If insurance didn't pay, then it's a de facto proof that the right codes needed to get it paid were NOT submitted. Insurance pays occurring to very rigid rules. Of course, you need to find out what those rules are for each insurance plan.
Medicare at least, won't tell you what codes need to be submitted to get them to pay. However, I went to one labcorp office so often the phlebotomist there told me confidently what codes the doctor could use to get it paid for using medicare.
You say "proper codes" but give me the actual codes that were submitted??
There are like 2-8 different codes that can be used to justify the same sort of test. Pick the wrong justification, insurance won't pay.
Of instance, for medicare, if a doctor orders a lipid profile and uses a code that calls it a routine test, medicare won't pay and the lab charged me 87.60. IF however the doctor codes was necessary because of possible cardiovascular problems, they will pay for the same test. THe same lab charged me 159.30 for a vitamin D test.
So I can get a lipid test for $20 and vit D for $25.
The local senior center has the following charges. There are local senior centers / wellness clinics in many locations.
Additional Services
- Hemoglobin A1C - $20
- Tdap (Tetanus, Diphtheria, Pertussis) - $45
- Total Cholesterol/Glucose - $5 (non-fasting, fingerstick)
- Complete Cholesterol - $20 (fasting, includes total cholesterol, HDL, LDL, triglycerides, and glucose)
- Vitamin D - $25
- Hepatitis C Screening - $20 (self-pay only - Medicare/Medicaid recipients not eligible)
- Low cost lab services are available for individuals with no health insurance or private health insurance (must have a doctor's order)*+
I spent 10 years with no insurance at all, then had maybe 5 different insurance plans in 3 years, so I know most of the cheapest ways to get tests done and some info about how those different insurance plans operated.
Some places like clinics you have to say you have no insurance. They don't check, it's just a federal rule.
Defy Medical usually has the cheapest prices for lab tests outside of going to some clinic. Life Extension has the cheapest prices for panels during their spring sale, but individual tests (even during their spring sale) may not be lower than discountlabs.com or
Defy. private labs md tends to be more expensive than discountlabs.com though often you can get a 15% discount on privateLabsMD. I have used all of the these at times including clinics.
I usually don't try and get medicare to pay as it first requires a doctors order, which means I need to make an appointment then convince the doctor it's a medical need to get that test and then make sure the doctor uses the code that is needed to get it paid.
How common a test is, what sort of volume the site has for those tests drives how much an individual test can cost.
It does require a lot more leg work and it's certainly not convenient to find the very cheapest prices.
