So I recently stated with Defy , had blood work , had consult, got my new meds, and on my way to feeling better. Today I open my mail and get a bill from labcorp for $750, my insurance denied coverage even though I verified with them over the phone prior. Come to find out I have a $6000 deductible on out of network facilities. So now I am faced with a dilemma of how to continue with defy. I know they have discounted prices on labs but I can find them. I also was wondering if I am due for labs at defy if I can get those labs done at my GP (tell him the labs I want) and just send them off to defy once I get the results from my local GP. If you see this Doctor Saya let me know your thoughts as well..
Defy Bloodwork
- Thread starter SAB
- Start date
Tom Larabee
Member
CoastWatcher
Moderator
Tom Larabee
Member
P
Palermitano
Guest
The same happened to me. My insurance will not cover out of state/Florida. I got stung with a tab of over $3000 from Lab Corp for several scripts from Defy, not their fault though, I should have checked first. I spoke with a very nice lady from my insurance and she sent an appeal for me claiming that I did not know about "out of state coverage" (and I didn't) and they picked up about 2k of it, but will not again in the future.
Best bet is to pay Defy for blood work, or Discounted Labs, or, find out what blood work Defy needs, then go through your "local" Dr. (insurance will then cover it) if he/she is cool enough to run scripts for you, luckily mine is, then email to Defy. I hope this helps.
Best bet is to pay Defy for blood work, or Discounted Labs, or, find out what blood work Defy needs, then go through your "local" Dr. (insurance will then cover it) if he/she is cool enough to run scripts for you, luckily mine is, then email to Defy. I hope this helps.
I got an actual script as well from Defy, and went to the local labcorp where I live. basically it comes down to contracts and Defy is out of network. I confirmed with Defy. I can just see my normal GP that started me on TRT anyway. I was going there every there every 3-4 months anyway. So I will just continue my bloodwork there and email them to Defy. As long as they are close to my followup date for bloodwork I'm good. Sucks Im still stuck with a $750 bill.
Vince Carter
Banned
This is what I do as I use the same scripts Defy wrote you. Look at your insurance for something called a "Lab Card". There's a logo of it on my actual insurance card. If you have this Lab Card as part of your insurance coverage, Quest Diagnostics will accept it. It's a no cost/no copay/no deductible part of your insurance. I get all my labs 100% covered, no out-of-pocket and i just ask the nurse Jill for a script for any labs I want, any time I want.
Alternative is to buy from Defy, or Discounted Labs.
Alternative is to buy from Defy, or Discounted Labs.
Dr Justin Saya MD
Moderator
SAB - sorry to hear of your troubles. Unfortunately, every insurance is different and some are much more restrictive than others. However, the "out of network", with regards to labs, typically refers to the actual lab facility in which the labs were drawn and billed (as others have stated)...if not, the insurance company's policies leave much to be desired. Think about it...they (your insurance) pay the LAB facility the same fee for the labs regardless of which doctor orders the labs...in other words they pay LabCorp the same amount for a cholesterol panel, for example, whether I write the order or your PCP writes the order.
Regardless, as noted, there are several work arounds including, as you mentioned, having your in-network physician order the appropriate labs (assuming they will), or using our discounted lab pricing.
I would also appeal the lab bill with your insurance...on principle if nothing else.
Regardless, as noted, there are several work arounds including, as you mentioned, having your in-network physician order the appropriate labs (assuming they will), or using our discounted lab pricing.
I would also appeal the lab bill with your insurance...on principle if nothing else.
Vince Carter
Banned
Dealing with an insurance carrier on my own was a nightmare and was really probably second reason I switched to Defy, after wanting to get with Dr Saya which put me in a position to be able to use my insurance for labs, and otherwise afford my meds out-of-pocket.
Some of the EOBs I see using that Lab Card of mine they total in to the thousands of dollars...for nothing but routine HRT tests we all get.
Some of the EOBs I see using that Lab Card of mine they total in to the thousands of dollars...for nothing but routine HRT tests we all get.
PAUL-E
Member
sorry to hear about that most insurance company's coverage sucks my in network deductible was 3000 and since I had a family there deductibles could be added to mine, I could be responsible for around $15,000 a year in network and out of network is about twice that and thats before insurance even kicks in and even then it's not 100% coverage.
Its crazy, I asked our benefits specialist here at work about this. They stated the problem with BCBS is they are comprised of over 30 other small companies. So contract vary from state to state. Good news is we are switching to Aetna at the beginning of the year for more unified coverage. I think what makes me so angry is I pay $290 a month for family health insurance and they never what to cover ANYTHING. Sometimes I result to goodrx for some meds, because it always seems I need prior authorization for everything.
Vince Carter
Banned
I think my insurance is outstanding with copays and deductibles the way they are, as long as it's in-network and the clinic files things but the moment I was out-of-network making my own claims for reimbursement placed me in the seventh level of hell trying to deal with them.
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