Defy vs insurance

[Rhino 2.0]

Would it just be cheaper just going straight with defy using thier discounted prices for blood work or would be cheaper to see if you’re insurance covered it?

 

[Vince]

If you can find a good doctor on your insurance, that would be the best price. The issue is trying to find a good doctor.

 

[DragonBits]

If you can find a good doctor on your insurance, that would be the best price. The issue is trying to find a good doctor.

Usually true, but not always. Sometimes insurance only pays part of the bill, sometimes the remainder is higher than if you paid it direct.

Then there are the times the test is coded in a way that insurance won't pay, such as medicare will only pay if deems the test necessary. If they don't pay, you end up with a costly unexpected bill.

 

[Vince Carter]

If your insurance covers labs like mine does, Defy writes me a script and I take it down to Quest and hand them the script and my Lab Card (google it). I pay nothing for labs, no copay, no deductible; ZERO.

 

[DragonBits]

If your insurance covers labs like mine does, Defy writes me a script and I take it down to Quest and hand them the script and my Lab Card (google it). I pay nothing for labs, no copay, no deductible; ZERO.

I see that Lab Card says it is designed for

• Program designed specifically for high-deductible plans, MSA plans and consumer-driven healthcare.

So it would seem medicare would not be eligible for Lab Card.

Is that your understanding also?

 

[Vince Carter]

Probably not, the Lab Card is included with my private insurance

 

[stevep]

Depending on the relationship you have with your PCP and what your insurance covers maybe you can get the labs through your PCP for Defy. That is what I do. My doc prescribes my testosterone, but won't prescribe HCG. But, I've talked him into running the labs for my Defy HCG prescription and faxing the labs to them every 6 months when my Defy appointments come around. Fortunately, I've yet to pay for labs.

Some people don't recommend this approach. Their PCP aren't as cooperative and they keep their PCP and Defy separate for good reason.

 

[lowTengineer]

Depending on the relationship you have with your PCP and what your insurance covers maybe you can get the labs through your PCP for Defy. That is what I do. My doc prescribes my testosterone, but won't prescribe HCG. But, I've talked him into running the labs for my Defy HCG prescription and faxing the labs to them every 6 months when my Defy appointments come around. Fortunately, I've yet to pay for labs.

I do the same thing. My insurance charges a regular office visit copay when I request labs.

 

[blackebob]

If your insurance covers labs like mine does, Defy writes me a script and I take it down to Quest and hand them the script and my Lab Card (google it). I pay nothing for labs, no copay, no deductible; ZERO.

Me too, I also submit my out of pocket office visit to my insurance, they still cover it 80/20.

 

[DragonBits]

The problem with medicare is the doctor needs to put in a code that medicare will accept.

For instance, I got charged full price for a lipid profile my PCP wrote me where he put in routine care. He would have needed to put in something like testing because I had high lipids in danger of CVC events.

It maybe difficult to justify to medicare why he is testing for something like the estrogen sensitive test.

 

[Vince Carter]

Every insurance carrier requires certain coding (re: diagnosis) to meet their criteria for payment.

 

[DragonBits]

Every insurance carrier requires certain coding (re: diagnosis) to meet their criteria for payment.

True, but I believe medicare is more stringent.

Also, I believe my PCP / staff isn't as familiar with how to navigate the medicare maze. But just my opinion.

I tried calling medicare, I got a run around and nothing useful, basically just look at the code book.

EDIT: If anyone uses medicare to pay for blood tests that are needed for TRT, please post. Another problem, my PCP feels he can't prescribe TRT because the practice he is in wouldn't approve of it, and for medicare to approve TRT I would need to be dead. Or below 264 ng/dl, whichever came first.