5 Confessions Of A Reference Lab Technician

He’s the guy whom pieces of your body get sent off to when you go to the doctor’s office, and he’s got some things he’d like to tell you. Like the secret manual covering which tests Medicare will and won’t cover, your rights under the Health Insurance Portability and Accountability Act, and can you please, please, write legibly and use a standard version of your name when filling out forms…

1) Medicare Sucks

This is pretty widely known, but I do not think many people understand just how little Medicare actually does until they are covered by it. First of all, with only five exceptions (that I know of; more on them later), Medicare will NOT pay for screening tests. Ever. If you are not sick at the time the doctor orders the tests you will have to pay for them some other way, probably out of your own pocket unless you have other insurance.

Even if you are sick there are tests that Medicare refuses to cover. Now, I wish I could tell you what these are, or when Medicare will not pay for the test, but the fact is that I legally cannot. See, we are given this nice booklet that outlines what tests Medicare will not pay for and when it will pay for them. The problem? It is actually against the law for me to show that book to anyone inside the company who does not need to know what is in it or to anyone outside of our company, including doctors.

Now, in the event that you have had a test ordered for you that Medicare will not, or usually does not, pay for you will be asked to sign a paper (called an ABN, or Advanced Beneficiary Notice). If you are shown this ABN do not immediately freak out because it does not mean that Medicare absolutely WILL refuse to cover the cost, and most doctors try to keep tests ordered for patients to the ones they know Medicare will pay for.

The paper is basically a waiver that says you understand that if Medicare does not cover the cost of the tests you could end up paying up to some amount of money. Something you need to know about this: You can refuse to pay for some or even all of the tests and they will not be run. It is not something I suggest, but it is your right to turn down any test (or all of the tests) if you wish. Second, it is your right to receive a copy of this slip of paper and you must be provided with one if you demand it. Finally, if you did not sign an ABN, or if Medicare does not pay for a test and that test is not indicated on the ABN, than it is against the law for any lab to bill you. Period.

As I said previously, Medicare will not pay for tests for the maintenance of your health; they will only pay for tests if you are sick. There is a slight way you can take advantage of this. If a test result comes back with readings that are considered abnormal than that is a test that can be run under Medicare (assuming it is one of the tests Medicare normally covers) without you having to pay (you will still probably be asked to sign an ABN) until the abnormal results go away. Usually doctors do not order unneeded tests, but you might want to ask your doctor the next time he orders a lot of tests if all of them are really necessary, or if it is just a standard procedure to order the whole battery. If it is simply standard procedure ask him to only order the ones he is sure you need.

I previously mentioned that there are five exceptions to the “No Screenings” rule that Medicare has. These are fairly recent because Medicare apparently recently realized that it is less expensive to screen for conditions and treat them early than to try and cure a problem after it is causing obvious illness. Men may have a prostate exam once every year. Women may have a pap smear once every two years. Medicare will also pay for a Lipid Screening or a Thyroid Test once per year. Finally, once every five years Medicare will pay for an Occult Blood (looks for blood in the stool).

2) HIPAA is Not Just Privacy

While a good chunk of HIPAA does pertain to patient privacy, it does have other provisions in there that I do not think are widely known. Most notably, it gives patients access to their own medical records. For example, you can demand a copy of your records and they must be provided to you.

This extends even further, though. If you are having blood drawn for a test, for example, you can ask that a copy of the test results be sent to you. You may even ask that the test be sent to your other physicians if you like. My lab does not charge for this service, but I cannot speak for other labs.

Personally I suggest that patients make it a habit to keep their own medical records on file in a safe place (stressing SAFE, many records have sensitive information). Also make a habit of requesting a copy of any tests run on you. I suggest this mainly because sometimes it can take time for doctors to transfer records to each other, and if you have your own personal copy it can greatly speed up a transition to a new physician so that duplicate tests that are not necessary do not get ordered (also a reason to send test results to different doctors).

3) Phlebotomists Sometimes Mess Up

Phlebotomists are the people who draw blood, but sometimes they make mistakes. While most Phlebotomists are in the business because they care about healthcare, that does not make mistakes any less painful or potentially damaging. Because of this you should be aware of the things you can do to make your visit more pleasant and less likely to have some sort of problem.

First of all, they should ask you to verify your information. Several times. Actually look at it and make sure it is all completely right. Name spelled correctly, address correct, sex, and everything else. When things get busy sometimes the staff does not check the paperwork as closely as they should because they are trying to get everyone through quickly. Sometimes paperwork just gets mixed up as well. If you cannot read the information yourself for some reason than ask to have it read to you.

