Blood Biomarkers not covered by Insurance
Annual Insurance blood tests are missing critical biomarkers
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Today’s post discusses some important blood biomarkers that are typically not covered by standard insurance, at least in the U.S. I have zero affiliation with any blood test company and this is not a sponsored post. I’m writing this because my friends often ask me which additional biomarkers they should test for, outside of the ones insurance covers. So, I thought others will find it useful too!
Two Critical Ways Insurance blood tests are lacking
A few days ago, my friend called me up and told me her blood work indicates she is pre-diabetic and her LDL levels are very high. I asked her if she got her ApoB tested, a more robust measure of cardiovascular health compared to LDL. She said she didn’t know what that was and had used her annual blood test through insurance to get her bloodwork done.
2019 was the last time I used my insurance to get my bloodwork. Unfortunately, standard American insurance blood tests are not comprehensive in measuring all your biomarkers, and they miss some important ones. You could ask your doctor to add on some of the missing biomarkers, but dealing with the American healthcare system can be a nightmare. Take for example, this poor guy who was charged $1,338 by insurance for asking his doctor to add on an ApoB biomarker which normally would cost under $40.
So, for the last 5 years, I’ve been getting my blood tests done with private companies who are a lot more comprehensive.
There are 2 critical ways in which insurance blood tests are lacking:
Important biomarkers are missing from the annual standard blood work covered by insurance
Reference ranges for biomarkers are sub-optimal (to be fair, even private companies may not do a good job at this)
In this post, I touch on both these points below, highlighting some of the important biomarkers to get tested for, and how to think about reference ranges.1 Please note I won’t be going into details explaining each biomarker. The purpose is to list out some of the important missing ones and give a brief description so you can start going into further details.2
Important biomarkers that are missing from standard insurance tests
My list of the missing biomarkers is based on 1) Comparing the biomarkers done by my friend’s insurance plan vs. the private companies I use 2) Researching biomarkers considered important by longevity doctor Peter Attia, a few other scientists, and doctors like Thomas Dayspring.
ApoB: Latest research points to how ApoB is considered the gold standard in measuring cardiovascular risk. This is not to say that HDL and LDL might not be useful, but that ApoB is the most reliable measure we have so far. If your ApoB is high, but your cholesterol is normal, it is not be a good sign. This is why measuring your ApoB is important. (Learn more in my episode with Dr. Ethan Weiss)
ApoE: This is a measure of a genotype that is highly correlated with dementia, Alzheimer's, and cardiovascular risk. For example, people with 2 copies of APOE4 have a 15x higher risk for these diseases, whereas an APOE2 type is protective. Note that this is not a deterministic gene but given how much your specific type could increase risk, it’s better to know in advance since you can start implementing certain lifestyle measures that are protective.
Lp(a): This is typically a one-time test and largely determined by genetics. A high Lp(a) increases your risk of heart attacks and stroke by 2-3x. It’s good to get it tested once to see where you stand.
hsCRP: This is a measure of the inflammation in your body, and a predictor of heart disease.
Homocysteine: An amino acid that is a modifiable independent risk factor for heart disease, stroke and dementia. High levels of homocysteine can in many cases be countered by an intake B vitamins.
Omega-3: A measure of the Omega-3 in your body which is a very important micronutrient that protects your brain and heart health.
Uric Acid: This is a chemical created when our bodies break down purines. High levels of uric acid can lead to gout, kidney stones and other metabolic disease.
Sex Hormones like SHBG, LH, FSH: Hormones that measure testosterone, estrogen, progesterone, help in production of eggs and sperms in the body.
Vitamin D: Many standard insurance blood tests won’t cover Vitamin D either! Vitamin D is not just a vitamin but also a hormone responsible for bone health, muscle function, immune health, mood, and more.
Note: Please don’t treat this as a comprehensive list.
Reference ranges – Normal vs. Optimal
Reference ranges can vary slightly depending on the lab because each lab sets its own reference range. They set the references based on studies conducted on healthy people accounting for factors like age, sex etc. And then the reference range is determined by the central 95% of the values, meaning that the lower and upper limits of the range encompass 95% of the results from the healthy population. All of this means that typically the reference ranges are too broad and what might be “normal” might not be “optimal”. For example, most blood tests will indicate that if your ApoB is below 90-100mg/dL, you’re normal. However, according to Peter Attia, below 65 is what is considered optimal. That’s a huge variance! Of course, this is not the case with every biomarker and in some cases the normal and optimal might overlap. But it’s important to keep this in mind so you can do your own research regarding reference ranges, and try to figure out what the optimal might be.
Why measurement and prevention is important
Since getting her bloodwork done, my friend has started taking exercise and clean food more seriously. If she hadn’t gotten her results done, she would have gone about her life as usual until some diabetic symptoms started catching up to her. But now, she can start nipping at the problem much earlier. Blood tests are a great way to proactively measure your health biomarkers instead of waiting for symptoms of poor health to catch on. Humans have a funny way of taking action when they see results on paper. Otherwise, we just about life blind-sided, having no clue of what’s going on inside your body, till one day we might fall very sick and realize our blood results don’t look so great.
Comprehensive blood work is the best way to check many of your health biomarkers. However, you cannot rely solely on insurance to provide you with this critical information.
Insurance does not care about your preventative health
Insurance is notorious for touting marketing claims on how they care so much about your preventative health. Take for instance this marketing message on United Healthcare’s (UHC) website3:
As we all know, their messaging does not align with their actions. Here is what is not covered in preventative health:
Checking for iron and vitamin D levels are not in the realm of prevention according to UHC! They’re only some of the most important biomarkers that influence your energy, mood, and susceptibility to illness.
One of the reasons U.S. insurance doesn’t care about your health is because it’s an employer sponsored model. In a world where people switch jobs frequently, you might switch to a different insurance plan under your new job, so the payor (insurance or your company) doesn’t want to unnecessarily pay for your expenses that will benefit you in the long-term, but not them. And if insurance companies or self-pay employers can stall long enough to not pay for your preventative care, then you will be the government’s problem.
In U.S. healthcare, all parties involved are engaged in lowering costs in the short-term at the expense of your long-term health. It’s on you to take care of your preventative health. And taking stock of your blood biomarkers is a good place to start.
Please share this post with someone who might find it valuable. You can follow me on X @aasthajs for more on the topic of health and longevity.
You might like my post Bryan Johnson’s Blueprint Simplified, if you haven’t read it yet. Also check out my Live Longer World podcast.
Until next time, stay in good health!
Aastha
Disclaimer: I am not a doctor or medical professional. The above information is based on my research and what I practice. Do not take this as medical advice and there could be errors in my description of why the biomarkers are useful. The information in this article is meant to be a starting point for those unaware of some of the biomarkers I mention. Use this as an initial guide to do your own research, in conjunction with your doctor if needed.
I don’t know much about what’s covered by insurance in other countries outside the U.S. but anecdotally I’ve heard that many of them also don’t cover some of these biomarkers discussed below.
UHC is one the largest private insurance companies in the U.S. (https://www.uhc.com/health-and-wellness/preventive-care)