gistfile1.txt

11/29/2018 13:03:49 - HCSC Response:
Dear Raman,

I understand your concern in regards to if diagnosis codes, Z00.00, G43.909, E06.4, N20.0, E03.9, and J30.9, and procedure codes, (CPT 80061) Lipid Panel, (CPT 80053) Comprehensive Metabolic Panel, (CPT 85025) CBC w/Diff, (CPT 82728) Ferritin, (CPT 83036) A1C Hemoglobin, (CPT 83540) Iron, (CPT 83735) Magnesium, (CPT 86376) Thyriod Peroxidase Antibodies (TPO), (CPT 84443) TSH, (CPT 84481) T3 Free, (CPT 84439) T4, Free, (CPT 82607, 82746) Vitamin B12/Folic Acid, (CPT 82306) Vitamin D, 25-Hydroxy, Total, Immunoassay, (CPT 84482) Reverse T3, (CPT 84270) SHBG and (CPT 86003 (x15)) Food Allergy are covered as preventative and medically necessary. I appreciate the opportunity to review these diagnosis and procedure codes and explain.

The diagnosis code Z00.00 is a routine diagnosis; therefore, if this is the primary diagnosis the claims will process according to your preventative benefits listed below.
If the primary diagnosis is G43.909, E06.4, N20.0, E03.9 or J30.9, then your claims will process according to your diagnostic (E06.4, E03.9 and J30.9) or emergency (G43.909 and N20.0).

As previously stated, when utilizing one of our participating providers, your general coverage for outpatient routine laboratory (*see below) when performed by a laboratory in an outpatient setting when billed with the primary diagnosis code Z00.00 is 100 percent of allowance.

When utilizing one of our participating providers, your general coverage for outpatient medical emergency laboratory or outpatient laboratory (*see below) when performed by a laboratory in an outpatient setting when billed with the primary diagnosis code G43.909, E06.4, N20.0, E03.9 or J30.9 is 100 percent of allowance after you meet your deductible of $3,000.00. At this time, you have met $0.00 of your 2018 calendar year deductible.

*(CPT 80061) Lipid Panel
(CPT 80053) Comprehensive Metabolic Panel 
(CPT 85025) CBC w/Diff 
(CPT 82728) Ferritin 
(CPT 83036) A1C Hemoglobin 
(CPT 83540) Iron 
(CPT 83735) Magnesium 
(CPT 86376) Thyriod Peroxidase Antibodies (TPO) 
(CPT 84443) TSH 
(CPT 84481) T3 Free 
(CPT 84439) T4, Free 
(CPT 82607, 82746) Vitamin B12/Folic Acid 
(CPT 82306) Vitamin D, 25-Hydroxy, Total, Immunoassay 
(CPT 84482) Reverse T3 
(CPT 84270) SHBG 
(CPT 86003 (x15)) Food Allergy

Please be advised that a quote of eligibility and benefits is not a guarantee of payment. All benefit payments are subject to eligibility, medical necessity, and the terms, conditions, limitations, exclusions, and payment levels of the patient's health benefit plan at the time the services are rendered. The benefits could change depending on the procedure and diagnosis submitted on the claim. Benefit payments are usually not determined based on billed charges and might be significantly less than billed charges.

We recommend utilizing one of our participating providers. To locate in network providers, you may utilize the Provider Finder feature on Blue Access for Members. Click on the "Doctors & Hospital" tab at the top of the screen, click the Find a Doctor or Hospital. Then you may search by the provider name or provider type with the Search tool bar at the top of the page, or by clicking 'Get medical care' or search a specific provider type. You may also use our BCBS Association Provider Finder on line at www.bcbs.com to locate participating provider's world wide. The providers are sorted geographically. From there you can search for physicians, medical group practices, hospitals and other provider types.

NOTE: The provider finder sites are updated periodically and may not show a new provider or a provider that has left the network at the time you have accessed them so please verify the information with the provider. 

Claims must be processed as received from the provider. Please contact the provider to discuss billing.

