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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
Question about Lab work quality
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<blockquote data-quote="Jason Sypolt" data-source="post: 168609" data-attributes="member: 13328"><p>You can use insurance for labs if you are out of state, yes. What you should do is check in the online directory for your plan to find an in-network facility. I would also call the carrier to check and see if "routine diagnostics" are covered and have no co-pay and no deductible. When Defy issues a lab rx for patients to use their insurance, we use the routine diagnostics code to help patients with that process.</p><p></p><p>You could be one of the lucky ones, but what many plans are doing with testing is they have what seems like a low 20% deductible. But like I said in my post above, my plan was billed $232 for a $15 test. If I had to pay that 20%, it would have cost me $46.40 or more than 3x what Defy's price is. My plan at the time just paid for everything and the hospital billed them directly. I presented my lab rx and insurance card and was done. Some plans make you pay upfront and then reimburse you, and some have other ways of processing claims. Definitely call them and check.</p><p></p><p>I'm not trying to dissuade you, but I have seen that it is becoming more difficult to go through insurance for much of anything proactive/preventative. Some people can save a lot on costs with insurance for labs, but you really have to be careful. Insurance plans are never intended to save you any money. They are designed to protect against financial catastrophe and the carriers are making money off of you long-term by betting that you aren't going to have a large claim for a while and by denying as much as possible. They aren't your friend and aren't there to help you. Even when you do save money, you're still paying them hundreds or even a thousand dollars or more each month for the premium.</p><p></p><p>Medications are another matter. What Defy cannot do if you want to use your insurance is call in controlled substances like Testosterone for you in a state other than FL. You could try to get reimbursed for the cost of medications like T, but they almost all deny claims for T and they will most likely deny claims for other meds like HCG, Anastrozole, etc because those are prescribed off-label for TRT and it gives insurance carriers a reason to deny.</p></blockquote><p></p>
[QUOTE="Jason Sypolt, post: 168609, member: 13328"] You can use insurance for labs if you are out of state, yes. What you should do is check in the online directory for your plan to find an in-network facility. I would also call the carrier to check and see if "routine diagnostics" are covered and have no co-pay and no deductible. When Defy issues a lab rx for patients to use their insurance, we use the routine diagnostics code to help patients with that process. You could be one of the lucky ones, but what many plans are doing with testing is they have what seems like a low 20% deductible. But like I said in my post above, my plan was billed $232 for a $15 test. If I had to pay that 20%, it would have cost me $46.40 or more than 3x what Defy's price is. My plan at the time just paid for everything and the hospital billed them directly. I presented my lab rx and insurance card and was done. Some plans make you pay upfront and then reimburse you, and some have other ways of processing claims. Definitely call them and check. I'm not trying to dissuade you, but I have seen that it is becoming more difficult to go through insurance for much of anything proactive/preventative. Some people can save a lot on costs with insurance for labs, but you really have to be careful. Insurance plans are never intended to save you any money. They are designed to protect against financial catastrophe and the carriers are making money off of you long-term by betting that you aren't going to have a large claim for a while and by denying as much as possible. They aren't your friend and aren't there to help you. Even when you do save money, you're still paying them hundreds or even a thousand dollars or more each month for the premium. Medications are another matter. What Defy cannot do if you want to use your insurance is call in controlled substances like Testosterone for you in a state other than FL. You could try to get reimbursed for the cost of medications like T, but they almost all deny claims for T and they will most likely deny claims for other meds like HCG, Anastrozole, etc because those are prescribed off-label for TRT and it gives insurance carriers a reason to deny. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
Question about Lab work quality
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