Strategies for getting Bloodwork covered by Insurance

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Vikingman
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Strategies for getting Bloodwork covered by Insurance

Postby Vikingman » Thu Mar 12, 2020 4:03 am

So I went to the doctor for the first time in 19 years to see if I could get any bloodwork. I explained my family history of Alzheimers, Cardiovascular disease, high blood pressure, cancer and diabetes. He said that means nothing and only approved a basic lipid panel.

I have paid into the healthcare system over $60,000 for prevention and have not been to doctor in 19 years and all they will give me is a $39 lipid panel. I don't trust the system enough to let them know of my genetic status but I may have too. Instead I just dished out over $1000 on tests online.

Any Hacks of the system? Work arounds? Strategies? Approaches?

Would it be easier to get blood work and scans from specialist? Maybe show them the results of my new tests?

DebbieG
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Re: Strategies for getting Bloodwork covered by Insurance

Postby DebbieG » Thu Mar 12, 2020 8:59 am

Vikingman wrote:So I went to the doctor for the first time in 19 years to see if I could get any bloodwork. I explained my family history of Alzheimers, Cardiovascular disease, high blood pressure, cancer and diabetes. He said that means nothing and only approved a basic lipid panel.

I have paid into the healthcare system over $60,000 for prevention and have not been to doctor in 19 years and all they will give me is a $39 lipid panel. I don't trust the system enough to let them know of my genetic status but I may have too. Instead I just dished out over $1000 on tests online.

Any Hacks of the system? Work arounds? Strategies? Approaches?

Would it be easier to get blood work and scans from specialist? Maybe show them the results of my new tests?


I'm definitely interested in learning about strategies as well.
I'm thinking I'll see a functional medicine practitioner, then will make an appointment with my primary care physician and see which of the tests ordered by the functional medicine practitioner my doctor will order.

I'm definitely interested in learning about strategies as well.

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slacker
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Re: Strategies for getting Bloodwork covered by Insurance

Postby slacker » Thu Mar 12, 2020 3:37 pm

I think there are two parts to the strategy.

One, finding an open minded practitioner. This is challenging, and often found through luck. In my experience, there is no way to know in advance, unless you get a recommendation from a friend or family member who has found someone who is willing to listen and not be dismissive of "out of the box" concerns.

Second, getting lab tests covered by insurance. Some insurances will pay for lab tests that are ordered during a physical exam or wellness check "within reason." Traditional Medicare only covers a very specific and limited number of labs for an annual wellness visit. At a visit other than an annual appointment, the practitioner must select appropriate diagnoses to cover which labs are being ordered. This is tricky for the practitioner. Traditional Medicare has strict guidelines on what diagnoses are are needed to cover each lab test. This may be true for Medicare Advantage insurances as well; I have less experience with them.

As a licensed practitioner with the legal ability to order lab tests, the above information is what I have learned over time. As an individual, I typically am not comfortable ordering tests that I am not familiar with, since I feel there is some liability to ordering something I don't know how to interpret, especially if it ends up being outside of the normal range. Just my opinion and comfort zone.
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sandyt
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Re: Strategies for getting Bloodwork covered by Insurance

Postby sandyt » Sat Mar 14, 2020 6:54 am

My insurance will tell me that a blood test is not covered. But if I decide to go ahead and take it anyway I only have to pay the negotiated rate. This is often a whole lot lower than the standard rate. So if your doctor orders some thing call your insurance with the lab code and the diagnosis code and ask them how much it will cost you. You may be surprised at how much cheaper it is then just paying on your own.

Vikingman
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Re: Strategies for getting Bloodwork covered by Insurance

Postby Vikingman » Wed Mar 18, 2020 5:23 am

Right now I am just going to RequestaTest.com and ordering from Labcorp and Quest.

Tiramisu1984
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Re: Strategies for getting Bloodwork covered by Insurance

Postby Tiramisu1984 » Thu Mar 26, 2020 7:40 pm

This subject is near and dear to my heart. I’ve had fantastic success with one doc, moderate with another and bombed with two.

With The one I had success with, I brought a copy of Bredesen’s study and email with me. She was immediately receptive and said she come up with diagnoses for several. We were able to push about 90 percent through. I moved. The next doc raised her eyebrows and said A1C wasn’t indicated!!!

So, I suggest persistence, sharing the truth, and stating you are willing to push the envelope and risk the test not getting covered.

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Re: Strategies for getting Bloodwork covered by Insurance

Postby marigold » Thu May 07, 2020 11:10 am

I live in Sarasota and get extensive blood work annually all covered by insurance. You need to find an integrative M.D. or a chiropractic full service clinic that has an MD on staff and will get you very comprehensive tests. I am on medicare so maybe that makes the difference. I even had a brain MRI scan that Medicare covered.
This is one of the reasons we need universal health insurance for all such as a medicare for all plan. Health care is a right not an option.


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