Crazy bill for a blood test. What can I do????

Question

Went to a doctor the other day because I've been having chest pains and was worried it was my heart. Got an insurance so I thought I got nothing to worry about. I had an echo-cardiogram and a blood test done. Two weeks later I get a bill from the lab. for 2295 dollars and another one for the cardiogram for 1300 from the place that I went to. Before having these procedures done I asked about how much it's going to cost and they said whatever your insurance covers (my insurance covers 90 percent of the total bill). Turns out they sent the blood to the lab what is not a "participating provider" and the cardiogram is just that much because they said so and because they did not properly bill it the insurance is not covering ****. Called the office and it got me nowhere. Call to the insurance company got me nowhere either. WTF am I supposed to do now? Pay 3500 like nothing? Court? Please tell me what's happening isn't true

Answer 1

The squeaky wheel gets the oil.  Call and complain and tell them you're only going to pay what you would have owed if they sent it to a network lab.  It's not your fault they didn't send it to the right place.  They know what coverage you have and it's their responsibility to get it right.

I complained at the doctor's office and they called the lab.  The lab wrote the whole thing off and I paid nothing.

Also, don't pay any bill until you get the EOB (Explanation Of Benefits) from your insurance company.  When they send you a bill tell them to bill the insurance company first and then bill you.  Good luck.

Jeff

Answer 2

What Sarah314 said, and also a person in the HR department where you work might be able to go to bat for you.  They have direct contacts at the insurance companies, etc.

Answer 3

Unfortunately Diane A is not entirely correct.  It is the patient's responsibility to make sure that a network lab is being utilized, if you're having services done in the doctor's office.

Yes, if you go to a hospital for services, you should be able to presume that the hospital's lab is in-network.  But, you can't make that same assumption with the doctor's office.  You should always be aware of what labs in your city are part of your insurer's network (whether the network hospital labs or independent labs), and you should always be aware of what lab your doctor is sending your information to.

Most doctor's offices have multiple labs that they are willing/able to utilize.  They may have a default lab that they use when the patient doesn't request a specific lab, but that doesn't mean that its the only lab they'll send blood work.

Of course, that's an expensive lesson for you to learn now.  I would recommend that you contact the lab and ask to negotiate the bill.  They may be willing to give you a discount on your balance...after all, getting you to pay a reasonable amount is better than you defaulting on the bill entirely.  (And/or having to spend money sending you to collections.)

That's my recommendation on the lab work - its the best option I can offer you at this point.

As far as the echocardiogram goes...what specifically was the reason for the denial?  When you say "wasn't billed right," does that mean there was a coding error?  (For example, a "screening" or "routine" diagnosis code instead of a diagnosis code that would indicate you were having chest pains?)

Unless you have a really funky benefit plan, it would be reasonable to assume that there would be some coverage for an echocardiogram for chest pain.  Its hard to give specific advice not knowing the exact reason you state it was "billed wrong," but I can offer some general advice...

If it was truly a billing issue (ex - relating to diagnosis code) and the provider is unwilling/unable to correct for some reason, I would recommend that you send a copy of the medical record with your appeal.  (Copy of the doctor's order and/or your office notes for that date, for example.)  In your appeal letter, I would also clearly indicate that you went to the doctor because you were having chest pains.

If the issue was that for some reason the provider billed with a "screening" diagnosis (which is a common situation when it comes to claim denials), then your insurer  may reconsider it as a diagnostic test based on your appeal letter supported by the office notes clearly stating you were having chest pains.

In a nutshell - not much you can do about the lab work, unless the lab company is willing to negotiate a discount with you.  (The standard disclaimer is always that its ultimately the patient's responsibility to be sure a network provider is being used.)  But you may have a decent chance of being able to resolve the echocardiogram issue.

Answer 4

when you get those bills from the insurance company you do not pay the total amount.  Most of those are for information only and you will receive a second bill forthcoming.  Submit it to the insurance company if you do not get a second bill with your 10% copay.

Good luck

Answer 5

You need to speak to the highest supervisor you can get at the insurance company as well as formally contest the ruling in writing (to the insurance company).  Your argument for the lab is that THE hospital/doctor is a preferred in network provider (I hope it is!) and you HAVE ABSOLUTELY NO control over where the hospital (or doctor) sends its blood work.  that is NOT your responsibility.  That is between the hospital/doctor & the insurance co. (Even tho I am in the field, I had a similar situation and it was reversed as the ins co realized that the patient cannot pick hospital subservices; all it says in your insurance contract is to go to the designanted hospital/doctor--a lawyer can also point this out in a nice letter).

Next, ask the hospital/doctor for the MEDI-CAL rate for the blood work if you have to pay cash (or see if your insurance company capitates the maximun allowed--it is NOT $2295.00 I can guarantee.  That is the amount they are billing your insurance co. again, you need to perservere to get the highest level of personnel you can; or send a letter (be concise & clear) to the administrator & the doctor.  Again, a legal letter gets attention.

Finally, you are generally not responsible for amount that was denied because the clinic improperly submitted the claim; and my insurance company has sent a letter to the clinic informing them of the fact--their s***w up--their loss.  See if your insurance company will do so as well. You can also contact the state insurance regulators if your state has one.

You need a plan; and be polite and concise (do not run on or get angry--just shuts down the doors).

Good luck

Answer 6

I agree with sarah314. One other thing you need to find out is if the contracted lab even DOES the test your doctor ordered. It's possible that the doctor's office had to send it to the lab they did-in which case you should be able to get it covered under your in-network benefits. Your doctor's office would be able to determine this and send a letter of documentation to have the test charges reconsidered.