Is this typical? Blood work and insurance questions.

[Bahzi]

So, I'm going the informed consent route and will be (Humana willing) starting on T next month.  I had my preliminary blood work done, and the claim for such is 'in review' as I've just viewed on Humana's site.   The charges for 7 tests?  $903!  So far Humana is stating that the plan will pay about $350 of it, but it just posted and that number often jumps higher by the time a claim is fully processed, in my experiences with other claims anyways.

But what if it doesn't?  The billing code I'm seeing online isn't the transexual-specific one I saw on the lab paper work I handed the tech from my doc, but surely that info would be available to them if they inquired, right?  My doctor wants to run levels after the first month and then every 3 months for the first year I'm on T...if insurance doesn't cover most of it, there's no way I can possibly afford that.  My detailed plan benefits would state any exclusions like GID, but I never was given a copy of such a thing, they're not available online, and my company is between HR people to inquire about it with.   

So my questions are:

1.)  Does anyone else have Humana PPO and have they denied or approved claims for HRT labs?  I know the plans are different based on the one your employer/you pick, but I can't find anything regarding Humana and GID exclusions at all.  They seem scummy enough to have that stipulation though, frankly.

2.) Is $903 really standard for pre-HRT transexual blood panels, or is it likely that my doctor was requesting special tests run?  I know blood work can be expensive, but I've mostly seen people here mention numbers around $200-300, nearly 1k just for one run seems ridiculous.

[M.Grimm]

Good grief, that sounds really high. I think my set of labwork specifically for HRT was $175, and more recently I paid out of pocket for blood work not related to HRT (it was for surgery) and that was just under $300 for 6 tests. $903 just sounds insanely over-inflated.

[Arch]

I don't have Humana, but I wanted to offer some support, especially since I think I effed up myself with my own insurance. I'm listed as female with them, I still have a claim pending from my last blood work about nine months ago (they don't cover trans stuff), and I just returned a call from my clinic's claims people--I stupidly called them back and used my full male voice, and I allowed the woman to call me "sir" like it was the most natural thing in the world. I hope that doesn't mess me up. I have no idea how these things work.

All the same, nine hundred bucks sounds absurdly high. Did your doctor order a chromosome test, or something?

[Arch]

BTW, I remember some threads that mentioned people's expenses...you might hunt around for those. Seems to me that Grimm's blood work is fairly typical, maybe up to around $400.

[Cindy]

Sorry for posting on boy stuff.

I'm not in the USA, but I do work in the medical field in Australia. There are MANY errors in billing, I would query them and get an itemised account. It is sadly quite common for private and public pathology servers to bill two or three times for the same test. You then get automated messages saying you will be sued etc. Go into an office if you can, and view what you are being billed for. If you see duplicates in code numbers, that will be the cause, it is a common error. You should be able, depending upon local laws, to get a copy of the  pathology request form and have it estimated.  That can be quite revealing.

Good Luck
BTW You look really good Jake   
Cindy

[Linus]

I think this might be one of those "it depends on the area". When I was in NYC, lab work was maybe $300 (I maybe paid $50 at most). Now that I'm in CA it's about $600 and I have to pay about $100-200 of that. I was kinda of shocked.

So a call to the lab and ask them why it was so expensive might be worthwhile. And you may want to check with your doc to ensure that they, the lab did the right tests, and that he/she got the results for all those tests.

[blackMamba]

This does seem high, but nowadays I can believe just about anything in regards to medical bills.  They will rape and pillage until everyone is completely broke.

Is this the negotiated amount for the insurance company?  Sometimes, the initial figure is high, but after the PPO factors in their discount, it could be a lot less.  It has always confounded why me hospitals charge the insurance company less than they do a non-insured person.  I usually wait until I get about 3 letters from the insurance company before they settle on a number.  They are intentionally bureaucratic so as to confuse us non-accountants.

Also, maybe the initial testing is more than the regular testing the doc wants to do.  Good luck and welcome to hormoneland!

[Bahzi]

I don't have Humana, but I wanted to offer some support, especially since I think I effed up myself with my own insurance. I'm listed as female with them, I still have a claim pending from my last blood work about nine months ago (they don't cover trans stuff), and I just returned a call from my clinic's claims people--I stupidly called them back and used my full male voice, and I allowed the woman to call me "sir" like it was the most natural thing in the world. I hope that doesn't mess me up. I have no idea how these things work.

