I&FM providers rely upon specialty labs to determine the course of care with patients. I&FM providers may use specialty labs to check nutritional status, digestive function, allergies, detoxification ability and cardiovascular risk. Specialty labs may require a blood, saliva or stool sample. Some specialty tests can be done at the provider’s office, while others are sent home with the patient to be mailed to the lab after collection.
The specialty labs used by I&FM providers may not be symptom driven or run by traditional labs, so insurance companies often do not cover these labs. I&FM providers may have patients complete an advanced beneficiary notice (“ABN”) or similar form that informs the patient of the test(s) the provider would like to order, the prospect of coverage by any insurance company and the potential cost to the patient. As the cost for specialty lab tests can be several thousand dollars or more, it is always a good idea to address the cost and payment BEFORE the test is ordered.
Insurance companies may try to dissuade members from specialty labs by telling members that specialty labs are inconclusive or unnecessary. Insurance companies may threaten I&FM providers with termination of their provider agreement for ordering specialty labs. Patients should consider the motives of both the provider and their insurance company regarding specialty labs. Insurance companies may have exclusive lab contracts for their members’ lab services and may want to avoid any responsibility they might have to pay for specialty labs.