Health ins. q. - Can someone explain how to get a blood test pre approved?

[jess_g]

My ds needs an expensive lab test (its a genetics blood test). 2 of his doctors are both recemending this test. But I am told that we need to get it pre aproved by our health insurance first. Does anyone know if the doctor needs to call the health insurance company for the pre aproval and what is involved. I have called the health insurance about 5 times about this and gotten 5 different answers. Sometimes they have said to just have the test done, other times they have said the doctor needs to call them. Does anyone have any experience with this kind of issue? I am told that if we don't get it pre aproved it would cost us about $6k but I don't know how to get it pre aproved. We have another apointment with the doctor next week so I want to know what I need to ask him to do. Hopefully he will understand and help us out but I need to know what exactly I need him to do for us first.

thanks,

Jessica.

[jerigirl]

IME, a billing/insurance person from the requesting doctor's office calls the insurance to get preapproval for test.

[Momof3Labs]

Instead of waiting and talking to the doctor, call tomorrow and talk to whoever handles insurance issues in his office. There should be someone who has done this before and can help navigate the insurance for you.

[Snow mom]

Someone in the office should be able to walk you through it. I always thought the doctors office was supposed to seek preapproval-- definitely talk to billing. Whatever you do, don't have the genetic testing done until it is preapproved. Insurance companies are always looking for ways to get out of paying for expensive things and somethings they won't pay for something that hasn't been preapproved, even if they would have preapproved it and paid for it.

[hardysmom]

I've had so many tests and procedures, including genetic testing, over the last couple of years... Yeah, genetic test can be steep, though 6K sounds high. Mine have ranged from $300 (CYP2D6) to $2500 (BRCA).

A question... Is your son currently uninsured? That may be the Catch 22 issue. We won't insure w/o the test, but we won't pay for the test. If he isn't covered, who would handle the pre-approval?

Legally, it is VERY important to have some kind of coverage at the time a problem is diagnosed. Insurance companies can't deny someone with a pre-existing condition if they had health insurance when that condition was diagnosed and their insurance has never lapsed. The moment you let a policy end without having another in place, you can be denied coverage due to the pre-existing conditions. This is the reason it isn't smart to let insurance lapse between jobs, etc.

If your child is a newborn, currently under your policy, you need to find out the consequences if the test shows a problem.

If you all carry a genetic quirk or thing think there may be a genetic issue of ANY kind and your child is currently uninsured, get him some type of quick coverage (cheapo, super high deductible, ANYTHING!) which doesn't require a blood test to make sure they can't be excluded from this policy do to a condition which turns up on the test.

You need a doctors office to work his out. Someone has to order the test, THAT someone needs to find out how to bill it... Usually, doctors' offices handle all the back-and-forth with insurance, including appeals, etc. Be a squeaky wheel with them to move it along and get an answer.

As mentioned, DO NOT order the test w/o pre-approval. Best case. if everything is OK, insurance may deny covering it because you didn't follow the rules. If your child has something wrong, they (and all other insurers) can deny ALL coverage for a pre-existing condition, diagnosed prior to coverage initiation.

Stephanie