When they wipe your arm with alcohol ask them to wait for 30 seconds or so before they stick you, since if it is still wet the needle will sting more. You should also probably tell them up front if you want to be warned when the stick is coming. Inform the Phlebotomist if you have taken blood thinkers or aspirin in the past 24 hours if they do not ask you since this will increase your chances of bleeding after blood is drawn or developing a bad bruise.

Sometimes they will ask you to hold the gauze for them after blood has been drawn. It does not take a lot of pressure, just as much as you would use if you were taking your pulse. Do not bend your arm for a couple minutes because that can cause bruising under your skin! You can elevate the arm above your head to help stop the bleeding if you like. Most people stop bleeding in less than 15 seconds. Ask the Phlebotomist to check to make sure you have stopped bleeding if you are old or know you have bleeding issues. Also if you have a purse, do not carry it on the arm that you had blood taken from.

4) What Fasting Is

While we are on the topic of drawing blood I figured that it would be prudent to touch on what “Fasting” means since many people misunderstand. There are a lot of tests that require a patient fast, and if the fasting is done wrong than it will effect the results.

If you are told to fast you may not eat anything. You also may not drink coffee or soda or juice or sports drinks, even if they are “diet” drinks. You may not chew gum even if it is sugar free. You may not smoke. Any of these will throw off the results and make it more likely you will need to have the test retaken. Avoid all of these activities until after the test.

You may, however, drink water. In fact, it is strongly recommended that you be well hydrated when you come in to get blood drawn because it makes it much easier to hit the veins. When you are dehydrated sometimes it can make your veins collapse down so that they are harder to find and hit. If you are dehydrated enough you may be asked to come back another day, although usually you will be provided with several glasses of water to drink before blood is drawn.

Diabetic people who are fasting for a blood test should probably have a snack with them to eat immediately after they leave. It is also prudent to notify the staff that you are diabetic so that they know and can get you through more quickly. It is recommended that diabetic people eat a breakfast as soon as possible after their sample is drawn if they were required to fast.

5) Social Security Number

One thing that I will say is that it is much easier to track patient history and make sure tests are assigned to the correct patient history if we have a SSN to work with. I bring this up because with identity theft on the rise the whole idea of putting your SSN on almost any form is a little risky; however on the other hand the lab is much less likely to have your results sent to the wrong patient if you provide it.

If you are uncomfortable with giving over your SSN that is your right, but there are several things you can do to make it easier for a Reference Laboratory to keep track of who is who. First of all, always fill out your name exactly the same and write as legibly as you can (print, not cursive please). This means you should be consistent about providing your middle initial or not, try not to switch back and forth. If for some reason you feel you have messed up please feel free to ask for another form! We have hundreds of them and would rather throw one into the shredder than have something with corrections all over it.

Have you recently moved? Consider having a copy of your previous address with you with a note to inform the lab techs that you have moved. Address is one way to verify that you are who we think you are, and when it changes that can sometimes cause confusion (standard procedure is to create a completely new patient profile if there is any doubt). Ask your doctor to attach the note with the lab order.

Provide your birth day please. Again, this is not required information but it helps to verify who you are. At my lab we must be able to verify 3 separate types of information in order to say that we have the correct patient (unless the SSN does not match). If we cannot match 3 types of information to your history than we cannot confidently say that the history is yours and will have to create a new patient history.

In essence, provide as much information as you can if you choose to not provide your SSN. Even if you do provide the SSN it will help us if you provide additional information like your birthday and address because company policy usually requires that SSN be the last thing we check in order to help protect the patient.

(Photo: Getty)

Comments

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  1. DrGirlfriend says:

    Re: The Medicare entry, that’s why I shudder when people say they want universal health care to basically be Medicare for all. Medicare doesn’t cover as much as people think it does.

  2. saltmine says:

    @DrGirlfriend: But it covers something. And something is better than nothing. At the very least, we should have access to something.

  3. rbdfoxes says:

    @drgirlfriend: I agree! It’s always funny when “universal healthcare” is anything but “all care for all people…”

    Working at a medical office I hate dealing with this stuff, and the patients who never bother to check their benefits, AND the evil companies who REFUSE to tell you them.

    …and in Massachusetts everyone is now REQUIRED to have “health insurance.” You can just hear the excitement in the voices of the insurance company reps when they call to ask whether or not my office provides health insurance.

  4. Landru says:

    @DrGirlfriend:

    How do you know that universal healthcare would be Medicare for all?

    Since we don’t have it yet, I’m not sure you can say that.

    The concept for universal health care refers to the idea that every American should have access to affordable, high-quality health care.

    It’s definitely possible, and actually necessary, as the health care costs skyrocket and service levels plummet.

  5. JustinAche says:

    I used to sell Medicare GAP insurance. I am still licensed, but the dog-eat-dog day to day battle wasn’t worth my sanity.

