It’s hard to believe it has already been a few months since my free preventive exam. Frankly, I wasn’t too impressed with my doctor’s attention to detail during the physical. But ultimately, the main reason I scheduled that exam was to get orders for some screening lab work. These labs included a comprehensive metabolic panel and a free lipid panel.
Let’s start by saying that I am probably approaching the best physical shape of my life. Over the last year, I have been regularly lifting weights and working on cardio. I am even in the midst of a 30-day plank challenge. So when a couple of my lipid panel indicators came in above the “desirable” ranges, Max got a little concerned. How could this be?
Today we are going to take a closer look at these surprise “undesirable” cholesterol results and why they aren’t as bad as I initially thought. We will also dig into the billing and how I made sure I got this preventive test for free.
My Free Lipid Panel
About a week after my free preventive exam, I was finally all ready to get my lab tests. So On November 6th, Max sprung out of bed all set to skip breakfast so I could run down to the hospital laboratory to get my blood drawn. I was asked to “fast” before my lipid panel. The doctor’s office said black coffee and water would be okay, but not to ingest anything else for 12 hours before the test. I opted to go with just water. Knowing that the last time I ate was 8 pm the night before, I could get the lab drawn anytime after 8 am.
It was a busy morning at the office so I didn’t check into the lab until around 12:20 pm. This made my total fast time about 16 hours. Max tends to go above and beyond with these types of things. Within 5 minutes of arriving at the front desk, my vein was punctured, my blood was put into test tubes, a band-aide was applied, and I was on my way. I went right down to the hospital cafeteria after the blood draw to load up on some much-needed chow. I probably had my food in front of me by 12:30 pm.
The Explanation of Benefits
I already discussed how much a lipid panel test might cost here. Since mine was done in a hospital lab, the “retail” price came out to $136.50. It would have been cheaper if I would have had it drawn in a clinic and sent to a reference lab. Although I was quoted $97.79, my EOB shows a final allowable of $102.85 for my lipid panel. As we already know, this test is mandated preventive by the Affordable Care Act when we meet certain criteria. Since I met those criteria, the $102.85 did not hit my deductible and my insurance paid it in full.
You can see I had three lab services done on 11/6/2019. The insurance company conveniently left the service descriptions off from my Explanation of Benefits (EOB) to make things hard to follow. I went ahead and added the description for the lipid panel to make sure we are all on the same page. They didn’t even show the standard code they use to represent this test which is CPT code 80061. The first line is the venipuncture (blood draw) and the second one is the metabolic panel. It makes me wonder if they don’t want consumers knowing how much these services actually cost.
So the retail price was $136.50, but my insurance negotiated the price down to $102.85. Here on the blog, I sometimes refer to the negotiated rate as the TJ Maxx sale price. Just like at TJ Maxx – nobody ever pays retail price for healthcare services.
Free Lipid Panel Billing
One thing I needed to keep in mind was to make sure my provider was billing this service as a
preventative preventive test. To do that, I needed to make sure they used the correct “diagnosis code” on the lab order. The diagnosis code is used to tell the insurance company why a specific service was provided. This coding logic helps my insurance carrier know when they receive the claim that this test is preventive. It prompts them to waive my deductible or other out-of-pocket costs even though I am on a high-deductible plan.
In most cases, the magic code is:
Z00.00 (Encounter for general adult medical examination without abnormal findings)
This code is telling my insurance company that my doctor examined me and didn’t see anything unusual. Since the test is still being ordered, my insurance interprets the Z00.00 code to mean the lab test being ordered is a preventive measure to screen for something. As we can see from the EOB, they paid my provider in full for the test and I was responsible for nothing. Hence, a free lipid panel.
We have to be careful here, though. Sometimes we don’t even see the lab order if it is sent directly to the laboratory “electronically”. So it doesn’t hurt to ask what diagnosis codes are on it to make sure we are on the same page with our provider. If these tests are preventive in nature, we don’t want them accidentally listed as a diagnostic test. Sometimes, they are even accidently grouped with other diagnostic tests
Cholesterol Test Results – What is My Deliverable?
We know how much it costs, but what do we get for this $136.50? A nice easy-to-read summary of my lipid panel results.
My provider uses an electronic medical record (EMR) called EPIC. All results for tests like this one are uploaded into a patient-friendly electronic medical record called MYCHART. I received my lab test results within a day or two of when the labs were drawn and I could review them with the MYCHART application right on my phone. It is a pretty amazing time we live in.
