Hidden Costs of Out-of-Network Labs & Tests: What Patients Need to Know

When managing kidney health, many patients make sure their nephrologist is in-network but forget to check whether their lab tests, imaging scans, and specialty diagnostics are covered. These services are often billed separately, meaning that even if your doctor is in-network, you could still receive an unexpected bill for an out-of-network test.

At Midwest Nephrology Associates, we want to help patients avoid these hidden costs by understanding what they are financially responsible for and how to verify insurance coverage before scheduling any tests.

What Patients Are Financially Responsible For

Patients are responsible for confirming all aspects of their kidney care are covered, including lab work, imaging, and specialized tests. While your nephrologist can order necessary tests, it is your responsibility to ensure the facility performing or processing the test is in-network.
Before undergoing any tests, you are responsible for:

Checking if the lab or imaging center is in-network – The test facility must be in-network for your insurance to cover it.
Confirming pre-authorization requirements – Some kidney tests (such as genetic screenings or MRIs) require prior approval. If you don’t get pre-authorization, you could be billed for the full cost.
Understanding out-of-pocket costs – Even if a test is covered, you may still owe copays, deductibles, or co-insurance.
Getting a referral if required – Some insurance plans require a referral for kidney-related diagnostic tests.
Confirming where your sample will be processed – Even if a blood draw or imaging test is done at an in-network facility, your sample could be sent to an out-of-network lab for analysis.

For a complete guide on verifying nephrology insurance coverage, take a look at our nephrology insurance guide.

Kidney Tests That May Not Be Fully Covered

Some kidney tests require extra verification before they are covered. These include:

Genetic Testing for Kidney Disease – This test helps detect inherited kidney conditions but may require prior approval.
Advanced Imaging (CT Scans, MRIs, and Nuclear Medicine Scans) – Some advanced imaging may not be fully covered unless deemed medically necessary.
Kidney Biopsies and Specialized Tissue Analysis – The biopsy itself may be covered, but the lab processing the tissue could be out-of-network.

If your nephrologist orders any of these tests, you must verify coverage before proceeding to avoid unnecessary medical bills.

How to Verify Insurance Coverage Before a Test

To prevent surprise costs, follow these steps before scheduling lab work or imaging:

1. Call Your Insurance Provider

Ask if the test is covered and whether pre-authorization is required.
Confirm which labs and imaging centers are in-network.
Ask about any copays, deductibles, or co-insurance you may be responsible for.

2. Contact the Lab or Imaging Center

Confirm that both the facility performing the test and the lab processing the results are in-network.
Request a cost estimate before scheduling.

3. Obtain Pre-Authorization if Required

Confirm that both the facility performing the test and the lab processing the results are in-network.
Request a cost estimate before scheduling.

4. Keep Written Confirmation of Coverage

If your insurance provider approves a test, ask for documentation in case billing issues arise later.

What to Do If You Receive an Unexpected Bill

If you receive an unexpected medical bill, take the following steps:

Call Your Insurance Provider – Verify whether the claim was processed correctly. If an error was made, they may adjust the charge.
Contact the Lab or Imaging Center – Some facilities offer payment plans or discounts for out-of-network services.
Request a Billing Review – Mistakes happen. Ask for an itemized bill and dispute any incorrect charges.
File an Appeal – If you were not properly informed about network status, you may be able to appeal the charge with your insurer.

Take Charge of Your Kidney Health

Verifying insurance coverage for kidney tests is the patient’s responsibility. Checking network status, confirming pre-authorization, and understanding out-of-pocket costs before testing can help prevent financial surprises.

At Midwest Nephrology Associates, we are committed to helping patients access high-quality kidney care while avoiding unnecessary medical expenses. Take a look at our physicians to find a specialist by visiting our physician directory, or explore our locations in Milwaukee, Waukesha, and Southeast Wisconsin.

If you need expert kidney care and want to avoid unexpected medical bills, schedule a consultation today by contacting us.
Visit Midwest Nephrology Associates in the Milwaukee, Waukesha, and Southeast Wisconsin area.