The Integrative Wellness Center and its practitioners are not contracted with any health insurance company.

Since we are not contracted with any health insurance plans, we simply cannot provide an exact answer for your specific plan coverage details. However, we are able to provide some general details regarding insurance billing codes and lab coverage, as well as alternative options for blood work available to you. Please read on below for more information.

As part of our Functional Medicine approach to helping our new and current patients achieve optimal healthy aging, we routinely order very comprehensive blood work. It is important to note that most of the blood work ordered for our patients are not only very extensive, but many of the tests are considered “diagnostic,” not preventive, and could come with out-of-pocket costs. In addition to the sex, adrenal, and thyroid hormones, we also check several vital bio-markers to help identify inflammation, stress imbalance, gut and digestive issues, and cardiovascular disease. This blood work serves as a starting point for new patients, as well as to identify and/or monitor a known condition for our current patients.

Health insurance typically covers blood work, but the extent of the coverage can vary based on the type of test being ordered, the reason for the test, your specific health plan, and whether the lab and ordering physician are in-network or out-of-network.

A Preferred Provider Organization (PPO) plan typically offers some coverage for out-of-network services, including blood work. How much you pay out-of-pocket is determined by your specific plan and whether you have a deductible, copayment, and/or coinsurance amounts for services provided. You may have to pay completely out-of-pocket until your deductible is met before your insurance starts to cover costs. And even after that, you may still have a copayment (fixed amount), or coinsurance (percentage of cost) for each service.

Following your initial consultation, our office staff are happy to provide you with a statement of service form for the consultation visit fee and other medical services provided by our office which you can submit to your PPO plan to request reimbursement. It is crucial to check with your insurance provider for detailed information about your specific plan coverage before deciding what the best option is for having your blood work completed, as well as to get an estimate of what you can expect in coverage and reimbursement for any other services provided through our office. Please refer to our CPT Code in the following FAQ. You can provide these codes to your insurance company when you call to get an estimate of what may be covered, and what your out-of-pocket expenses will be.

Here is a complete list of CPT codes for insurance use that we utilize in our practice: CPT Codes

If you have a Health Maintenance Organization (HMO) plan, out-of-network services are typically NOT covered, except in the case of an emergency. It is not unusual for our patients who have an HMO plan to present the lab slip order from our office to their HMO practitioner and request that he/she order the tests within the HMO network and lab. If the HMO practitioner agrees, you would simply need to forward a copy of the lab results to our office once available. With an HMO plan, you will not be able to submit a reimbursement claim form for any of the services provided by our office.

Please note that you can use HRA, HSA, and FSA to pay for the portion not covered by PPO insurance companies. In addition, the Hormone Pellet Therapy and supplements prescribed based upon the diagnosis may be reimbursable under HRA, HSA, and FSA. We are happy to provide the billing statements for your submission for reimbursement.