Here is a download of Max’s results from the website view on Google Chrome.
Since there are six components to this test, I must assume each component costs my insurance about $22.60.
My phone will no longer allow me to take a screenshot when I have MYCHART up. Pretty nifty security feature. Since Max is a master hacker I got a photo of it anyway.
The Good and Bad Side of Cholesterol
We are going to focus on only three of my values; Total Cholesterol, HDL Cholesterol, and LDL Cholesterol. We measure cholesterol in “milligrams per deciliter (mg/Dl)”. My triglycerides were within the normal range for a fasting test.
My total cholesterol value came in at 221 mg/dL. This is beyond the standard range listed on the right side of the chart. I have come to learn that the “standard range” is another way of saying “desirable” level.
My HDL cholesterol came in at 73 mg/dL. This is within the normal range. HDL cholesterol is often known as the “good “cholesterol.
Finally, save the bad for last. Bad cholesterol is also known as LDL Cholesterol. My LDL “calculation” came in at 136 mg/dL. The normal range according to my provider’s chart is 0-99 mg/dL. I was wondering how this calculation worked so I googled it.
Total Cholesterol – HDL Cholesterol – (Triglycerides/5) = LDL Cholesterol
I have all of these variables so I can check their math.
221 – 73 – (61/5) = 136 (Max’s LDL Cholesterol)
I do not claim to be an expert in any of these numbers or how the lab comes up with them. Those kinds of things are figured out by people much smarter than me like my medical provider and the lab technician. I just know I am outside of normal ranges.
A Silver Lining?
These charts made me a bit nervous. I really didn’t like the phone version showing me hanging way out in the yellow area. But before converting to an all lettuce diet, I thought I would poke around the internet a bit to see just how far off the mark I was.
Max is quickly learning there is a spectrum to just about everything in this world. Although I was disappointed to see I was not within the “desirable” level on some of these indicators, it isn’t nearly as bad as I initially thought.
Since my provider didn’t bother to call me about these results, a few google searches got me a little more information about acceptable ranges for cholesterol. Web MD suggests borderline high total cholesterol is from 200 and 239 milligrams per deciliter. Since mine came in at 221, I am right smack dab in the middle of borderline high total cholesterol. Healthline corroborated these numbers. It is considered “high” cholesterol when we hit the 240 mg/dL mark.
Similar situation for my “bad” LDL cholesterol. Healthline suggests borderline high is between 130 and 159 mg/dL. Again, since mine came in at 136 I am just above the threshold for borderline high “bad” cholesterol. It technically isn’t considered high LDL cholesterol until it’s above 160 mg/dL. They don’t really explain what it means to be in the 100 – 130 range, though. Max will assume that range is “borderline to the borderline” high? Who knows.
But Max is Healthy, How Can My Numbers be “Undesirable”?
I conveniently let the holidays roll by without addressing these results here on the blog. Perhaps I didn’t want to make any radical changes to my diet before the new year. I also wanted to spend some time making sure I understood the numbers. Now that I understand where I am, I can make some moderate changes instead of declaring an all-out war on my cholesterol. That was my plan when these results first hit my phone.
My understanding is elevated cholesterol can be a combination of genetics and diet. I am generally a pretty healthy person. I tend to think I eat healthy, but there is always room for improvement. People who know me would be surprised to know I got hit with an elevated cholesterol reading. Could it be an incorrect test? Absolutely. But I have already validated these results elsewhere. We can touch on how I went about that later.
Free Lipid Panel: Final Thoughts
I am happy my $20,000 insurance plan is able to offer me a free lipid panel test. It seems like a pretty fair trade.
Max found out he has some work to do here, but don’t worry, I am not going vegan. Although my primary care provider didn’t bother to call and discuss these results with me, that doesn’t mean I will pretend I didn’t see them. I will plan on tackling this problem on my own. Since I would prefer not to get to the point where I need medication to manage my elevated cholesterol, so I will put some minor processes in place to start working on this number. I am still researching my options but I know more oatmeal is in my future. Hopefully, when I get this tested again in several months we can show some improvement.
This is not a recommendation of any kind. Ordering a medical test is between you and your provider. I am not a clinician and have no formal training in this stuff. The content of this article is my own opinion and meant to entertain and inform on my own experiences. If you have other questions see my disclaimer page.