My husband recently had this test, requested by his PCP among a bunch of others, and this test alone was not covered. Does anyone here have any idea why not? It cost $306 out of pocket.
We haven’t had a chance yet to ask the doctor why she ordered it. Could the doctor be unaware that this test is not covered? I believe her practice has a lot of patients on Medicare.
It’s no longer covered by my non-Medicare insurance, either.
I just had Vitamin D test covered by my BlueCross Medicare Advantage plan a couple weeks ago [my levels were a bit high, and I got advice on dealing with them]. I also had a blood test for lead poisoning [ditto…], which was initially rejected by insurance, until the test lab technicians recommended back to my PCP submitting it under a different ‘code’ which was readily accepted - I got the impression that the doctors know what tests they want, but are rarely involved in the nuances of ‘coding’ for insurance, which are probably opaque to most of us.
The test is likely actually 25 hydroxy vitamin D, not D3.
Screening for vitamin D deficiency as routine preventative care is not currently recommended as best practice by the expert guidelines only testing as medically necessary relevant to specific conditions. (Guidelines instead advise just taking an age appropriate RDA’s worth daily.)
So a test ordered other than paired to an accurate specific medical condition will typically be denied.
At least that is my understanding.
Found this which includes a list of diagnoses that would likely justify the test, assuming the notes appropriately and accurately document the diagnosis.
The Medicare summary specifically said D-3.
I too had a Vitamin D test denied by Medicare about 18 months ago, as well as several others. These include, amazingly to me, PSA tests (at least more than once a year), even though my doctor was mildly concerned that my level was trending up.
I got educated real fast in the first 6 months of being on Medicare, including that “Medicare does not pay for annual physicals”. The DO pay for Annual Wellness Visits, and there is some overlap, but they are not the same thing.
I now have to scrutinize what blood tests my doctor orders to avoid surprise charges from the lab.
The lab we went to had us sign a waiver before blood was drawn that this specific test was probably not covered, and in that event we would pay for it. I assumed this was required, but it may just have been to make sure they got the money. Other labs may have that sort of thing already in their fine print somewhere else.
My primary care doctor ordered a Vitamin D test for me about ten years ago, and found I was deficient. So she put me on a Vitamin D supplement and ordered an annual test every year since then.
And since then every time I get bloodwork they warn me that my insurance may not cover the Viitamin D test, and I could be on the hook for paying for it out-of-pocket.
But apparently because I’ve now been diagnosed with Vitamin D deficiency my insurance always covers it. (I guess I was just lucky they covered it the first time before I was diagnosed as deficient.)
But what I don’t understand is that if the insurance companies don’t cover the test for routine screening, how is anyone supposed to find out they are Vitamin D deficient? Do they want people to wait until osteoporosis manifests itself?
Mine does not, despite wacky fluctuations into the red zone on both sides (deficient/toxic) and an oncologist ordering the test.
It is nevertheless actually measuring 25 OH vitamin D.
In this case they are following the recommendations of a variety of professional groups’ guidelines.
Their logic is that a majority of Americans not taking a vitamin D supplement of RDA amount minimally have vitamin D insufficiency. The risk and cost of a daily vitamin D supplement RDA level is de minimus. The benefit is possible. So don’t bother to test, just take.
Then it seems like the doctor is at fault here, for testing without talking to us about why and what the results mean.
Is it possible the PCP ordered an inappropriate, more expensive vitamin D test, which is why Medicare refused payment (the cost quoted in the OP sounds high for typical 25-OH testing).
It’s possible, I’m not sure how I would know. It’s going to be months before the next visit, and I’m not sure how I could ask about it before then.
Do you have electronic access to your medical records? I just checked mine and confirmed my doctor has been been ordering “Vitamin D, 25-OH, Total”.
Most medical portals also now have a way to contact your doctor. I’ve had good luck with this in the last year or so. Much easier than trying to contact them by phone or waiting for the next visit.
That’s a good idea. There is a portal, and it does allow for messages to the doctor, so I sent one just now. That’s the first time I’ve tried doing that through a portal, so it will be interesting to see if there is any reply.
Good pick up! Unfortunately I would be unsurprised if full retail at a specific lab is priced that high while insurance companies pay a literal order of magnitude less.
Quest labs says $75 + $6 (I presume out of pocket), but I was quoted closer to $200 out of pocket, which I declined to do.
Vitamin D Test
This vitamin D blood test measures the amount of 25-hydroxyvitamin D in your body. Vitamin D is a key nutrient that helps your body absorb calcium and phosphorus – both of which are essential to bone health. Read more
Sample type:
Blood
Preparation:
Fasting (not eating or drinking anything except water) for 8-12 hours is recommended. More details
**Test type:**In Person
$75.00
+ $6.00 Physician Service Fee