Differences in both diagnostic care services and reimbursement may vary between private and government insurance. Nonetheless, quality of care should not be compromised in favor of cost reduction. Advocate for patients regarding insurance coverage for diagnostic services by informing the patient and their family or significant others that it may be necessary to check with their insurance company before laboratory and diagnostic testing to make certain that costs are covered. Coordinate with other healthcare team members, such as social workers and facility billing staff, for resources regarding insurance reimbursement.

Many insurance companies employ case managers to monitor costs, diagnostic tests ordered, and other care. As a result, the insurance company or third-party payer may reimburse only for certain tests or procedures or may not cover tests they consider to be not medically necessary. To help facilitate reimbursement for diagnostic services, be sure to include proper documentation (e.g., date of laboratory service and specimen collected) and proper current procedural terminology (CPT) codes. Chart 1.2 lists laboratory tests that are covered by most insurance carriers, both private and government, which should be taken into consideration by the healthcare provider when selecting a diagnostic test.