Many major insurance companies are refusing to cover Vitamin D tests unless you have a narrow range of specific diagnoses (this has been true for at least a decade, as far as my knowledge goes). Based on the evidence, the insurance companies have determined that Vitamin D tests are not considered medically necessary outside of those diagnoses.
Unfortunately, many physicians are unaware of this issue and continue to order Vitamin D tests. And, if the insurance considers the test "not medically necessary", you're paying the lab's "Cash" price and don't get any of the discounts the insurance company has negotiated for medically necessary tests. I was in a situation some years ago where I needed to have quite a few lab tests done, and kept track of the "cash price" that was billed initially, and the discount my insurance company had negotiated, i.e., their "allowed price" (of which the insurance company paid 85% and I paid 15%). Quest Diagnostic's "cash prices" ranged from 3x to 16x my insurance company's "allowed price" (my insurance company was part of Blue Cross/Blue Shield).
So, you could try to negotiate with Quest Diagnostics, although quite honestly, dealing with Quest Diagnostics customer service is such a nightmare, I'll tell you your time is worth more, and to just pay the bill. Learn from this - some physicians may order tests your insurance won't consider medically necessary. I've tried to get straight answers from insurance companies as to whether certain tests will be covered and it can be a nightmare to get such answers, but if the tests don't need to be done urgently, you can go to a Quest blood draw station (make an appointment), get their test code numbers, and submit the diagnostic codes to your insurance company and try to get an answer. (I'm not sure if Quest can submit the same in advance as a preapproval - you can ask).
My insurance company (in WA state) had some contractual term with Quest Diagnostics which said Quest Diagnostics had to tell you, at least for certain tests, that the insurance company would not cover the test, given the diagnoses specified. I had one lab test done, and while my insurance company said they would not cover it, they also said that I wasn't responsible for the cost, either, because Quest had failed to inform me of this and get a signature from me saying I was aware of this, and wanted the test anyhow. WA state in general has very good consumer protections, and I doubt you'll find this kind of contractual term in other states (and probably not even with most WA state policies), but you could always ask your insurance company about whether Quest had any contractual obligation through your insurance to tell you up front that the insurance company considered the test to be "not medically necessary".
You can talk to your physician and make sure the diagnostic codes submitted are correct, just in case there was a mistake and your diagnostic codes were entered incorrectly (but it's unlikely this is the case).
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I would not advise simply not paying. You'll be dealing with bigger headaches if you don't pay the bill. It's simply not worth it to save a few hundred dollars.
Unfortunately, many physicians are unaware of this issue and continue to order Vitamin D tests. And, if the insurance considers the test "not medically necessary", you're paying the lab's "Cash" price and don't get any of the discounts the insurance company has negotiated for medically necessary tests. I was in a situation some years ago where I needed to have quite a few lab tests done, and kept track of the "cash price" that was billed initially, and the discount my insurance company had negotiated, i.e., their "allowed price" (of which the insurance company paid 85% and I paid 15%). Quest Diagnostic's "cash prices" ranged from 3x to 16x my insurance company's "allowed price" (my insurance company was part of Blue Cross/Blue Shield).
So, you could try to negotiate with Quest Diagnostics, although quite honestly, dealing with Quest Diagnostics customer service is such a nightmare, I'll tell you your time is worth more, and to just pay the bill. Learn from this - some physicians may order tests your insurance won't consider medically necessary. I've tried to get straight answers from insurance companies as to whether certain tests will be covered and it can be a nightmare to get such answers, but if the tests don't need to be done urgently, you can go to a Quest blood draw station (make an appointment), get their test code numbers, and submit the diagnostic codes to your insurance company and try to get an answer. (I'm not sure if Quest can submit the same in advance as a preapproval - you can ask).
My insurance company (in WA state) had some contractual term with Quest Diagnostics which said Quest Diagnostics had to tell you, at least for certain tests, that the insurance company would not cover the test, given the diagnoses specified. I had one lab test done, and while my insurance company said they would not cover it, they also said that I wasn't responsible for the cost, either, because Quest had failed to inform me of this and get a signature from me saying I was aware of this, and wanted the test anyhow. WA state in general has very good consumer protections, and I doubt you'll find this kind of contractual term in other states (and probably not even with most WA state policies), but you could always ask your insurance company about whether Quest had any contractual obligation through your insurance to tell you up front that the insurance company considered the test to be "not medically necessary".
You can talk to your physician and make sure the diagnostic codes submitted are correct, just in case there was a mistake and your diagnostic codes were entered incorrectly (but it's unlikely this is the case).
===
I would not advise simply not paying. You'll be dealing with bigger headaches if you don't pay the bill. It's simply not worth it to save a few hundred dollars.
Statistics: Posted by mariezzz — Sat May 04, 2024 8:52 pm — Replies 7 — Views 296
