Know the Code

I had my regular annual physical and anal probing last week but I had to make an earlier visit to the doc’s office that they might let some blood.

Regular readers might be aware that I am pugnaciously parsimonious (Rufus says that is spelled “c-h-e-a-p   b-a-h-s-t-i-d”) so I was curious about how much the tests cost and whether or not my Obamacare Gold policy would cover them.

Drawing Blood for a TestObamacare covers preventive care.

I called my insurer, Blue Cross.

“Blood tests aren’t preventive care, even if they are done as part of a preventive care visit,” the rep said. Unless they are coded as preventive care and they fit the government guidelines. And the test is done on Wednesday after 5 p.m. or any time Saturday morning. With a blue-topped test tube. Not the red one.

That means I could need to make my deductible before they would pay 80% of the cost of the two or three hundred bucks worth of tests. Amount I’ve spent toward my deductible this year: $0.

My Blue Cross rep was very knowledgeable about my concerns. I couldn’t tell him exactly what tests the doctor wanted, so he volunteered to call their office to find out.

The doc’s office has no idea what codes they use; they order the tests from the lab in English. Or Latin. Or maybe Abenaki. They sent the Blue Cross guy to “billing.” Billing has no idea what codes they use; they simply invoice Blue Cross for the needle stick.

Ah hah. The LAB codes the analysis but they won’t know what codes they will use until the doc’s office sends in the request. In some non-accounting language.

The doc’s office did admit that they draw blood for three tests.

Complete Blood Count
▪ White blood cell count.
▪ White blood cell types.
▪ Red blood cell count.
▪ Hematocrit.
▪ Hemoglobin.
▪ Red blood cell indices.
▪ Platelet count.
▪ Mean platelet volume.
Comprehensive Metabolic Panel
▪ Albumin
▪ Alkaline phosphatase
▪ ALT (alanine aminotransferase)
▪ AST (aspartate aminotransferase)
▪ BUN (blood urea nitrogen)
▪ Calcium
▪ Chloride
▪ CO2
▪ Creatinine
▪ Glucose test
▪ Potassium test
▪ Sodium
▪ Total bilirubin
▪ Total protein
Lipids Panel

The Complete Blood Count is diagnostic, not preventive, and not covered under ObamaCare. Ditto the Comprehensive Metabolic Panel, except when it is. Both plus Lipids, a PSA (Prostate-Specific Antigen), and even the Shingles vaccine could be covered if you code them correctly.

The hospital did tell me a not-covered Complete Blood Count costs about $29 and the Comprehensive Metabolic Panel, $35. The Lipid panel is $46. A PSA test costs between $60 and $80. I don’t get one anymore because the doc says my anal probe is always “fine.” And because it is known to be diagnostically flawed. The shingles shot cost between $200 and $250 alone.

There is a catchall code V70.0 that identifies many of the tests as “preventive.” I just had to remind the doc’s office to use it.

But wait. There’s more!

I should not have to manage this.
As she was filling and filling and filling the gallon-sized test tubes with my blood, I told my favorite nurse she should have a price list on the wall.

“The corner gas station does it. The grocery store does it. Restaurants do it. Even Walmart does it,” she agreed.

She doesn’t know how to get the prices, though. They are hidden and scattered and seem to change by the time of day and color of my belt buckle.

The doc also thinks providers should post a chart of charges. He doesn’t know how, though.

Everyone seems to agree. No one seems able or willing to do it.

As anti-regulation as I am, I suspect regulation or law
will be the only way to get ‘er done.

2 thoughts on “Know the Code

  1. “I suspect regulation or law will be the only way to get ‘er done.”

    Yes, we need more Federal laws and regulations. (satire)

    As I posted in a previous e-mail to selected recipients, I am going to see a Viet dentist today. He pulled a tooth for me two years ago, and he was able to tell me the exact cost down to the penny. When I asked him about the cost for this one (if necessary), he said, “samie samie”.

    — George

  2. Just got charged full price for the same preventative Comp Met Panel I’ve been getting for free since the dawn of time. So with Obamacare, preventative is free…but with Obamacare the definition of preventative is now simply “open your mouth and say ahhh” and doesn’t include even the most basic of blood tests. I have some sheep shears if any Obamacare supporters would like to trim some of the wool covering their eyes.

Comments are closed.