It’s time for your annual checkup! As part of your annual preventive care exam, your provider will likely order routine blood work, a fundamental part of preventive care. But did you know some labs ordered by your provider must meet medical necessity criteria in order to be covered by insurance? We’re here to help you prepare for your next checkup, so you don’t end up with a surprise bill. 

In 2022, new coverage determinations were made for Vitamin D testing. It was found that Vitamin D testing is unproven and not medically necessary for routine preventive screening due to insufficient evidence of efficacy. 

Most people gain enough Vitamin D from sun exposure or from fortified foods.1 However, some medical conditions — like Crohn’s and celiac disease — and certain lifestyle factors can contribute to low Vitamin D levels. Speak to your provider about which tests are recommended for you. 

Unless you have a condition or diagnosis associated with Vitamin D deficiency, the test may not qualify for coverage as part of your routine lab work. 

Though network providers have been sent a bulletin regarding this new coverage determination, you should still check to see if it is listed on your order form. While annual routine blood work performed at a preferred network lab is free, you may have to pay out-of-pocket for any tests that are not medically necessary. 

Make sure your routine lab work is covered at 100% by either visiting one of our two preferred network labs: Quest Diagnostics® and LabCorp; or ask your provider to send your labs from their office to one of the two covered labs. Both Quest Diagnostics® and LabCorp have facilities nationwide. Some providers may offer lab services at their office, which require you to pay out of pocket. 

Use this checklist to help you save on preventive care and routine lab work: 

  • Visit an in-network primary care provider  
  • Tell your provider you must get your lab work done through Quest Diagnostics® or LabCorp
  • Ensure you review the labs ordered by your provider and ask any questions you may have  

At the end of the day, an open dialogue with your provider not only keeps your health on the right path but can also help you avoid any unnecessary costs. 

1 National Institute of Health. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/