What's the best way to avoid surprise bills for lab tests under Medicare Advantage?

Question

Joseph Meyers · Accepted Answer

When having lab tests done check with your Advantage plan agent or customer service center to ensure you are staying IN NETWORK! Also ask the medical provider ordering the labs if these are standard, common and preventative tests or if they are more rare. The insurance company can also help with pricing if they have all the information.

Answered by Joseph Meyers on April 7, 2025

Broker Licensed in MI & TN

Answered by Joseph Meyers Medicare Insurance Agent

Charise Karjala · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/whats-the-best-way-to-avoid-surprise-bills-for-lab-tests-under-medicare-advantage#charise-karjala

William Lawler · Answer

The best way to avoid surprise bills for lab work is to contact your insurance company`s member services. Make sure the proposed lab tests are covered by your health plan.

Ben Washington · Answer

What's the best way to avoid surprise bills for lab tests under Medicare Advantage? To go in network or go to lab in the office

William Gray · Answer

In your summary of benefits and your annual plan book there will be a list of costs associated with lab tests 

You should not be getting surprised billing you should only have to pay your co pay.

Edward Givens · Answer

I know this stuff can get confusing, but I don’t want you to ever get stuck with one of those surprise bills for lab work. So here’s how we can stay ahead of it, step by step — think of it like a little checklist before getting any lab tests done under your Medicare Advantage plan:

Make sure the lab is “in-network” – This is a big one. Your plan has a list of labs they work with. If your doctor sends you somewhere else, even by accident, you could get a big bill. So always double-check that the lab is covered under your plan before any tests are done.

Ask if the lab test is “covered” or “medically necessary” – Not all tests are automatically approved. Ask the doctor, “Is this covered by my plan?” and “Do you need to get prior authorization for it?” If they say yes, great. If they’re unsure, we can call the plan and ask.

Get everything in writing if you can – If the doctor says it’s covered, ask for something simple in writing or a copy of the order that shows they’re sending it to a network lab.

Check your plan’s Evidence of Coverage (EOC) – I know it’s a thick book, but I can help look it up for you. It will show exactly which lab services are included and what you might owe.

Don’t be afraid to say “wait” – If a lab tech or someone says “we’re not sure if this is covered,” don’t feel pressured. Just say you’d like to check first. It’s always better to take five minutes to call than to deal with a $300 surprise bill later.

And if anything ever seems fishy or confusing, just call me first — or better yet, let’s talk to your plan together. We’re going to keep you protected and make sure every dollar counts.

Sandy Johnson · Answer

The best way to avoid surprise bills for lab work is to contact your insurance company`s member services. Make sure the proposed lab tests are covered by your health plan.

Answered by William Lawler on April 20, 2025

Broker Licensed in MO, FL, IA & 12 other states

Answered by William Lawler Medicare Insurance Agent

Lynn Pepsidero · Answer

It’s important to have a dependable local Independent Advisor you can call or text throughout the year with any questions about your Advantage plan. I explain the plans copays, networks, Out-of costs and I provide all my clients with the Summary of Benefits and the Evidence of Coverage to keep for their records.

Answered by Lynn Pepsidero on April 22, 2025

Broker Licensed in FL, AL, GA & 12 other states

Answered by Lynn Pepsidero Medicare Insurance Agent

Steven Bleicher · Answer

There should be nothing at all that is considered to be a surprise. But I know what you are referring to re. MA plans. It’s just that there are so many things in Part B Medicare that it is impossible to name them all. If you specifically state “lab tests”, then ask your agent or the head of your insurance company’s underwriting department to coach you about what tests are commonplace (in theory, cheaper) & which cost more than normal? One of the tests that I know are expensive are those where the doctor is checking your blood for potassium & calcium levels and also for vitamin D. There likely are others, too. This is not an easy question to answer. I am sorry.

Answered by Steven Bleicher on June 4, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Mal Varlack · Answer

Use in-network labs only. In other words, use your HMO or PPO's contracted labs to get coverage. 
Also, your doctor's office if the labwork is considered in-network with my plan.

Finally, there is with your policy what is called an EOC or Evidence of Coverage. A very lengthy document to go through so its best to call your Medicare Advantage Plan and ask about labwork and what the costs may be for you.

Gary Henderson · Answer

Well you can ask for pre-approval as one method 
So if your doctor orders a test you can either call or have them send it to your insurance company to determine if they're going to pay for it and how much it's going to cost you

Jerry Cohen · Answer

There are at least two things a Medicare Advantage covered person can do to avoid surprise bills for lab tests 1. make certain that thelab in questions is a participant in the network of the plan you are covered by. 2. Consult with the company or the Evidence of Coverage to make certain that the specific test being requested is a covered test under your plan and what the terms of coverage are.

Answered by Jerry Cohen on May 19, 2025

Broker Licensed in NY

Answered by Jerry Cohen Medicare Insurance Agent

William Scott · Answer

The best way to avoid suprise bills for lab tests from your Medicare Advantage plan is:

1. Speak with your Medicare Advaqntage Agent/Broker to get a full understanding of what co-pays you are responsible for prior to having medical procedures. 

2. Get a full understanding from your Primary Care Doctor and/or Specialist what lab procedures are expected in the near future.

3. Contact your Medicare Advantage carrier and confirm the co-pays you are responsible for future procedures explained by your PCP and/or Specialist.

Sonya Chandler · Answer

If you want to save money on lab test under a Medicare Advantage Plan, you need to use a participating lab.

Wild Bill Anderson · Answer

Know your plan and call us with questions. Knowledge is power! This is why we are here for our trusted clients.

Lesley Burns · Answer

The best way to avoid surprise bills for lab tests is to have prior authorization under Medicare Advantage.

Dominic Javier · Answer

Lab tests are usually prescribed by your doctor (in-network) and coverage of tests should be thereby indicated. You can call and ask the laboratory prior to the test so you'll know your benefits and the net cost, out of your pocket.

Answered by Dominic Javier on April 22, 2025

Broker Licensed in TX

Answered by Dominic Javier Medicare Insurance Agent

Britania James · Answer

Ask the billing office at the provider's office if there is an out-of-pocket cost for the lab or test. Most non-routine labs and tests require a prior authorization from the insurance carrier before they are conducted.

Your Medicare agent can also assist with any additional information that is unclear. As a Medicare agent, I am always happy to inquire with insurance carriers regarding coverage based on a client's specific plan and the lab/test in question.

Gus Kinnie · Answer

Most places can run your insurance card to see if the lab test are covered before hand. You can also call your insurance company, and go over your plan with someone who is trained to help like a insurance to see if the lab test is covered.

Answered by Gus Kinnie on April 9, 2025

Agent Licensed in IN, CA, IA & 6 other states

Answered by Gus Kinnie Medicare Insurance Agent

What's the best way to avoid surprise bills for lab tests under Medicare Advantage?

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