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Non covered tests: 

Why your insurance company 
does not pay for certain tests
and treatments:

If you have any kind of managed care plan like an HMO or PPO), most likely you are required by them to have all your lab testing done at a laboratory and testing company that has a contract with your plan.

Unfortunately, no laboratory company performs every test.

Also, holistic medicine today uses tests that other doctors (and insurance companies) often do not know about or understand. They use these tests to obtain more or different kinds of information than the conventional tests. One group of such tests is called functional testing, which report on the changes in a body over time, like a movie, instead of just the state at a particular moment (i.e. conventional blood test), which is more like a simple photograph.

For more on this, click on functional medicine testing.

What this means is that there are some tests you will have to pay for out of pocket. This happens regardless of how important you or the doctor think the test is. We have all heard the stories of patients having to legally fight their insurance company to pay for expensive tests that are covered under their policy.

The insurance company will still say that they pay for anything your doctor recommends be done, as long as it's medically necessary. But that's the catch. They get to decide what is medically necessary, not the doctor.

There is an exception:
  • If you have out-of-network benefits, usually you will get  reimbursed, at least partially. 

Never covered by anybody:
  • Insurance will also not reimburse for any non-prescription treatment, including vitamins, minerals, herbs, nutrients, digestive aids, etc., regardless of how helpful they may be. 
  • Lastly, insurance will also not pay for certain types of therapies, even if there is a ton of evidence that they will help your condition. Included in this list is acupuncture, massage, classes on stress management, rolfing, homeopathy. Many more. 
Medicare does not use one particular lab. (There are only a few lab companies.) And they only cover certain tests, even if they are done in the labs they like.

Again, it does not matter what the doctor thinks will be beneficial to you, and it does no good to ask them. This system was designed by the insurance companies themselves. They are simply non-covered services to the insurance company, and the company prospers by finding ways to not pay.