All the same, nine hundred bucks sounds absurdly high. Did your doctor order a chromosome test, or something?

Haha, you'd think so for that price, huh?  I didn't study the papers much before giving them to the lab tech, but I'm fairly sure it was just estrogen/testosterone levels, cholesterol, liver function, ect.   They must be having the tests run by someone really over-qualified for that kind of money though.  Well, that or the healthcare industry is just bloated and inefficient, imagine that!

Sorry for posting on boy stuff.

I'm not in the USA, but I do work in the medical field in Australia. There are MANY errors in billing, I would query them and get an itemised account. It is sadly quite common for private and public pathology servers to bill two or three times for the same test. You then get automated messages saying you will be sued etc. Go into an office if you can, and view what you are being billed for. If you see duplicates in code numbers, that will be the cause, it is a common error. You should be able, depending upon local laws, to get a copy of the  pathology request form and have it estimated.  That can be quite revealing.

Good Luck
BTW You look really good Jake   
Cindy

  It's not boy stuff, more like general insurance/health care fail stuff.  I'm new to even having health insurance (just got it last year after going without it for 7 years), so claims and billing is all Greek to me.  So far the online claim is only showing general codes, not specific (i.e. 300/LABORATORY-GENERAL, 301/LABORATORY-CHEMISTRY), no decimals yet.

Thanks for the advice, I do want an itemized report, and I'm going to ask my doctor if it's really necessary to run all those tests again or just the hormone levels.  I don't want to draw notice from my employers, and I don't want to run up more charges than I need, even if I'm not paying for it, it feels greedy.

Aww, and thanks Cindy! I needed that, I've been feeling pretty down on myself lately. 

This does seem high, but nowadays I can believe just about anything in regards to medical bills.  They will rape and pillage until everyone is completely broke.

Is this the negotiated amount for the insurance company?  Sometimes, the initial figure is high, but after the PPO factors in their discount, it could be a lot less.  It has always confounded why me hospitals charge the insurance company less than they do a non-insured person.  I usually wait until I get about 3 letters from the insurance company before they settle on a number.  They are intentionally bureaucratic so as to confuse us non-accountants.

Also, maybe the initial testing is more than the regular testing the doc wants to do.  Good luck and welcome to hormoneland!

Hmm, today it has a 'Humana discount' listed, although it still says 'in review'.  Is that what you mean?  Here's what it says:

        Date of Claim:   03/04/2011   
        Total Charges:    903.00      
   Humana Discount:    521.59      
   Plan Paid:    381.41
   You Pay:    0.00

So I'm guessing this means unless they find out it's for transexual HRT, it'll be fully covered?  Even if I'm not paying for it, I'm still disgusted on principal.  Why on earth should it cost that much?  How long can those tests really take to do, you know?  I'm also wondering if my employer's group plan rate increase because of me if the subsequent panels cost that much.  Man, what if they try to get rid of me for costing them more money?  It'll be obvious to them in a few months what's costing so much....ugh.

Thanks for the well wishes, I'm glad to finally be getting started on hormones, just frustrated with all the details, haha.

[JennX]

Welcome to my world! 

I used to have insurance thru my work, but dropped it since the provider did not cover any of the costs associated with HRT, blood work, or GRS. The costs you mention above seem about right to me. Now I'm a MTF, but my lab work costs are as follows:

1. Estradiol = $200.00
2. Testosterone (Total + Free) = $600.00
3. Potassium = $75.00
4. Liver function = $50.00

As you can see the T test is by far the most expensive. My endo also advises to have these tests run every 3 months for the first year to make sure everything is where it needs to be, and to ensure I'm progressing normally and safely. Yup, this is an expensive process. No two ways about it.

If you or anyone else out there is aware of an insurance provider that covers HRT and/or GRS with a reasonable monthly rate & yearly deductible, please let me know. I'm all ears.

[Arch]

Fortunately, I only got the testosterone test once, before I started HRT. I guess I'm lucky to be an FTM. Anyway, my doctor was able to justify it by saying that low T levels, even in women, can cause fatigue. He asked me if I was tired, and I sure was. I was exhausted from grappling with my demons and my then-partner's issues about transition, and it was winter, my sluggish time. I was tired as hell.

