how to get diagnostic blood tests prescribed as preventative

January 10, 2016 11:51 AM

I'd like to get baseline blood testing from Wellness FX. Is there a way to get my new doc to prescribe this test as preventative?

I'm going to see a new doctor in about three weeks. I'd like to start getting my blood tests done through Wellness FX so I can hopefully derive some useful tracking from this over time unlike what I get from my doc's usual printout from a local lab. The local lab results are hard to interpret much less track the results from test to test.
My understanding is that if the doctor prescribes preventative test medical codes, then my insurance is likely to cover it. When I've spoken to an insurance rep, I pretty much got the run-around and no help there.
How can I have this discussion with my doc without coming off like a flake? It seems like a reasonable request, but when you get in the trenches of the medical bureaucracy they resolve to doing what's easy and convenient.
The baseline test is $197, which I can pay out of pocket if I have to. What can I do to optimize my chances of getting this covered by my medical insurance plan?

posted by diode to Health & Fitness (7 answers total)

My understanding is that if the doctor prescribes preventative test medical codes, then my insurance is likely to cover it.

You might want to take a look at this question at the Wellness FX website. It appears that, at best, you can apply the cost to an HSA.
posted by Thorzdad at 12:04 PM on January 10, 2016 [1 favorite]

Most health plans include a yearly well visit for tests and baseline labs. The tests mentioned are in those baselines and many more. Plus you have your personal physisian to discuss these results with you, in hopefuly, a meaningful way. You shoud be able to pay this outfit to enter the results for you so as to run their algorithms, for what they charge. Usually yearly labs are free as preventative care.
posted by Oyéah at 12:26 PM on January 10, 2016 [1 favorite]

Best answer: Another option is to ask if your doctor provides online chart access. Almost every provider uses one of the major EHR software packages and all of those software packages have patient access portals.

If you haven't looked at your EHR recently then you might be surprised what's there in your history and what's been graphed for you. Graphing that stuff over time is one of the benefits of EHRs.
posted by 26.2 at 12:45 PM on January 10, 2016 [3 favorites]

It isn't that anything your doctor says is preventative is covered 100% there is a very specific list of things that are covered under the preventative coverage mandate.

So your insurance company isn't just going to say, "oh the doc said preventative, pay that 100%." If it isn't on the list then they are going back to your doc and he will have to lay out in detail why this test was medically necessary in order to have your insurance company think about paying for it. Even then they may not agree.
posted by magnetsphere at 1:40 PM on January 10, 2016 [4 favorites]

Best answer: Is Quest Diagnostics in your insurance network? If so, ask your doc if you can have your labs drawn there (in my previous city the doc ordered blood work and you had it drawn at one of the labs you were in network with...Quest was one of them). Then Wellness FX can access those results. Most of those labs can be marked as preventative during your yearly physical. Some aren't (the inflammation marker) but is no big deal to add to the order. It's up to your insurance as to how much they cover for those types of labs.
posted by MultiFaceted at 1:48 PM on January 10, 2016

Seconding magnetsphere-- I had this exact experience with some fairly run-of-the-mill labs my doctor ordered. Called the office, got my labs recoded as preventative without difficulty (to do this, I just spoke to someone in reception and they took care of it), but it turned out that the only tests covered under my insurance's "preventative" category were blood glucose and cholesterol, so the "preventative" coding made not one lick of difference.
posted by Bardolph at 4:05 AM on January 11, 2016

These are consensus guidelines in the U.S. for screening/preventative care. I suspect most insurers likely use these guidelines for re-imbursement/coverage purposes regardless of how your doctor might code the order. You can certainly inquire with your insurer in advance.

Depending on your age/gender, there are very few preventative labs recommended by the USPSTF, and with good reason. Despite what Wellness FX is trying hard to sell you, the real world value and meaningful impact on lifestyle recommendations of random/screening hsCRPs, electrolyte panels, and the rest is not well established based on the best available scientific evidence.
posted by drpynchon at 11:13 AM on January 13, 2016