Questions about blood work coverage.

[Coffeedrew]

The insurance company deined my claim to pay my bloodwork, but they pay for my prescriptions.I called them and asked why they denied it so quick. They told me that the doctor has it locked up with special medical codes. I have to ask him the why they won't cover it.
I had a total of 6 tests the 4 normal tests I guess of overall health.The other two were the levels of testosterone and estradiol.I understand the  hormones and not being covered, but why can they not make a partial payment for blood work a docter would normally do? I already expected the worst case scenario,but I just feel defeated about the whole situation being denied so quickly. The insurance company doesn't know I consider myself transgendered, is that something I have to tell them?
I would love to know if anybody had any information on this topic, either, from dealing with it themselves or if they did medical billing.

[jill610]

This does not seem right, these are all routine tests that should be covered regardless of your trans status. From your description it sounds like it was coded incorrectly?

Also make sure that you are using an approved facility. For me I have a $100 penalty for not using labcorp, but bloodwork is free if I use labcorp.

If it truly is not going to be covered, request that the lab bill you at the agreed upon rates with insurers, which is much lower than what you were probably billed for.

[Coffeedrew]

I did use the correct lab.They hit me at max retail price even though the lab tech said even uninsured is not expected to pay that much. I did call the insurance company and ask them to review it. That was when they told me to call the endcronoloist. I should  say it was the endocrinologist who ordered  the lab work. I don't know if I was supposed to have a primary care doctor do that for me and then get the labs back to the endocrinologist to avoid this whole mess. 

Thanks for your reply I think I'm definitely going to ask the office about it .

[jill610]

Sounds like it was coded incorrectly, call the endo and see what they have to say

[Coffeedrew]

They told me the only way they code it is for hormone replacement therapy.So I guess it's not covered like that coding with my insurance.

[Faith]

My blood work got kicked back for the same thing. My GP did an extra test that fell under auto-gender flag. Labs used the wrong code and they denied the whole thing .. $750+ 

On resubmission, they covered partial ..~30.00  I complained to my GP about the wrong code (nicely) and he checked with the labs they finagled something and my bill got dropped to a patient responsibility of ~$28.00

I was OK with that.

[Coffeedrew]

I got got told is the diagnostic code is for hormone replacement therapy .They do not have codes to send in for Gender Dysphoria.They told me if another doctor can pull a different code for blood work it would work.( I will add I have no idea of how all that stuff works legally, so, I need to just pay the bill.

[ainsley]

I got got told is the diagnostic code is for hormone replacement therapy .They do not have codes to send in for Gender Dysphoria.They told me if another doctor can pull a different code for blood work it would work.( I will add I have no idea of how all that stuff works legally, so, I need to just pay the bill.

F64
https://lgbtrightstoolkit.org/wp-content/uploads/2014/07/InsuranceCoding.pdf

[Coffeedrew]

This my sound like a stupid question...

Do I forward that  document to docter's coding/billing guy or the insurance company?

[Coffeedrew]

I got it solved. Thanks. I will post a update if it works.

[Coffeedrew]

I tried that and it was like kicking the hornet's nest.They told me you need to know what your insurance covers because they cannot change the codes after the doctor has said them :/.

[Coffeedrew]

New update! :
My insurance decided to not cover me because of a e66.9 (Obesity, unspecified) The other two codes were z79.890( Hormone replacement therapy) and z79.899(Other long term (current) drug therapy) those were on on the blood work invoice.
I am in the process of doing a external review. I am trying to let them know that I went to the doctor for gender dsyphoria and I was being treated by WPATH standards of care.That says the doctor should:

Responsibilities of Hormone-Prescribing Physicians
In general, clinicians who prescribe hormone therapy should engage in the following tasks:
1. Perform an initial evaluation that includes discussion of a patient's physical transition goals,
health history, physical examination, risk assessment, and relevant laboratory tests.

My insurance says things related to gender reassignment, gender dsyphoria, and gender transition are covered.

I'm not sure why they want to tell me this is not covered. It's pretty lame to tell me I am fat lol.

Sources cited



https://www.icd10data.com/search?s=z79.899
https://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z77-Z99/Z79-/Z79.890
https://www.icd10data.com/search?s=e66.9
https://www.wpath.org/publications/soc