How Insurance and Billing Codes Decide Which Labs You Get

Colin Renaud says the decision often is not the provider's to make. Insurance dictates what providers and health systems get reimbursed for, so a test outside the standard annual physical, hormones or vitamin levels for example, may not get paid for. A provider might feel the test is important but have no choice, because it is not part of the algorithm they are expected to practice within. Ordering it anyway can mean a denial, or a slap on the wrist.

Colin opens with a patient he saw the day before, after an uncomfortable visit with his primary care provider. The patient was doing well and felt his doctor could not have cared less, and he left turned off. Colin says the response should have been curiosity: what did you do, and how can I support you? He adds that he knows amazing primary care providers, internists and family doctors, and that the problem he is describing is systemic.

Colin says health care plays a really strong role in emergency medicine and trauma. If you are bleeding out on the side of the road, need surgery, have an infection, or hit something really severe, insurance is not what anyone is worried about in that moment. Chronic care is different. Dr. Rose sets acute, urgent and emergent medicine against chronic disease, which consumes the bulk of health care and health care costs while prevention sits outside the model.

Dr. Rose says patients often arrive worried about something they saw online instead of something in their own history or lab work, and that nuanced topics get simplified into one message. Colin says much of what people follow is there to sell them something, and that fear drives reactive decisions. They put their own role in the middle, between a conventional system with real limits and an influencer feed that, as Dr. Rose puts it, has a lot of conviction but no training as far as she knows.

No. A viewer wrote in to say doctors often push statins without recommending diet changes, and that they want alternatives. Colin answers that he and the providers at Med Matrix are not anti-medicine and not there to bash anybody, and that medicine is effective and saves lives. Earlier he says plainly that he and Dr. Rose prescribe medication every day. His point is that health care as a system, for the most part, lacks the preventive measures needed to keep people healthy long term.

Colin puts the money question plainly. If he spent an hour talking about diet inside a big box health system, nobody would make money on it. There is no exchange of goods, and information on its own is not profitable in that model. Dr. Rose describes what the time buys instead: a personalized evaluation, lifestyle medicine, nutrition, and advanced testing. Blood work is read against optimal targets rather than the lab's normal reference range, targets set in the context of that patient.