Self-Pays and Lab fees

Those of you that self-payed for your surgery, do you pay for your labs?  If insurance picks it up, what diagnosis code do you use?

Insurance paid for my DS, but DH left the job through which we were insured after I had surgery.  We elected not to do COBRA, and were uninsured for 90 days until our new insurance started.  Our new insurance considers my DS a pre-existing condition.  It's time for me to run labs and I'm wondering if there is a way to get them at least partially covered.  Thanks for any advice you may have.

-Ann

579.9 is the ICD9 code for non-specific malapsorption.  Try that, if your insurance still won't cover I have some links where you can self-pay for labs and I think I got them all for around $500.00.

Let me know if you want the links.

HTH,
Michele

Thanks, Michele.  I've grabbed a couple, but I would love your links.  $500 is pretty darn good for what we require.

These are the two I have used:

http://www.directlabs.com/index.php

http://www.health-tests-direct.com/

HTH,
Michele

The DS isn't a "condition," pre-exisitng or otherwise.


And any malabsorption you have may or MAY NOT be related ot the DS.  Some of mine is, some is not.

What is the insurance company not paying?

The more obscure labs not normally found on an annual physical.  A, E,K1, PTH, Ferritin, and I don't remember what else without looking through files.

When the last labs were submitted, I was required to present all doctors seen and prescriptions for one year prior to being insured with them. 

Here's my list of labs. Please note the 2nd page is the codes the docs need to use to order them.

Any 579 codes are a red flag for my insurance and they will not pay if we use it.

Any of the other ones are valid. They generally only need 2-3 codes, so these cover the truth, no fraud.

****




Not to be construed as medical advice, this list includes labs we have had performed as gastric bypass patients. The first group, every 3 to 6 months for life, as we are able. The second group, annually, as long as the results were comfortably within normal limits for more than 2 years in a row.



1st Group



*80053 Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase) (10231)

* 84134 Pre-albumin:

* 7600 Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 10256 Hep panel: includes ALT (SPGT) & GGT)

* 84100 Phosphorous - Inorganic: (718)

* 83735 Magnesium:

* 84550 Uric Acid: (905)

* 7444 Thyroid panel: (T3U, T4, FTI, TSH) (84437; 84443; 84479; 84480)

* 85025 Hemogram with platelets: (1759)

* 7573 Iron: TIBC, % sat

* 83550 Ferritin: (457)

* 84630 Zinc: (945)

* 84446 Vitamin A: (921)

* 82306 Vitamin D: (25-hydroxy) (680)

* 84052 Vitamin B-1: (Thiamin) (4052)

* 84207 Vitamin B-6: (Pyridoxine)

* 7065 Vitamin B-12 & Folate: (82607; 82746)

* 83970 Serum intact: PTH

* 83937 Osteocalcin:

* 84597 Vitamin K:

* 85610 PT:

* 85730 PTT:



2ND GROUP



* 593 LDH:

* 31789 Homocysteine, Cardio:

* 83921 MMA:

* 367 Cortisol:

* 84255 Selenium:

* 84590 Vitamin E:

* 82525 Copper:





For diabetics: *496 - HEMOGLOBIN A1C













POSSIBLE DIAGNOSIS CODES





269.2 Hypovitaminosis



268 Vitamin D deficiency



275.40 Calcium deficiency



266.2 Cyanocobalamin deficiency (B12)



281.1 other B12 deficiency anemia



281.0 Pernicious anemia



280.9 Iron-deficiency anemia



281.2 Folate deficiency anemia



285.9 Anemia, unspecified



269.3 Zinc deficiency



244.9 Hypothryoidism



250.0 Diabetes



401.9 Hypertension



276.9 Electrolyte and fluid disorders



272.0 Hypercholesterolemia

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -



*579.3 Surgical malabsorption*



*579.8 Intestinal malabsorption *





* Bands or sleeves should not use these codes as they are not accurate.



*Some insurance companies will not pay for any procedure that uses these codes.





LAB TARGETS





This is NOT medical advice, just my own targets for the main blood levels I watch.



Protein: 7's

Albumin: 4's

Pre-Albumin: 20-30's



Iron: 80-100

Ferritin: 200-300

HGB: 12+

HCT: 36+



Vit A: 60- 80

Vit D: 80-120



Calcium: 9.0-9.4

PTH: 20-40



Vit B1: Mid to top of range

Vit B6: Mid to top of range

Magnesium: Mid range (but also go by if we have leg/foot cramping)

Zinc: Mid range



Vit B12: 1000 +

Folate: Top of range



AST (sgot): Below 40

ALT (sgpt): Below 40



We usually want to "meet or beat" pre-op levels. In some cases, higher is better, and in other cases (Cholesterol, PTH for example), lower is better.



The only things *I* don't mind being on the high end of out of range are Ferritin and B12. But that applies to ME.



My doctors don't show interest in any of these until I am out of range. *I* am interested when I begin heading that direction.