Question about insurance and "medically necessary" diagnostics.
When I call my doctor's office for a physical (annual) exam, the office requires all patients to get labwork(blood, urine test) first and then come to the office for their physical a few days to a week after to get their physical and also go over the labwork results.
When I call my insurance they tell me they cover the physical exam itself 100%, however things like labwork are considered to be diagnostics to them and therefore they don't cover that in full so I have to pay a $30 co-pay. I explained to my insurance that I can't make the appointment for my physical without the labwork, that the doctor's office has a process this way. It's not like I'm the one asking for the labwork. The insurance company responds, the doctor's office may have their procedures, but the insurance company does not consider this labwork to be necessary/required, therefore they don't cover it in full and I will have to pay a co-pay.
I just found out recently that it's not just the annual physical, but the insurance company also does this with other types of visits. I just recently found out I am pregnant. So my doctor says, "Ok, please create a 1st prenatal visit". I call to schedule this, the office tells me their procedure is :1st I go to ultrasound, then with those results I will go over them in the prenatal visit, then the doc will send me to get lab work.
I call the insurance company as I was previously told that they cover prenatal visits 100%, and then I am told that ultrasounds, x-rays and labwork are again… considered diagnostics, therefore not required and I will have to pay a co-pay each time I am getting these. I explained again, that the doctor requested for these, the insurance rep. doesn't care. They say these tests are optional and that I have to ask doctor why they're asking me for these when they don't see these are necessary. That I should also ask how many labs and ultrasounds I will be getting throughout pregnancy to calculate my co-pays as I will need to pay each time.
I find this ridiculous on how am I supposed to even tell the doctor of these things, they do this with all patients. I feel that it doesn't allow a doctor to do their work as they would like with these setbacks. I mean not everyone has the money to be paying for co-pays for each visit and the patient is not even the one asking for these.
Is there any way that I could ask the doctor to put the labwork and all other tests within the same visit so that all is covered?
submitted by /u/ANonyMouseTwoo
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