    I will say I had a good time some days, and I really did try to help the people I worked with, and I did more informing than selling most days.

    In that vein, I suggest re-reading the medicare guidebook sent annually, or order copies through the phone or internet. You can order up to 5 copies over the phone, so get some for your older family members while you are at it, and go through, and HIGHLIGHT all the parts that may pertain to you. It’s a hefty guide (85 pages in last years edition), but it is larger print and somewhat laid out correctly

  6. Alcadema says:

    I realize that nobody’s really questioning what the lab tech is saying, but just to throw in my $0.02, he’s right on all counts to one degree or another. I spent 13 years in a reference lab, in the department (specimen management) that preps the specimens for lab techs, enters all the clerical info (including ABNs) from test requisitions, and stores the specimens after testing. It’s my experience that the various billing departments handle the Medicare issues most directly, but I can honestly say that HIPAA was drilled into all of us most thoroughly once the Act came into effect. We took (and still take) patient info very seriously and carefully. As far as ABNs go, they’re extra paperwork that nobody really cares for, but they are very important, and labs most definitely record the patient’s ABN signing status. And while the lab I worked in only used SSNs as a backup verifier for patient profiles, we did keep them on file (where they were as secure as all the other HIPAA-protected info).

    There might be minor differences between the companies running the labs (I worked for the largest diagnostic lab company in the US), but everything the tech said is on the money.

  7. mrestko says:

    @Landru: We know because that’s what politicians say it will be.

  8. DrGirlfriend says:

    @Landru: I am referring to those who call for Medicare-for-all as the way to achieve universal healthcare. I worded it the way I did to specifically refer to those who hold that POV.

  9. vongarr says:

    So who really gives a damn about what a lab tech has to say?

    No offense to the lab tech. I just don’t see why this is interesting. Slow news day?

  10. uricmu says:

    @DrGirlfriend: The problem is that we don’t just need universal health care, we need government ran labs.

    The reason that you are charged 100$ for a 5$ thyroid test or 20$ for a 3$ urine analysis comes from the fact that all those labs are for-profit.

    In countries with nationalized health, these routine blood tests are covered automatically no matter what.

  11. ceejeemcbeegee is not here says:

    Is there a way to avoid ever using Medicare? It seems all my parent’s friends had great insurance and then hit 65 and were forced into the Medicare circle of hell.

  12. ceejeemcbeegee is not here says:

    @vongarr: Wheves. I got a diabetic parent on Medicare, and this is info very useful. Thanks Lab Tech.

  13. XianZomby says:

    @vongarr: You should care. This advice he gave might very well prevent some clown from coming on here six months from now and boring us with the tedious details about how some lab screwed up his tests. Nobody will ask him if put his SSN on the form or spelled his name right, but they will find a way to amuse everybody by spinning the name of his particular lab like they do for “Comcrap.”

  14. 1964F100 says:

    Actually, vongarr, the description of a proper fast is great information for needle-phobics. Getting blood drawn generates considerable angst, and anything to prevent a do-over arising from faulty results from improper fasting or from a vein petering out in the middle of a draw can help lessen the anxiety.

  15. savdavid says:

    Universal Health is NOT MEDICARE. The term UNIVERSAL means it covers everyone for everything. It is like using the word “socialized” as though it is bad.

  16. Shadowfire says:

    “It is actually against the law for me to show that book to anyone inside the company who does not need to know what is in it or to anyone outside of our company, including doctors.”

    Why does this bother no one else? Our tax dollars are going to pay for this, but we’re not allowed to know exactly what’s being paid for? Unacceptable, and I’m pretty bothered that no one else here seems to feel any outrage.

  17. gingerCE says:

    Maybe this guy can explain to me why I had blood drawn from my body at my dr’s office–the lab ran the tests twice (by accident it appears although they billed me and my insurance company for both tests) and from the same blood sample, I had two different results. On a scale from 1-100, one test came back 81, the other 72 on the same blood. Huh?

  18. gingerCE says:

    By the way, the difference in my bloodwork put one result in the normal category, and the other in the elevated out of range category.

  19. ginnylavender says:

    @Shadowfire: I’m curious about that also. I assumed when he said “against the law” that it must be a government manual. However, when he said “outside of our company,” it leads me to believe he means “against company policy.” If Lab Tech is still around, I’d like to know the answer.

  20. mattpr says:

    I’m sorry, but if you don’t already know 2, then you’re not a particularly well-informed patient.

  21. Valhawk says:

    @Landru:

    Costs are so high because you are paying for people who use medicare/medicaide (which pays below cost for treatment) and those who don’t (unable or unwilling). If you want lower healthcare prices then raise the medicare/medicaide payout to doctors and have people pay their bills.

