Posted in Updates

Aetna Reminder: Investigational / experimental lab tests

There are several lab tests that Aetna does not cover for most of their plans. Patient is responsible for the full amount of those lab tests.

Among the most common of those tests are:

1.  Lyme Disease  (medical policy CPB  #0215)

2. Vitamin D Essay  (medical policy CPB #0945)

3. Lipoprotein cholesterol test  (medical policy CPB #0381)

4. Homocysteine Test (medical policy CPB  #0381)

It is extremely important that you inform your Aetna patients, that these are non-covered services and that the member/patient will be financially responsible for the full amount of that lab test BEFORE ordering the lab tests.

Note: (image is courtesy of clipart-library.com)

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

2 thoughts on “Aetna Reminder: Investigational / experimental lab tests

  1. What recourse do I have if my doctor knew I had Aetna, did not inform me that this Lyme Disease test was experimental and would not be covered by Aetna (or I would have declined it), and that I am now stuck with paying a $481.87 bill? I submitted an appeal to Aetna, who declined it. Small claims court? Who do I sue? My doctor or Aetna or both?

    Thanks and apologies for the rant, but I’m sure you can imagine how frustrating this is.

    1. What type of test did they do? Aetna does have some Lyme disease tests that are covered- to confirm that patient indeed has it. Maybe the lab was out of network with Aetna and you have an out of network “surprise bill”? If you are in NY you can fight it. Also before ordering anything the provider, “physician”, needs to have the correct diagnosis, so maybe your provider didnt put the correct information on the request or the lab messed it up and you get a denied claim with a crazy amount due. No payer has the right to deny an appeal, unless you are no longer with that insurance, otherwise you have appeal rights.

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