Does free preventive care not include lab

[Mrs. Ciz]

We have to ask our doctors to send our stuff to Quest Diagnostic vs Lab Corp. Quest is our preferred provider Lab Corp not. I learned this the hard way.

 

[DebbieB]

My annual gyn visit and pap smear was paid 100% this year. My PCP visit was paid 100% but the bloodwork had a 10% coinsurance (but no deductible). Mammogram was 100%. My policy usually has a $24 PCP and $35 specialist copay, $550 deductible.

 

[lanejudy]

There's a few possibilities...
1) the lab sent the bill before the claim was submitted and/or processed by your insurance. This happens to me all the time, I think the providers just bill on a certain day of the month. I always wait for a second bill. The bill should actually show if there was a payment from the insurance company.
2) the lab used the wrong billing or diagnosis code to be considered "preventative." It happens. You'll need to get your doctor's office to provide the correct details to the lab, who can then resubmit the claim.
3) the doctor used a non-participating lab. You say you recently changed insurance. This happened to me once when I was literally one week into a new policy and didn't have the right card yet but I did have a letter from my company on letterhead with the correct info. Unfortunately, the doctor's office messed up and sent my sample to a lab that wasn't approved by the new insurance. I had to fight to get that one resolved but it was eventually.

I can check our claims online through my insurance company's website. I always know what has or hasn't cleared processing yet. My insurance company even told me once to never pay a bill from a provider until I receive the EOB (Explanation of Benefits) from the insurance company for that claim.

Good luck, I hope it resolves easily! Fighting insurance companies is never fun.

 

[Tiffylv]

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[tvguy]

The lab work done in association with the one physical (well check) allowed per year insurance pays for. The 2 other sets of lab work I have done each year to monitor what my blood pressure medicine is doing to my blood chemistry I pay for, until our total medical out of pocket hits $2,500 per year, then insurance will again pay.

 

[pweyl36]

Is it an EOB from our ins ? if so it is not a bill, if it is a bill the Dx code could be wrong. They just changed the ICD9 codes to
ICD10. If it is a wrong code the Drs office can correct it.

 

[Disneefun]

Did you have a pap smear last year? They changed the recommendations (last year or year before, I can't remember) and now you're only supposed to get/need one every three years. You insurance won't pay for more than that, unless the doctor has a good reason for overriding that recommendation. So if you got one last year, they may have denied you for exceeding the guidelines.

 

[Sadie22]

We have to ask our doctors to send our stuff to Quest Diagnostic vs Lab Corp. Quest is our preferred provider Lab Corp not. I learned this the hard way.

I'm sorry that happened to you. We have to make sure that every provider is part of our network before we go. Most of them are, but there are exceptions.

As far as the Pap smears, some insurance may limit how often they are done. This is not true for all.

 

[Saphire]

Blood work was always covered by our insurance, but no longer. My husband and I each had physicals this year, and the charge was over $400 for both of us. Thanks Obama. This is only the beginning.