  22. Uh oh... Cleveland says:

    @ginnylavender and @Shadowfire: There are several government manuals and manuals written by the various companies that administer the Medicare program (themselves called “contractors”) that are available on the CMS website or the sites of the various companies. But these are sometimes pretty hard to decipher. What the lab tech is probably talking about is some manual written by his lab, or the company that owns the lab, that represents their interpretation of what the government and contractors’ manuals say. And it’s likely, as @ginnylavender put it, “against company policy” to release it because it represents either attorney work product or trade secrets.

  23. alice_bunnie says:

    @Shadowfire:

    No, you’re not the only one. Another thing that bugs me about Medicare is we pay our whole working life into it, and then when it rolls around, we still pay premiums into it like a regular plan (reduced but still) and then we still pay deductibles and copays.

    @gingerCE:

    My husband’s doctor put him on cholesterol medicine for ‘slightly high’ cholesterol. I asked my husband how high, he didn’t have a clue. I told him to ask his doctor what/if there was a margin of error on these tests. I didn’t want him taking a medicine if it’s possible the test could be in the normal range. It’s something they need to tell us. I’m sick of this “you’re borderline”. I’m either there or not there, don’t give me this “borderline” crap.

  24. spazeboy says:

    I worked in a medical records office for three years (recently left for school), and one thing that came up again and again regarding tip #3 is that while patients do in fact have a right to a copy of their medical record, the hospital/office/lab has a right to charge a “reasonable” fee of no more than 65 cents per page (which I have always thought was pretty unreasonable).

    If a patient requested his or her records be sent to another physician directly, we waived the fee. The medical records release clerk has (at least where I worked) a lot of leeway in deciding whether or not the patient gets charged. If paying for a copy of one’s medical records would be a hardship, or if the number of pages is low, we would often waive the charge altogether.

    The hospital/office/lab also has 14 days to provide you with a copy (this may be a state of Connecticut thing, however). If you want a copy on the spot or within a short time-frame, you need to understand that you’re not entitled to getting it that quickly. We deal with tons of requests and are less willing to accommodate someone who comes in and makes demands, so if you need records quickly just ask nicely. If you’ve been nice and your request isn’t unreasonable (more than 50 pages with a 24-hour turnaround is somewhat unreasonable) then ask for the department director if the clerk won’t help.

    Patients also need to know that their requests must be made in writing, on HIPAA-compliant release forms, and that their signature on the forms must be original. If the form is not signed in the presence of a hospital/office/lab employee, it must be notarized. We cannot fax you your medical records (though we can fax directly to another medical facility for continuity of care, meaning that you are physically at that medical facility for treatment and the only thing holding up the doctor is that he doesn’t have your records from our facility). This is for the protection of the patient and for us. If we compromise the security or privacy of any protected health information, we are at a huge legal risk. We are not in the business of trying to match the voice at the end of the phone with the patient on the record, and should not under any circumstances release information without full verification.

    I know it’s a huge pain in the ass, especially for patients who need their records for some unexpected reason, but hopefully knowing a little bit about the process will motivate you to get copies of your records _before_ you know need them.

  25. aka Cat says:

    @gingerCE: I’m not a lab tech, but I work for the IS department of a medical lab. My guess is that they reran your test because they discovered something was wrong with the instrument; most likely the controls that were sent through at the same time came back out of range.

    Have you asked why they double-billed you? The CS rep you speak to about it might have info on why the test was rerun.

  26. @alice_bunnie: I hate it when doctors make you ask them what the results of a test are. You can’t do that and then whine in a medical article about how most patients don’t know what their numbers are for blood pressure, cholesterol, etc.

  27. @Shadowfire: I want to know what law requires us to be ignorant about what Medicare covers. I don’t understand what they think they get out of it: they won’t pay for the lab work whether the patient is aware of it ahead of time or not so why not let them know? Maybe people’d rather skip the test then go into debt.

    Seems like a crappy thing to do with no real reason behind it.

    Why isn’t this information given out in the plan anyway? The next person who wants to say, “Check your plan” in another medical post needs to read this first.

  28. Mollyg says:

    If the manual in question that describes what Medicare pays for and what it does not is a government document, then it can be obtained by filing a Freedom of Information Act (FIOA) request. The federal agency that administers Medicare should have on its website instructions for filing FOIAs.

  29. Snakeophelia says:

    As a former phlebotomist, I’d also like to point out that sometimes the doctor orders the wrong tests, so when a phlebotomist comes back to draw yet another tube of blood from you, don’t assume it was their fault! I always tried to keep the patient informed about what was going on, and I also wasn’t shy about pointing out that the 2nd stick in 10 minutes was because of the doctor’s revised orders.