A Basic Explanation
If you go to your doctor because your stomach has been hurting for a while, it’s unlikely he’ll just guess at what’s ailing you. After a physical examination and talking to you, he may decide to run some tests to help find the cause of your pain.
Medical tests–such as a CT scan, MRI, EKG, blood test, or urinalysis—are procedures to help your doctor find, diagnose, and treat, a medical condition.
Expert Advice About Medical Tests
Many tests designed to monitor your health are included as part of your essential health benefits. For instance, mammograms, blood pressure readings, and some blood tests, which help catch health problems early, are usually offered at no cost to you if you bought your health coverage through one of the Affordable Care Act (ACA) marketplaces (on healthcare.gov, your state-based exchange, or through an approved Web broker like this site).
If your doctor thinks there’s a medical issue and a reason to order some additional tests, the costs of those tests will usually be counted toward your annual deductible or will require a copay.
Every plan handles payments for testing a little differently, so check with your insurer.
Depending on your plan, your doctor may need to get preauthorization from your insurance company (confirmation that they’ll cover the cost) before you receive certain medical tests or diagnostic exams. And even if your carrier approves coverage for a test, it may only pay part of the cost. The amount you’ll owe may vary depending on your plan, the doctor’s charges, and where you have the procedure done.
If your plan requires you to meet a deductible and you haven’t already, you might be responsible for the entire cost of a (possibly pricey) test. In a case like this, consider doing some comparison shopping. If, for example, you’ve got a bum knee that needs an MRI, check around with various hospitals and/or diagnostic centers in your area to see what they charge. You may be surprised at how much money a few phone calls could save you, since fees can vary widely depending on the provider, the facility, and the lab that reads the results of a test and prepares a report for your doctor’s review.
What else you need to know
Occasionally, your doctor might recommend a test that isn’t covered by your insurance. (And if you proceed with the test, you may be responsible for the entire cost.) If you get a letter from your carrier saying they won’t authorize a test, you can always appeal the decision and ask for a review of your case. In the meantime, talk with your doctor. Sometimes a less expensive test, or one that your carrier covers, will provide the same information. Or together, you and your doctor may decide to proceed with a treatment and skip the test altogether.
