Routine Blood Work and Your Health Insurance Deductible: What You Need to Know

Have you ever received a medical bill for routine blood work, only to discover that it’s not covered by your health insurance? This can be a frustrating surprise, especially if you’re used to having your lab tests covered in full.

As the post above highlights, it’s important to understand how your health insurance policy works, including what types of services are covered and how your deductible applies.

Deductible vs. Copayment vs. Coinsurance

Deductible: A deductible is a set amount of money that you must pay out of pocket before your insurance starts to cover the costs of your medical care. Once you meet your deductible, your insurance will typically cover a percentage of the remaining costs, known as coinsurance.

Copayment: A copayment, on the other hand, is a fixed amount that you pay for specific medical services, such as doctor’s office visits or prescription drugs. Copayments are usually less than the full cost of the service and do not count towards your deductible.

Blood Work and the Deductible

According to the post, the individual was surprised to learn that their routine blood work was subject to their deductible. This is because most health plans do not consider routine blood work to be a preventive service.

Preventive services are those that are recommended by medical experts to help prevent or detect diseases early, such as mammograms, colonoscopies, and certain vaccinations. These services are typically covered in full by health insurance, even before you meet your deductible.

However, if your blood work is ordered to diagnose or treat an existing condition, it may not be considered a preventive service and could therefore be subject to your deductible.

What to Do If Your Blood Work Is Not Covered

If you receive a bill for blood work that is not covered by your insurance, here are a few steps you can take:

Review your policy: Carefully examine your health insurance plan’s Summary of Benefits and Coverage (SBC) to determine if routine blood work is covered and under what circumstances.
Contact your insurance company: Call your insurance provider to inquire why the blood work was not covered. They may be able to explain the reason or help you file an appeal.
Seek assistance from a licensed insurance agent: An experienced insurance agent can provide guidance and help you understand your coverage options.
Consider paying out of pocket: If your insurance does not cover the blood work, you can choose to pay for it yourself.