When you have health insurance, it’s tempting to think that everything is covered. Your doctor recommends a test, and you think that you should probably get it. Later, though, you find out that the test isn’t covered by your health insurance company.
While some health insurers will cover various lab tests, there are those companies that deny even the most basic of tests. Before you have a test done — especially if it is likely to be non-essential — find out if your health insurance company will cover it.
High Deductible Health Plans
First of all, it’s important to understand what it means if you have a high deductible health care plan. While you are entitled to a preventative health care visit with a high deductible plan, you might not be entitled to lab tests. As a result, even if your health insurance company normally covers the lab test in question, you might not have the cost covered until you reach your deductible.
This is a consideration for me, since my family is on a high deductible plan. We don’t need a lot of health care services, though, and we rarely need lab tests performed. When my health care provider suggested that I have my blood tested for Vitamin D levels (I was fighting a losing battle with my immune system), I agreed.
I had to pay for the test, since I hadn’t reached my deductible. Luckily, the test wasn’t very expensive. However, even if my deductible had been reached, I still would have had to pay for the test since my health insurer doesn’t cover it. My health care provider thought it too bad, since she said that Vitamin D deficiency is an increasingly common problem, particularly in women.
What about More Expensive Tests?
My health care provider also thinks I should get the relatively new BRCA test. This is a test that looks for specific genes related to cancer. Women who have the genes are more likely to get cancer. Since my maternal grandmother died of ovarian cancer, and my paternal grandmother is currently fighting round two of breast cancer, my health care provider would like me to get the test so we can start talking options.
Unfortunately, the test, unlike the Vitamin D test, is rather expensive — about $4,000 right now. And my insurance company doesn’t cover it. Plus, what happens if the test comes back positive? What am I going to do with that information? There are surgeries that could make ovarian cancer a moot point, but without coverage they cost anywhere between $10,000 and $20,000. Even with insurance, there is usually a co-pay and the patient is responsible for between 20% and 50% of the cost.
And, while it’s nice that Angelina Jolie could afford to have a double mastectomy, it’s not something most people can pay for out of pocket. Indeed, many insurers, even if they cover these types of surgeries, might not cover them unless the patient meets a host of factors that indicate “high risk”.
No matter the lab test, and no matter that your health care provider calls for it, your insurance company might still deny coverage for the test. This can be a real problem if you go ahead and have the test, only to have a bill arrive in your mailbox 60 to 90 days later (usually following a note denying the claim for coverage.) If the test is expensive, you might have to arrange a payment plan in order to avoid serious financial hardship.
Before you agree to have a lab test done, find out if your insurance provider will cover it. Check your deductible (if applicable) to find out whether or not you will have to pay out of pocket — even if your company does cover the test.
If your insurer doesn’t cover the test, you can find out if there are options for those with low income. If you qualify for a medical research program, or if you qualify for financial help getting a test, you can still get the information you need to make the right decision about your care.