This is OP, thanks for the replies. So to be clear, I had indicated that this visit was simply a physical/well-visit, I had indicated no concerns that would trigger a "diagnostic" charge. I went through my BCBS coverage and found that the plan covers the following:
- A lipid panel/cholesterol screen 1x every 5 years for adults over age 20
- Comprehensive Metabolic Panel (CMP) and Lipid Panel, Hemoglobin A1c (HbA1c) only if you have a BMI above 27 or a history of diabetes

I've done the math comparing my company's high-deductible plan to its traditional PPO. The difference in premiums between the two is more than the deductible, so I keep the high deductible plan and come out ahead even in years I reach the whole deductible (rarely). The deductible was increased to $2k this year so as not to cause a big jump in premiums.

It's just a bit shocking that health plans aren't required to cover these basic labs 1x per year as a preventative measure, especially for middle-aged and older people. I can pay the bill, but know that there are so many others who would truly be in trouble having to pick up a bill like this. Totally understand why people with tight finances forgo healthcare until a crisis hits. Healthcare in this country is shameful.

I think even with a High Deductible Plan, annual physical and associated bloodwork should be covered as NOT part of the deductible. This was part of the ACA, was it not?

Anonymous wrote:Is HealthLabs.com really a better deal than just ordering through provider? I looked up a HCG pregnancy test as an example and it’s still $49! A urine pregnancy test is $39.

You can search different companies. Personal Health has a bundled package through Quest Lab that includes:

Wellness Checkup Blood Test. $123

CBC with Differential/Platelet Count (6399)
Comprehensive Metabolic Panel (CMP 14) (10231)
Hemoglobin A1c with Estimated Average Glucose (16802)
Lipid Panel with LDL/HDL Ratio (19543)
TSH (899)
Urinalysis, Complete (5463)

It is so much better to know how much it is going to cost you instead of paying $500. Some of these companies also run sales on certain occasions.

If you’ve not met your deductible yet then this sounds accurate. The standard tests should be pretty cheap, but if your provider ordered some extras like a vitamin D test or B12, that will inflate the bill.

High deductible is only good if you have an employer funded HSA

Anonymous wrote:

Anonymous wrote:My BCBS high-deductible plan covered the "visit" portion ($200) of my annual physical, but covered none of the associated blood tests: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Lipid Panel, Hemoglobin A1c (HbA1c), Thyroid Stimulating Hormone (TSH). Just the basic stuff, no vitamin panels or anything exotic. Total cost was $700, with the insurance negotiated rate bringing it down to $500. I don't understand how insurance is allowed to not cover these sorts of basic screens. No wonder most Americans are so unhealthy. How many can afford a $500 bill when they aren't even sick?

Call BCBS. It is possible it was sent to the wrong BCBS affiliate. (This happened to me following an ER visit).

Oh yes that is another thing.

BCBS is composed of hundreds of umbrellas.
If the hospital / provider sends their bill to the wrong umbrella, you would think the insurance would internally forward it or alert its subsidiary or something.

but not, but just send us the paperwork back saying "this patient does not have insurance"
and often it's not even possible to tell by looking at the back of the insurance card where the bill needs to go, we need to call the BCBS number and wait on hold for 30 minutes or more for them to tell us.

Anonymous wrote:

Anonymous wrote:(provider)

BCBS, especially plans administered out of state, have created their own list of admissible diagnostic codes.
It's a scam, they are also barely covering our patients' basic prenatal labs (we are an obgyn group)

Here is what one smart patient did
Request a list of acceptable codes that they are willing to process (CPT codes)
Bring like a cake to the office because you are asking them to work for free, and ask them to re-code your visit and labs from that list
It will have a different identifying number for annual exam
We are all amazed it's legal, they just went ahead and invented their own CPT system it looks like without any informed consent from ANYONE

Anyway, my patient's labs got covered that way.

I am guessing someone at some point will be fed up, will take them to court, and they will immediately fold and stop it
But until them, they will collect $500 for basic annual labs from lots of people who do not know better, and cause all of use in healthcare to lose their minds adjusting all the bills to their new, unannounced, and probably illegal system.

Rant over, please get a nice cake for your PCP's office... veggie tray will also work

I don't think any health care provider will be willing to risk their license or assume liability for their practice by coding something that did not happen, much less for a tray of sweets

IT's not that we code it as if it did not happen.
It's still preventative adult annual with a certain age group.
They just literally want it coded with a different CPT code that we have never even seen before, BCBS is the only one using it, and I've been doing it for a while.

Is HealthLabs.com really a better deal than just ordering through provider? I looked up a HCG pregnancy test as an example and it’s still $49! A urine pregnancy test is $39.

Healthlabs.com you don’t need a doctor’s order. They give you a paper to print out and you take it to Quest. Recently I started getting emails from Quest asking me to register and make an appointment. Maybe they got tired of me doing a walk in appointment and clogging up their schedule.

Anonymous wrote:Order these directly yourself (bypass insurance) and dr. visit.

The labwork is still done at Labcorp or Quest.

Google for info.

I tried getting one of those fancy cholesterol tests on both of those sites, but it said not possible in VA without a dr’s order.

Order these directly yourself (bypass insurance) and dr. visit.

The labwork is still done at Labcorp or Quest.

Google for info.

Healthlabs.com is cheaper but they don’t automatically show up in the Inova system so your doctors can see them.

Anonymous wrote:

Anonymous wrote:Annual physicals are supposed to be 100% covered since they are preventative, but it turns out it can’t be part of another complaint. If you go to the doctor and say this or that hurts, and he says ok let’s do your annual physical since you’re due, they won’t consider it as a preventative. You have to say I want my annual physical and nothing else. I have ended up in the same boat as you a few times because of that. It’s bs.

Right but those lab tests should be part of an adult physical, especially middle aged or older. Do they expect you to forgo the blood tests and then suffer the consequences (and financial costs) of uncontrolled diabetes because it wasn’t discovered earlier?

They should be covered since they are part of your physical. The blood tests really are your physical, the rest is pretty minor, mostly dumb questions, are you suicidal etc. As I mentioned, you just have to schedule it as an annual physical, not due to some health issue you are having. That was the explanation given to me when I was billed for my annual physical. The insurance companies will look for any possible reason to not pay, so try not to give them a reason.

And when and if you can, switch to a no or low deductible plan. Nothing is covered until you meet the deductible. Someone is having the exact same issue with a HDDP in the expecting forum. Had to pay 1k for a fetal Ultrasound.

Anonymous wrote:My BCBS high-deductible plan covered the "visit" portion ($200) of my annual physical, but covered none of the associated blood tests: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Lipid Panel, Hemoglobin A1c (HbA1c), Thyroid Stimulating Hormone (TSH). Just the basic stuff, no vitamin panels or anything exotic. Total cost was $700, with the insurance negotiated rate bringing it down to $500. I don't understand how insurance is allowed to not cover these sorts of basic screens. No wonder most Americans are so unhealthy. How many can afford a $500 bill when they aren't even sick?

Call BCBS. It is possible it was sent to the wrong BCBS affiliate. (This happened to me following an ER visit).

Mine covers a few ( cholesterol, rbc, wbc) but not all. I was able to get the vitamin D recoded since I had a history. Some of the ones you mentioned are not part of what my doctor provides as part of annual. I would ask doctor to resubmit as annual physical in case anything wasn’t coded correctly. This is how I learned my insurance doesn’t cover all lab work.