Questions to the Community (New)

July 31st, 2015: Annual Physical Examination & Insurance Coverage


We have PPO coverage through Aetna.  

In the past, annual physical examinations usually were covered part of the plan, which also included Vitamin-D analysis. Unlike the previous years, we received a bill from the diagnostic lab earlier this year after more than 7-8 months from the day of the procedure asking us to pay for Vitamin-D test. We were informed that Vitamin-D test was not part of the coverage plan, though it was recommended by our physician part of the Annual physical examination. After verifying with the diagnostic lab, our healthcare provider, and the insurance provider, we paid that amount in full. Now, after 2-3 months since that bill, we have received another bill from the same diagnostic lab asking us to pay for various other tests mentioning again that these tests will not be covered part of the insurance plan (Note: All these tests were part of annual physical examination). By the way, we received this bill after almost a year since we had the procedure. 

For someone with a reasonable healthcare background, this kind of arbitrary billing appears weird, and might call for process mining and improvement at one or several connecting points. Any insight in this regard would be appreciated. I hope our experience with insurance claims will turn for the better post Aetna's merger with Humana, in spite of the fact that the size of the company will double to more than $75B causing further decentralization of organizational resources.