posted
I did a search on Lymenet to see if this has been covered and can't seem to locate a post. Tell me- what's the deal with IgeneX not accepting insurance?? I just received an initial packet from my LLMD that orders IgeneX Western Blot IgM, IgG, and the Dot Blot Assay ... all will cost me 400$ if I prepay. What's the deal? Michelle
Posts: 64 | From Pittsburgh | Registered: Sep 2005
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posted
My insurance covered it, I had a IgG an IgM western blot. My primary insurance paid all but 13 dollars. Medicare my secondary insurance must have paid the 13 dollars because I never paid anything out of pocket.
Kathy
-------------------- You never know how strong you are until being strong is the only choice you have. Posts: 807 | From South Dakota | Registered: Jul 2005
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posted
Whether it is covered all or in part depends on your insurance. What kind you have.
IGeneX does not want to get involved in the ins billing business. As you know, ins involves a whole lot of paperwork.
So, what you do is pay, get the receipt provided and then submit it to your ins co, following their rules. Helps to know the coverage your co provides, read your contract, especially the part about submitting claims for payment.
Posts: 8430 | From Not available | Registered: Oct 2000
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mbroderick
Frequent Contributor (1K+ posts)
Member # 5220
posted
I think that everyone must prepay. You need to submit the statement to your insurance company that Igenex sends you. We have been reimbursed (through Blue Cross) for 4 tests so far - unfortunately, all positive.
Posts: 2097 | From PA | Registered: Jan 2004
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posted
Talk to your insurance co prior to the draw. If
you are on a PPO, you may qualify for a PPO
waiver.
(some policies will cover a non-participating provider at the in network coverage, if you make previous arrangements since they are a specialty lab)
That means they may pay 100% instead of 80% on
lab work.
Thru our previous BCBS policy. We had PPO waivers
for IGeneX and Dr. J.
Also if you are testing the whole family ask
IGeneX if they will give you a family discount.
If medicare is your primary it is Paid In Full.
Posts: 399 | From Texas | Registered: Apr 2005
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livinlyme
Frequent Contributor (1K+ posts)
Member # 3773
posted
I dont recall if I prepaid or not ..
-------------------- "Hatred paralyzes life; love releases it. Hatred confuses life; love harmonizes it. Hatred darkens life; love illuminates it." Posts: 1389 | From who knows, who cares, but somewhere over the rainbow | Registered: Mar 2003
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livinlyme
Frequent Contributor (1K+ posts)
Member # 3773
posted
Hey Joe, I can appreciate your logic it is refreshing to hear someone ready to blast like I am.. have you looked into the bands that were removed from the original WB test in 1990 due to them being too sensitive and too many people showing positives.. GF the CDC be wrong about that and have to admit the original tests with all the bands was in fact accurate!! and htat many people really did and still do have LD..
GF!!
-------------------- "Hatred paralyzes life; love releases it. Hatred confuses life; love harmonizes it. Hatred darkens life; love illuminates it." Posts: 1389 | From who knows, who cares, but somewhere over the rainbow | Registered: Mar 2003
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Kara Tyson
Frequent Contributor (5K+ posts)
Member # 939
posted
Whether or not your insurance company pays is a seperate issue. Mine always did.
But billing for a patient requires time plus you have to hire personel proficient in coding just to do the paperwork! They could end up spending just as many man hours doing paperwork as testing.
-------------------- Kara Tyson Lyme Disease Support Group Of Alabama--MobileChapter Posts: 6022 | From Mobile, AL | Registered: Apr 2001
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posted
Thank you to all who responded. I was misinformed. I was under the impression that IgeneX only accepted cash or credit and didn't realize I could pay and then submit my receipts to my insurance company. It will indeed be covered 100% once submitted. Thanks again. Michelle
Posts: 64 | From Pittsburgh | Registered: Sep 2005
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-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
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SForsgren
Frequent Contributor (1K+ posts)
Member # 7686
posted
My insurance did pay for Igenex testing, but my experience has been that most good doctors and labs don't take insurance and require that you file on your own.
-------------------- Be well, Scott Posts: 4617 | From San Jose, CA | Registered: Jul 2005
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Monica
Frequent Contributor (1K+ posts)
Member # 224
posted
Also don't forget that insurance companies have "deals" with doctors, labs, etc. The insurance company actually pays less than the charge billed.
To take insurance (in most cases) a doctor or lab must be willing to take a lesser payment than what they usually charge.
Posts: 1757 | From Somerset County, NJ | Registered: Oct 2000
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I read recently where labs are now giving referral fees to physicians who use the lab. This is happening with both in-network labs and providers and out of network. In the article that I read, many in-network physicians now contact labs and inquire about referral fees.
This might mean that if a standard lab offers a lyme test, a physician might prefer to prescribe the standard lab test because they make money on it, and that a high quality-specialized testing would get overlooked. Now that this has been exposed, I am sure that someone is looking into it but it might take awhile before this becomes unnacceptable behavior.
In network is not as much as an immediate issue, but if your health insurance will only pay a set amount per code for lab testing, it could cost a lot more to use out of network labs if the lab is giving a referral fee to the provider.I Of course in the long run, these referral fees cause increases in health insurance premiums.
I wonder if there is an easy way to find out if a laboratory gives referral fees to physicians, and whether or not they give the fee to every physician. This way, you could save money by having the provider who does not get a referral fee oversee and prescribe the testing,a nd you might have a broader choice of labs to get testing from.
It would be interesting to look into that infamous Boston duck's integrated medical practice and laboratory. The infamous duck probably participates with insurance and federal insurance programs.
I wonder if the duck self-refers patients to his own lab, and whether or not the duck receives a referral fee from his self-referral to his lab. Also wonder if the duck has a patent or two on the testing process, and whether or not the duck collects a royalty fee on his duck testing. Talk about vertical integration!
Of course the duck could run into a problem, especially if the duck participates in federal insurance programs. I am not sure if self-referral plus referral fees are completely legal.
Here is a thought: Someone might want to check this and/or ask a gee whiz I was wondering if question or two this about this particular duck at the upcoming hearing.
Posts: 183 | From US | Registered: Feb 2004
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
IgeneX billed medicare for me in October of 2003. If you state that you have medicare, they are legally obligated to bill medicare as are all labs and providers who accept medicare. Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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