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Post by Zee on Mar 1, 2023 20:28:09 GMT
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Post by lisae on Mar 1, 2023 21:05:10 GMT
As long as my routine blood work is coded as such, mine are covered once a year. If they submit a diagnosis of anything other then well visit it will apply to my deductible and copay. There is about 5 lab tests that are covered as preventative End of billing ? ( do you mean Explanation of benefits statement from they insurance company?) Yes you are right. Explanation of Benefits.
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Post by bianca42 on Mar 1, 2023 21:10:28 GMT
From the link above: Cholesterol screening for adults of certain ages or at higher risk I wonder what the age/risk thresholds are for having cholesterol covered.
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Post by lisae on Mar 1, 2023 21:11:42 GMT
Do you not at least get your physical covered? The ACA mandates that some preventative care must be covered. The catch might be if they are coding it correctly. My DH’s old MD would never code the physical or labs as preventative care and always submitted them with just codes for hypertension 🤬 so they got denied every time and went against our 🤑 deductible. I thought this was the case and it is part of the problem. When I checked out at the doctor's office, I asked them to be sure to submit this so that it would get paid and we didn't have to go through what we had the last year. They did not but resubmitted when I called them after the first claim was denied. The first time they coded the cholesterol so it wasn't even an 'allowed' test and the lab wanted me to pay $145 for my cholesterol check. The doctor resubmitted with new codes and now it appears that everything is allowed and I just have to pay the allowed amount. I'm so tired of this I would just change doctors but I live in a small community and there aren't that many practitioners in our town. They are handy when something goes wrong. They have never failed to see me same day if needed.
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Post by cmpeter on Mar 2, 2023 1:55:43 GMT
The lab has always billed me separately and the work is covered just like my exam.
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Post by rcarpen on Mar 2, 2023 3:54:28 GMT
I just have to pay a co-pay, here in NC. I have United Health Insurance, if that helps any.
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Marina
Pearl Clutcher
Posts: 2,509
Aug 12, 2014 23:32:21 GMT
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Post by Marina on Mar 2, 2023 7:10:35 GMT
Ours are covered unless there is an underlying related issue. Insurance drives me nuts.
Last year a preventative x-ray should have been covered but due to how it was coded I couldn't get it adjusted. Today the doctors office won't deduct the insurance contractual allowance and now I have our insurance trying to get that squared away. I spend too much time dealing with that.
And then there is dental. For one service they will only pay for 2 teeth per quadrant and if they bill more than 8 they automatically reject the entire amount. Where is the logic.
But $7000 deductible is just too high.
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Post by bratkar on Mar 2, 2023 11:28:35 GMT
The catch might be if they are coding it correctly. My DH’s old MD would never code the physical or labs as preventative care and always submitted them with just codes for hypertension 🤬 so they got denied every time and went against our 🤑 deductible. I thought this was the case and it is part of the problem. When I checked out at the doctor's office, I asked them to be sure to submit this so that it would get paid and we didn't have to go through what we had the last year. They did not but resubmitted when I called them after the first claim was denied. The first time they coded the cholesterol so it wasn't even an 'allowed' test and the lab wanted me to pay $145 for my cholesterol check. The doctor resubmitted with new codes and now it appears that everything is allowed and I just have to pay the allowed amount. I'm so tired of this I would just change doctors but I live in a small community and there aren't that many practitioners in our town. They are handy when something goes wrong. They have never failed to see me same day if needed. I will admit I live near a big city, but my dr (PA) is in a small town hospital/ office building and they never fail to see us as well and finally after 5 or so years they have learned the tricks to submitting health care reform covered charges to getting them paid. Before the reform it was so difficult to get them to understand if they wanted to be paid they needed to submit it a certain way. It really should not be so difficult that drs offices and patients have to work so hard to get things paid.
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Post by lisae on Mar 2, 2023 12:06:50 GMT
I thought this was the case and it is part of the problem. When I checked out at the doctor's office, I asked them to be sure to submit this so that it would get paid and we didn't have to go through what we had the last year. They did not but resubmitted when I called them after the first claim was denied. The first time they coded the cholesterol so it wasn't even an 'allowed' test and the lab wanted me to pay $145 for my cholesterol check. The doctor resubmitted with new codes and now it appears that everything is allowed and I just have to pay the allowed amount. I'm so tired of this I would just change doctors but I live in a small community and there aren't that many practitioners in our town. They are handy when something goes wrong. They have never failed to see me same day if needed. I will admit I live near a big city, but my dr (PA) is in a small town hospital/ office building and they never fail to see us as well and finally after 5 or so years they have learned the tricks to submitting health care reform covered charges to getting them paid. Before the reform it was so difficult to get them to understand if they wanted to be paid they needed to submit it a certain way. It really should not be so difficult that drs offices and patients have to work so hard to get things paid. Exactly. I think part of my problem is that the doctor's office is submitting the codes but they aren't the ones who need to get paid. They get their part paid. They used to do their own in house bloodwork and I had no issues. Now they outsource to a lab so if they code it wrong, the lab is the one not getting paid. The lab is the one who will send this into collections rather than try to get it coded properly because they remind me that I signed a document saying I would be responsible for the charges.
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Post by bratkar on Mar 3, 2023 11:42:38 GMT
I will admit I live near a big city, but my dr (PA) is in a small town hospital/ office building and they never fail to see us as well and finally after 5 or so years they have learned the tricks to submitting health care reform covered charges to getting them paid. Before the reform it was so difficult to get them to understand if they wanted to be paid they needed to submit it a certain way. It really should not be so difficult that drs offices and patients have to work so hard to get things paid. Exactly. I think part of my problem is that the doctor's office is submitting the codes but they aren't the ones who need to get paid. They get their part paid. They used to do their own in house bloodwork and I had no issues. Now they outsource to a lab so if they code it wrong, the lab is the one not getting paid. The lab is the one who will send this into collections rather than try to get it coded properly because they remind me that I signed a document saying I would be responsible for the charges. And then trying to get the doctors office to submit to the lab company the correct codes is just another 2 hours of time that we spend... The lab wont change it unless the doctors office submits to them and getting the doctors office to tell them. its a stupid circle. Everyone that complains here about these types of things I wish had the insurance I work for and I could help at least a small bit... Because it does make me crazy how much some people have to go through to get claims processed and paid.
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Post by birdy on Mar 3, 2023 12:03:00 GMT
Always had to pay for blood work unless I've hit my deductible Same! Unfortunately!!!
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Post by **GypsyGirl** on Mar 3, 2023 20:32:12 GMT
We have a $3,000 deductible each and pay 100% of everything until we reach that deductible. That includes labwork and blood tests. Once that threshold is reached, we pay nothing out of pocket unless it is out of network. Do you not at least get your physical covered? The ACA mandates that some preventative care must be covered. I apologize for not answering your question earlier as I am dealing with a family health crisis. Yes, one of my exams each year with my GP is run through as an annual physical and is covered. Also, my annual mammogram is covered.
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Post by lisae on Mar 3, 2023 22:05:18 GMT
Do you not at least get your physical covered? The ACA mandates that some preventative care must be covered. I apologize for not answering your question earlier as I am dealing with a family health crisis. Yes, one of my exams each year with my GP is run through as an annual physical and is covered. Also, my annual mammogram is covered. No problem, I hope you get everything resolved.
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