Later, when I was well into HRT, I complained to my GP that my endo hadn't ordered new T tests. My GP said, "How do you feel on your current dosage? If you found out that you had high or low T levels, would you want to change your dosage?" I admitted that I was getting good results and wouldn't want to reduce my dose under any circumstances; I had also experimented with a higher dose, and it didn't do anything for me. So I was happy where I was.

I guess I'm just curious.

[Bahzi]

Welcome to my world! 

I used to have insurance thru my work, but dropped it since the provider did not cover any of the costs associated with HRT, blood work, or GRS. The costs you mention above seem about right to me. Now I'm a MTF, but my lab work costs are as follows:

1. Estradiol = $200.00
2. Testosterone (Total + Free) = $600.00
3. Potassium = $75.00
4. Liver function = $50.00

As you can see the T test is by far the most expensive. My endo also advises to have these tests run every 3 months for the first year to make sure everything is where it needs to be, and to ensure I'm progressing normally and safely. Yup, this is an expensive process. No two ways about it.

If you or anyone else out there is aware of an insurance provider that covers HRT and/or GRS with a reasonable monthly rate & yearly deductible, please let me know. I'm all ears.

Interesting.  Well I know they checked my testosterone levels, but the highest charge I've got is $200, so I guess it varies widely from lab to lab and such.  As for insurance providers that cover HRT and GRS, from what I've heard, it's nearly impossible to get any new private/personal policy to cover such things, at least until they change the 'pre-existing condition' laws/exemptions.  In general though, I've heard that Aetna covers a lot of things with GID, as well as Kaiser, who I've heard tell covers all sorts of SRS.

Fortunately, I only got the testosterone test once, before I started HRT. I guess I'm lucky to be an FTM. Anyway, my doctor was able to justify it by saying that low T levels, even in women, can cause fatigue. He asked me if I was tired, and I sure was. I was exhausted from grappling with my demons and my then-partner's issues about transition, and it was winter, my sluggish time. I was tired as hell.

Later, when I was well into HRT, I complained to my GP that my endo hadn't ordered new T tests. My GP said, "How do you feel on your current dosage? If you found out that you had high or low T levels, would you want to change your dosage?" I admitted that I was getting good results and wouldn't want to reduce my dose under any circumstances; I had also experimented with a higher dose, and it didn't do anything for me. So I was happy where I was.

I guess I'm just curious.

Ha, good way to bill it, that's cool that your doc was willing to help you that way!  Since my lab orders said 'code: transexual' under each test, I'm guessing that's how they billed it, yet the claim has been completed and I don't owe a dime.  I'm shocked, really.  I really do want to track down the detailed description of benefits for my insurance plan now though, this makes me think that maybe Humana doesn't have exclusions for GID.  I'm honestly happy just to have HRT covered, but I'm curious if it covers surgery too, although I highly doubt it.

I am curious about seeing my T levels 1 month on T, at 4 months, ect, but if I'm getting good changes and feel well, I'm not $900 a pop curious, that just seems like a waste of...someone's money. ^^;

[ClaireA]

I think it really does vary WIDELY from lab to lab. One thing that I love about Park Nicollet (where I primary care from) is that their lab sheet had the cost for EVERY TEST AVAILABLE printed right next to the test, and your doctor just checked off which ones he wanted. Their lab tests (from what I can remember) were much cheaper than some of the numbers posted here - there were only like 2 tests in the whole lab that cost more than $100. And, your doctor should be able to write a lab order that can be taken to an outside lab that will in many cases be a lot cheaper.

If money is an issue, let your doctor know and they should try to work with you. While I don't know anything about FtM HRT, the experience for me is that there are the tests that might be helpful to run, and then there is the much shorter list of tests that need to be run. Big difference.

[jessica45qt]

Ok what i have read thru alot of you that some of your test are really high and a good way to avoid this is to get them thru a online company like this one here >>

http://www.privatemdlabs.com/lp/female_specific_testing.php

http://www.privatemdlabs.com/lp/hormone_blood_tests.php

i use this company most of the time and use labcorps as my lab i deal with ounce you pay this company they setup everything for you.

http://www.privatemdlabs.com/lab_process.php

Above explain how the company works and procedure to get testing done.