What exactly does "laboratory services" mean on an EOB?
August 1, 2015 11:09 AM   Subscribe

I had blood work done recently. The lab results show five tests, two of which are on the list of free preventative services, implying (at least to me) that I probably shouldn't be paying for them. The EOB from the insurance company lists five items, three of which are describing matching the lab results and the last two are just "laboratory services". Are these actual lab costs or are they hiding the HIV and syphilis tests?

Under my old insurance, I paid nothing for the same blood work (no HIV or syphilis screening the last time), so I was a bit surprised when I opened the EOB. When I saw the doctor, he actually said "Hey, you didn't get charged for the bloodwork last time did you? Because they're not supposed to." However, my doctor's understanding of the ACA and my understanding don't always coincide, and by new insurance isn't as good as the old, so I'd not be shocked if the "metabolic panel" and so on were subject to the deductible. But am I right that I'm not meant to be paying anything for an HIV test? (It looks like syphilis screening is on the list for people who have sex with men who have sex with men (i.e. me), but I don't know that my health insurance company knows about my sex life.) How do I go about figuring this out?
posted by hoyland to Work & Money (5 answers total)
Hard to say with out a copy of both the EOB the list of tests that were actually done.

Is it possible that they are tagging on a phelobotomy fee for actually taking the samples? That would be pretty bogus in my experience.

I would definitely request clarification on the lab services charge. Is there a code supplied for those?
posted by SLC Mom at 11:36 AM on August 1, 2015

Does the EOB show the CPT/HCPCS codes for the laboratory services charges? They would be a five digit number, or a sequence of a letter and four digits, for each charge, probably beginning with the digit 8 for most of the charges if it's a bill for labwork. Does it show the patient liability amount for each individual charge?

If you can tell us what the patient liability amount posted for each CPT code is, it'll be easier to figure out what's going on. Also, if it gives any reasons by line-item for why the balances dropped to patient liability, that would be helpful too.
posted by strangely stunted trees at 11:40 AM on August 1, 2015

The EOB is probably hiding the HIV and syphilis tests under "laboratory services" for privacy reasons. It's SOP for insurance companies to be vague about potentially sensitive tests since the person receiving the EOB may not be the patient. You can imagine that if (for example) you were on your parents' insurance you might not want them to know you were getting STI tests when they got the EOB in the mail. The cost for phlebotomy is usually bundled into the visit (if you had the blood done at your doctor's office) or the test itself (if you went to a free-standing lab).

Whether you should be paying for part or all of them is another question. Especially with the free preventive services ones it can sometimes be unclear how to code them when ordering them so that you signal to the insurance company that you're doing preventive care, so it may just be a matter of asking the insurance company what code they need for preventive services and asking your MD to change the code. (Like for Medicare, a cholesterol test has to be ordered under something like "screening test for cardiovascular disease" even though you might be ordering it because the patient has hypertension or a history of heart attack. It's unbelievably annoying and the codes needed for the same test differ from insurance to insurance. I spend a lot of time debating how to code labs that are obviously clinically relevant but it's unclear how to order them in the best way).
posted by The Elusive Architeuthis at 1:20 PM on August 1, 2015

The Elusive Architeuthis is correct, screening tests need to be coded a specific way. Of course, if you actually have a disease or some symptom that makes the doctor want to order a test, then it isn't a screening. Reporting codes that aren't supported in the medical record just to get the bill paid by insurance is the very definition of insurance fraud.
posted by Apoch at 8:52 PM on August 3, 2015

There are no codes on anything that I can find. The two unlabeled tests on the EOB were billed as $28.12 discounted to $5.70 and $104 discounted to $31.49. (Quest's website lists the CPT code for the HIV test as 87389 and syphilis as 86592.)

So, yeah, I'm annoyed over $36 that I'm just going to end up paying. On the other hand, if my insurance company is charging people for Things that are Good For Public Health that it's not supposed to, there's principle involved.
posted by hoyland at 4:11 AM on August 4, 2015

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