Defy - Insurance covering bloodwork

[RVAwhat]

I'm in Virginia and working with defy. They prescribe bloodwork for me and obviously the prescribing physician is from FL.

When I get my labs, labcorp bills thru Florida...thus making it an out of network provider under my plan.

Is there anyway to avoid this? Other than discontinuing with defy and finding a local doctor?

 

[captain]

Should be billed where you get the labs done. I haven't had a problem with this yet. I don't see how it would have anything to do with the location of the Doctor. Only problem would be if your insurance don't let you use LabCorp.

 

[Vince Carter]

Look at your insurance coverage and see if you have something called a "Lab Card", it's a logo on my insurance card, check and see if you have this by chance.

 

[RVAwhat]

I have Blue Cross Blue Shield. LabCorp is on contract with BC BS at each one of their locations across the country. The customer service rep from BC BS told me that they bill to the state of the prescribing doctor...

I might just try a different LabCorp location to see if each location does this.

 

[Vince Carter]

So you're not paying Defy for the labs, is that right? I thought thats how Defy did this.


edit: nvm I think I know what you're saying. Can you compare the costs thru like discountedlabs and pay them out-of-pocket?

 

[RVAwhat]

I certainly can do all of that math and figure out which would be cheaper. However, right now I am at my in network deductible on my insurance plan. Therefore, all of this bloodwork would be covered at 100% until June 1 which would be ideal for me.

 

[CoastWatcher]

I'm in Virginia and working with defy. They prescribe bloodwork for me and obviously the prescribing physician is from FL.

When I get my labs, labcorp bills thru Florida...thus making it an out of network provider under my plan.

Is there anyway to avoid this? Other than discontinuing with defy and finding a local doctor?

I'd also contact your plan administrator, your in-house HR contact, and enlist their help. Perhaps cutting through first line staff at BC/BS.

 

[RVAwhat]

Are you meaning to imply that if I contact my employer's HR director who has some contacts with BC BS, I may be able to get someone more knowledgeable and qualified on the phone?

 

[CoastWatcher]

Are you meaning to imply that if I contact my employer's HR director who has some contacts with BC BS, I may be able to get someone more knowledgeable and qualified on the phone?

Essentially, yes. Who in your organization handles HR/benefits questions? I understand every company is different, size being the biggest variable, but I have always worked for an outfit that had an internal HR dept that would respond to employee issues. If that's the case with your employer I would see what they might be able to do. I wish you luck.

 

[RVAwhat]

Thank you - I haven't thought of that!

 

[Vince Carter]

I know first-hand dealing with insurance is a real headache, luckily I have that lab card thru my carrier for Quest and I get all my labs 100% covered. Its really worth digging around your coverages and seeing if BCBS has it for you.

http://www.labcard.com/

 

[HarryCat]

I also have a BCBS plan in my home state and they also process the claim through BCBS of Florida. But in my case my plan covers so called "out of state labs" even though I had the blood draw done in my home state.

 

[BryanW]

I call my PCP office and ask them to enter the script into their system. I think it gets bucketed under "fertility". That way the prescription is coming from an in-network provider.

 

[captain]

I would have them set you up with discounted labs if they are not going to pay. When I get my labs done at LabCorp they make you sign a paper agreeing to pay if insurance don't. The charge is up to 800 bucks when I sign. I think labs are around 200 paying cash so it's not worth rolling the dice if you think they will not pay.

 

[RVAwhat]

So you call ur PCP ... tell them you're working with an out of state fertility doctor the has prescribed blood work and you then ask them to match the prescription?

 

[RVAwhat]

I also have a BCBS plan in my home state and they also process the claim through BCBS of Florida. But in my case my plan covers so called "out of state labs" even though I had the blood draw done in my home state.

How can I find out if my plan covers "out of state labs"?

I have called customer service numerous times and those people are clueless. I call 3 times and get 3 different answers.

 

[CoastWatcher]

How can I find out if my plan covers "out of state labs"?

I have called customer service numerous times and those people are clueless. I call 3 times and get 3 different answers.

Get very basic.

1. A licensed physician I consult in the state if Florida has ordered a number of labs. He is not in-network, but I am his patient.

2. The blood will be either drawn at LabCorp or Quest. Are these labs in-network?

3. Are these covered expenses?

4. If not, why not? Please explain where in the plan the determination of coverage for lab tests is spelled out. Are labs covered only if they are ordered by in-network providers?

The more focused you can make your question the better. Don't ask them to think - force them into as many yes or no answers they you can.

 

[HarryCat]

How can I find out if my plan covers "out of state labs"?

I have called customer service numerous times and those people are clueless. I call 3 times and get 3 different answers.

I've also found that BCBS customer service is worse than useless because they give out contradictory answers. Honestly they are just not supplied with the information to answer the question.

At one time several years ago I was considering going to T pellets and I called them up to ask if the pellets and the procedure would be covered. After getting the usual run around I was told that the only way to know for would be for the provider to call BCBS and ask what would be covered, and then they could tell me what they found out.

So you may want to call the lab that you use and ask them if they can ask BCBS before your next blood work if it will be covered.

 

[HarryCat]

Get very basic.

1. A licensed physician I consult in the state if Florida has ordered a number of labs. He is not in-network, but I am his patient.

2. The blood will be either drawn at LabCorp or Quest. Are these labs in-network?

3. Are these covered expenses?

4. If not, why not? Please explain where in the plan the determination of coverage for lab tests is spelled out. Are labs covered only if they are ordered by in-network providers?

The more focused you can make your question the better. Don't ask them to think - force them into as many yes or no answers they you can.

If only it were this simple.

 

[RVAwhat]

If only it were this simple.

Yes, it is not that simple. I wish it were. You can ask all of the questions you would like to and different customer service agents will give you different answers. But when the bill comes in the mail, no one has any definitive answers. All they can do is put it under review which requires 30 days.