Laboratory Benefits
If your healthcare provider is in New York State and requires you to use laboratory services for testing, the In-Network Laboratory to use is Quest Diagnostics. If your provider is in New Jersey and requires you to use laboratory services for testing, the In-Network Laboratory to use is Lab Corp of America. Remember – the Laboratory to use is based on where your healthcare provider is located. (When Medicare is primary, you do not need to choose In-Network or Out-of-Network facilities. Always be sure the facility is a Medicare provider.)
To search for an in-network laboratory in your area, go to www.anthem.com.
Examples below. For additional information, see the Plan Document.
| In-Network Provider | Out-of-Network Provider | |
|---|---|---|
| Diagnostic Testing(out-patient hospital) | $35 co-pay per day | $70 co-pay per day, and 25% co-insurance |
| Imaging (CT/PET scans, MRIs)(out-patient hospital) | $50 co-pay per day | $85 co-pay per day, and 25% co-insurance |
| Chemotherapy(physician’s office) | $25 co-pay per visit | $25 co-pay per visit, plus deductible and 25% & co-insurance |
| Hemodialysis(out-patient hospital) | No co-pay | $0 co-pay per day, and no co-insurance |
| Hemodialysis(physician’s office) | $25 co-pay per visit | $25 co-pay per visit, plus deductible and 25% co-insurance |
| Radiation Therapy(out-patient hospital) | $0 co-pay per day | 100% of u&c (no co-pay) |
| Radiation Therapy(physician’s office) | $25 co-pay per day | $25 co-pay per visit, plus deductible and 25% co-insurance |
| Mammography(out-patient hospital or physician’s office) | Paid in full. One baseline – women age 35- 39. Annual – Women age 40 and over. High risk, any age. | 100% of U&COne baseline – women age 35- 39. Annual – Women age 40 and over. High risk, any age. |
| Lab & X-rays (out-patient facility) | $50 co-pay per visit | $85 co-pay per visit, plus deductible and 25% co-insurance |
| Lab & X-rays (physician’s office) | $25 co-pay per visit | $25 co-pay per visit, plus deductible and 25% co-insurance |
| Lab-Quest Labs | $5 co-pay per visit | N/A |