FOLX Lab Fee Exceptions in New York, New Jersey, and Rhode Island

Some states require different payment methods for labs than others. It’s different for NY, NJ, and RI—but don’t worry, it’s pretty simple!

May 4, 2022
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This article was reviewed by Michelle Forcier, MD (she/they). Images are illustrated by Leo Mateus.

If you're new to FOLX and need more information about how to get your labs done, read our article on How to Get Your Labs Done At Quest.

If you've made it to this article, chances are you have have received some orders for blood work laboratory tests ("labs") from your FOLX provider. In most states, FOLX bills you for the labs and then pays the labs on your behalf. However, in New York, New Jersey, and Rhode Island, FOLX is not legally allowed to pay for the labs. This means that you (and/or your insurance, if you have a health insurance plan) are responsible for paying.

Quest Diagnostics labs located in New York, New Jersey and Rhode Island are required to charge the person having their labs done, including FOLX members. However, we have a way to accommodate FOLX members located in these three states in the Northeast.

For members located in North Dakota or South Dakota there aren't any Quest Diagnostics locations in your states, so you'll need to find a lab location that is within your price range and that you can travel to.

If you need help finding a lab, submit a support ticket and one of our Member Navigators will be happy to work with you to find the right location.

If you already have a preferred non-Quest lab in mind, please reach out to your clinical team via the patient portal in Athena to let them know!


How FOLX accommodates those who live in NY, NJ, and RI

FOLX members in NY, NJ, and RI pay their lab fees directly with Quest, but we have negotiated with our lab partners to ensure members are paying the exact same reduced lab costs that we FOLX gets charged for other members!

“What if I can’t go to Quest for my labs?”

If you’re not located near a Quest Diagnostics location, or otherwise prefer to conduct your lab work elsewhere, FOLX members can get their labs done from another kind of lab location outside of the Quest network. Our team can send orders to other lab locations as long as the lab is available for us to choose in your Athena Patient Portal. Fortunately, most labs are! However, if Quest isn't an option for you, please discuss this with your clinician directly since not all lab locations test for certain kinds of lab work.

Additionally, lab results may not be automatically integrated and visible in your Athena Patient Portal, so members would have to upload their results as a .pdf file and notify their clinician (in the Athena Patient Portal) letting us know they’ve been uploaded for our review.

Members are still as responsible for non-Quest lab payments directly to the lab as they would be for Quest locations. If you are going to a non-Quest location, the estimated lab fees do not apply to your labs; please contact the lab's billing department for lab fee estimates. If Quest is not an option for your lab work, please contact your clinician to coordinate the alternative lab work route.

A Leo Mateus illustration of science beakers.

Know before you go

Your provider might order blood work/labs to help you meet your goals and to make sure your care is on track. Labs are tools we use to help you make decisions about your health plans. Some people may need labs more regularly than others. Some people may only need labs once a year. It is important to remember that more labs does not mean better care and more labs do not always actually help you and your goals.

If you're on PrEP, whether you’re on hormones or not, you’ll also need your labs done. There isn’t a standard that applies to everyone on PrEP. Those who are just starting PrEP with FOLX need to be tested for HIV and hepatitis B, as well as have their kidney function checked.

For those who are currently on PrEP or have been recently, you’ll need to be tested every three months for HIV. Creatinine will need to be tested for less frequently, such as every six or 12 months, depending on a person's age and kidney function when starting PrEP. Additional tests may be recommended based on your risk factors; your clinician will speak with you if they feel this is medically necessary.

With that said, we know it's important to have an idea about how much lab work will cost, so you’re able to prepare financially and plan ahead. Different labs have different costs. FOLX Health looks for the best labs for your care but with the least cost to you (if you are going to a Quest location). Please note the charts below include estimated fees for Quest labs only. These are subject to change in the future. If you are getting your labs done at a non-Quest location, these rates and lab codes can (and likely will) look totally different; we encourage you to contact your lab's billing department to learn about estimated costs ahead of time. If you have any questions about which labs you need for your prescription, please speak with your FOLX clinician to verify this. 

GAHT labs typically cost between $20 and $50.

Testosterone lab work

Those on testosterone get two main labs drawn. For more information about this, read our article called The Deal with Testosterone Labs.

Estrogen and spironolactone lab work

Those on estrogen get three to four depending on whether they are also taking spironolactone. For more information, read up on an article called The Deal with Estrogen Labs.

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FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!

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