This and That and Talk - My Transplant

@caretakermom hello! You will notice that I have moved your post into a discussion in the transplant group that will allow you to better connect with other transplant patients. You can find your post here:
- This and That and Talk - My Transplant: https://connect.mayoclinic.org/discussion/this-and-that-and-talk-my-transpant/

Members like @hello1234 and @rosemarya may have some helpful information they can share. Have you called your insurance company to find out their specific requirements and what will be covered?

I live in Illinois and had my transplant at Mayo in Rochester, MN. I do my lab work in Illinois. I have United Health.

May I ask if United Health is your primary? If it's Medicare then there is no restriction on where you can get blood work done, and there is no cross over billing for blood work!

Yes, I've asked my insurance company and they're looking into this matter. Usually our insurance requires lab work done in same state as ordering physician. But since we use Quest which is nationwide, it depends on which location Quest is billing from, ie. Arizona vs California. If it's California(where I live) Quest is in-network statewide but just not sure if it's also in-network in Az which is something our insurance has to find out. I was just wondering if anyone else here in this forum has run into same issue and if it's standard policy for insurance to require blood draw in same state as ordering provider.

@caretakermom,
I live in Kentucky, and transplanted at Mayo Rochester. I am covered by a Commercial Medicare Advantage plan and I have always requested my PCP to re-write my lab prescriptions to my local hospital lab. Since my routine lab order is updated annually during my annual checkup, I just drop it by his office and he calls me when it is ready for pick-up. It is also good for one year and remains on file at the lab.

Are you having a problem getting your PCP to authorize the lab order?

Oh I'm so sorry. I had thought I started this discussion in the Transplant support group. Thanks for bringing it to my attention !! I've reposted in the appropriate group. Yes I have corresponded with @rosemarya and @hello1234 numerous times!!

No, we've been using the lab orders from the ordering provider which is in Az and we live in Ca. May have to have a local provider(I'm thinking any provider can rewrite the lab as long as they're local, husband sees endocronologist regularly) to rewrite lab if our insurance does not cover the Quest lab work we are doing now. The insurance rep they can also get an exception but she is trying to find out if our plan covers blood work done at Quest in Calif, which is different of the ordering provider at Az. Quest is in-network state wide in Calif under our plan, but our insurance rep is looking into whether it's also in-network in Az, because the claim is probably billing from the Az location where the ordering physician is. Anyways, I'm waiting to hear back from our insurance about this matter and was wondering and anyone else ran into same issue!

Hi @rosemarya 😊
I hope all is well! I have a curiosity question. If your PCP in Kentucky rewrites the lab work order, then the results are sent to your PCP instead of Mayo. Is that right? Does your PCP forward the results each month to Mayo for you or do you fax or portal the results each month to Mayo?

@caretakermom I am not a transplant recipient but I have used Quest for many years. When I moved from California to Oregon almost 4 years ago, they had to do some masterful software working behind the scenes to correlate everything between the two states. In the end, it was not a problem, and my health insurance had no glitches. Hope this helps you in some way, and eases your mind a bit. It's not fun to be left wondering what might happen, and good for you for looking into it, so you don't get a "surprise" billing!
Ginger

United Health is my primary uninsurable. Mayo Drs in MN order for Labcorp in Illinois (or whatever state I need).