self pay for CTX P1NP

Posted by gently @gently, Sep 20 10:32am

CTX blood test (17406) for $50, and the P1NP blood test (16609) for $80 at Jasonhealth.com.
Quest Diagnostics for the blood draw.

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@06111945cc

Quest charged $217.77 for CTX

Ordered through Jason drawn by Quest-$50

Who gets the $167.77?

cc

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You should not have been charged. Go back through Jason. In their contract Quest is not allowed to bill. I'm certain it is just a billing error. You'd better keep the 167. 77.

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My Endo prescribed CTX and P1NP at my request. (She told me that these two blood markers have not been proven to be indicative of bone loss.) My insurance didn't pay for either and my out-of-pocket cost for both was approx. $220.00. When I asked insurance why the charges, I was told your doctor can resubmit the test w/different codes. I didn't want to do that and paid the test charges.

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@06111945cc

Quest charged $217.77 for CTX

Ordered through Jason drawn by Quest-$50

Who gets the $167.77?

cc

Jump to this post

If your doctor's office fills out the form for medical necessity of the test, your insurance may pay. Otherwise, Quest makes the profit. Some physicians will tell you that the bone markers are not medically necessary.
privatemd is list price$ 177/$ Ulta 119 for CTX.

I mistakenly thought that you'd gone through Jason and Quest accidentally billed you as well.

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Mine cost me nothing for labs and tests. I suggest everyone call their insurance companies BEFORE they get services and find out the guidelines. "Medically necessary" or "medical necessity" are usually the terms needed. Doctors or patients can write the insurance companies for coverage, appeals and reimbursements.

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I understand why the tests are not necessary. There is research that says that they are not conclusive. They have to be done properly and at proper intervals. So, you really DON'T need them! It is a nice luxury to have if you can get it covered because it can support/sustain your enthusiasm along the way.

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@rajmayo22

My Endo prescribed CTX and P1NP at my request. (She told me that these two blood markers have not been proven to be indicative of bone loss.) My insurance didn't pay for either and my out-of-pocket cost for both was approx. $220.00. When I asked insurance why the charges, I was told your doctor can resubmit the test w/different codes. I didn't want to do that and paid the test charges.

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Most of the tests prescribed are not medically necessary, except we don't know until we have them. And we probably don't want our physicians to guess.
One of the endocrinologist I consult with said that he doesn't prescribe without bone markers. He won't risk the moral hazard of prescribing medication to a woman on the verge of fracture without understanding whether the drug is effective.
If your osteoporosis doctor is passive you could be on a useless, expensive, potentially harmful medication for two years between dxas.
Bone markers are never used to diagnose osteoporosis.

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