find the right code.. that is if there is any..

 

[DrRoy]

I wonder the same thing about Medicare.

 

[Sarah S]

I wonder the same thing about Medicare.

Medicare is kind of the reverse of aca. They cover diagnostic tests so if your code is a disease or a symptom appropriate to the code they mostly cover ( there are a few limited frequency tests like glycohemoglobin). Screening tests like a lipid panel are every five years but can be covered more frequently with a diagnosis like hyperlipidemia

 

[PaunchyPirate]

This is my sixth year on an ACA plan. 2x per year, I see my doctor after getting a full set of the standard blood tests. I don't know what the categories are called, but there are usually about 50 different "results" in the testing. I know this includes A1c, PSA, Cholesterols, and a bunch more. I have never paid more than the $20 or $25 or $30 (it has varied with my various insurance plans) co-pay that is specified in my insurance plan for blood tests. Maybe I'm just lucky or maybe my Doctor codes them properly. I am treated for diabetes, prostate issues, cholesterol, and hypertension, so perhaps the coding is done to stay on top of those issues. Whatever it is, it works.

 

[MichaelB]

Good point... I have not yet received it but will look online... but I still need to find the right code.. that is if there is any..

The EOB must include the billing code, and you can look it up online.

I recall LabCorp always billed full list price directly to me even though insurance was covering the charge. Why the did that was a mystery, it creates so much overhead for them and confusion for the patients.

 

[Texas Proud]

The EOB must include the billing code, and you can look it up online.

I recall LabCorp always billed full list price directly to me even though insurance was covering the charge. Why the did that was a mystery, it creates so much overhead for them and confusion for the patients.

I did not get a bill until they got insurance... but the full price was $851... they then have a line called adjustments for $771 so owe just under $80...


Two tests were over $200 list... probably that is where the cost is for me..

 

[RetMD21]

This is my sixth year on an ACA plan. 2x per year, I see my doctor after getting a full set of the standard blood tests. I don't know what the categories are called, but there are usually about 50 different "results" in the testing. I know this includes A1c, PSA, Cholesterols, and a bunch more. I have never paid more than the $20 or $25 or $30 (it has varied with my various insurance plans) co-pay that is specified in my insurance plan for blood tests. Maybe I'm just lucky or maybe my Doctor codes them properly. I am treated for diabetes, prostate issues, cholesterol, and hypertension, so perhaps the coding is done to stay on top of those issues. Whatever it is, it works.

IDK if I would say that you are lucky but if they are submitting codes for all your problems many tests can be justified. Maybe that was OP's problem, too many tests too few medical problems