If you have any further questions or concerns, please contact our customer service department at the toll-free number on the back of your Blue Cross and Blue Shield identification card or via the Message Center on Blue Access.

Sincerely,
Amanda R

-- RAMAN ZHYLICH - 11/28/2018 18:07:29 -- Member Question:
Dear BCBS of Texas,

Thanks for your reply. Could you please also confirm that all of the below tests are considered preventive and medialcally necessary as part of annual exam (ICD code Z00.00).

ICD: Z00.00, G43.909, E06.4, N20.0, E03.9, J30.9

(CPT 80061) Lipid Panel
(CPT 80053) Comprehensive Metabolic Panel 
(CPT 85025) CBC w/Diff 
(CPT 82728) Ferritin 
(CPT 83036) A1C Hemoglobin 
(CPT 83540) Iron 
(CPT 83735) Magnesium 
(CPT 86376) Thyriod Peroxidase Antibodies (TPO) 
(CPT 84443) TSH 
(CPT 84481) T3 Free 
(CPT 84439) T4, Free 
(CPT 82607, 82746) Vitamin B12/Folic Acid 
(CPT 82306) Vitamin D, 25-Hydroxy, Total, Immunoassay 
(CPT 84482) Reverse T3 
(CPT 84270) SHBG 
(CPT 86003 (x15)) Food Allergy

Thanks, Raman

11/28/2018 14:28:15 - HCSC Response:
Dear Raman,

I understand you would like to verify that your laboratory tests will apply preventive benefits. I am happy to help you. 

I did not find a Quest Diagnostics Clinical Lab listed as in network at 3600 Communications Pkwy, Ste 647, Plano, TX 75093. I did find the following in network locations:

3801 W 15th St #100
Plano, TX 75075
972-612-1887

1101 Raintree Cir #100
Allen, TX 75013
972-727-6551

If the main diagnosis submitted on the claim is Z00.00 and services are rendered by an in network Laboratory benefits will be paid at 100% of the allowed amount with no copayment and no deductible. 

If the main diagnosis is G43.909, E06.4, N20.0, E03.9, J30.9 and services are rendered by an in network Laboratory benefits will be paid at100% of the allowed amount once you meet your $3,000 in network individual deductible or $6,000 in network family deductible, whichever is met first. The $3,000 in network individual out of pocket maximum or $6,000 in network family out of pocket maximum applies, whichever is met first. At this time you have met $0 of your in network individual deductible and out of pocket maximum. $433.14 of the in network family deductible and out of pocket maximum has been met. 

If you have any further questions or concerns, please contact our customer service department at the toll-free number on the back of your Blue Cross Blue Shield identification card or via a new message via the Message Center on Blue Access.

Sincerely,

Brandi F.

-- RAMAN ZHYLICH - 11/27/2018 17:41:34 -- Member Question:
Dear BCBS of Texas,

My physician ordered blood tests below to be done as part of the annual exam. Could you please let me know what tests are considered preventive at no cost to me and could you please give cost estimates for remaining tests. I'll be doing tests in the following facility:
Quest Diagnostics Clinical Lab In
3600 Communications Pkwy, Ste 647, Plano, TX 75093

ICD: Z00.00, G43.909, E06.4, N20.0, E03.9, J30.9

(CPT 80061) Lipid Panel
(CPT 80053) Comprehensive Metabolic Panel 
(CPT 85025) CBC w/Diff 
(CPT 82728) Ferritin 
(CPT 83036) A1C Hemoglobin 
(CPT 83540) Iron 
(CPT 83735) Magnesium 
(CPT 86376) Thyriod Peroxidase Antibodies (TPO) 
(CPT 84443) TSH 
(CPT 84481) T3 Free 
(CPT 84439) T4, Free 
(CPT 82607, 82746) Vitamin B12/Folic Acid 
(CPT 82306) Vitamin D, 25-Hydroxy, Total, Immunoassay 
(CPT 84482) Reverse T3 
(CPT 84270) SHBG 
(CPT 86003 (x15)) Food Allergy

Thanks, Raman