<p>I have having a problem that I am not sure how to solve and would appreciate input. My dc was seen at her college and a very expensive blood test was ordered. Many insurance companies do not cover it and my insurance sent me an explanation of benefits that has a $750 out of pocket expense. The testing company has said they will file an appeal and perhaps will reduce the out of pocket to $250. I find this number to still be outrageous. My child had no idea that there would be this enormous cost and I am certain the ordering physician did know. What are my options? </p>
<p>Things I have considered.</p>
<p>Writing a letter to the medical center where the test was ordered and complain about this test and the unnecessary cost. </p>
<p>Speaking directly with her doctor and telling him she will not be able to receive any treatment until I have a written detailing the out of pocket costs. </p>
<p>Just curious as to why the test was ordered and if the test showed something that was important and treatable. If it was an urgent medical problem and the only way to confirm whether your D had the condition, what other options were available?</p>
<p>I’d have your D talk with the doc’s office who ordered it and let them know about the huge out-of-pocket expense due to the blood test, so they are aware of it for future patients. I’d also ask them about whether future testing can get pre-authorized so you and D won’t be surprised by the bill.</p>
<p>It’s good that the lab will be appealing to try to get insurer to pay a larger portion of the bill.</p>
<p>Depending on what the medical issue(s) are with your D, you may wish to be clearer on when you need to get pre-authorized (by insurer and you) and estimate of your out-of-pocket costs. I’m assuming that if the costs are for urgent medical care, you’d prefer your D to get treatment first and worry about payment later?</p>
<p>We have had some expensive lab testing done on ourselves and our kids. We were fortunate that MOST of the labs were participating and preferred, but some weren’t. The lab at one decided NOT to bill us for the balance, which we were grateful for.</p>
<p>When we have had medical treatment, a few times MOST of the healthcare provider were participating and preferred but sometimes a few were NOT. We had to wrangle with the insurer that we had NO idea that the anesthesiologist was not participating and preferred, as the surgeon and hospital were and as patients and parents of patients were NOT in a position to argue and ask for credentials of everyone who touched our child. We did contest the low coverage by insurer and were successful, but it took a bunch of letters and phone calls on our part and some persistence. We felt it was worth it, as the bill was about $630 or something and insurer was only going to cover about 20%. Ultimately, insurer paid most all of the bill and the non-participating provider reduced its bill.</p>
<p>Is your D 18 or older? If so, and she consented to the test, you are probably out of luck. I had a similar experience with my D from which we learned an expensive lesson. </p>
<p>In my experience, physicians rarely inform patients of the cost of their services, or whether such charges are covered by insurance. I suspect this is because costs to the patient vary so much depending on their particular health coverage. Negotiating with the provider, as you are doing, is probably your best bet. </p>
<p>Perhaps the physician could write a letter of medical necessity to the insurance company. This might help them authorize payment for the test. I do this all the time in my own practice.</p>
<p>Did your insurance company state why this test was not covered?</p>
<p>You may be able to negotiate with the laboratory. Often, providers charge double to triple their contracted prices to get better reimbursement from the insurance companies. But they typically cut 40-60% price cuts for cash pay.</p>
<p>Thanks for all the responses. To be clear, the insurance company has paid and there is a $750 balance. The doctor and staff are very aware of the cost and that this particular lab is often not covered by insurance or inadequately covered. We have had other tests done by this lab in the past and were always informed of the cost. Twice we have opted to go ahead and pay the out of pocket as the test was essential. This particular test is not essential and does not yield information needed to change treatment. We would have opted against the test. The insurance company has already paid 70% of the cost of the test. And HImom. you have hit the nail on the head on the issues going forward. DD still needs care and I do not want to tie their hands however I do want to make it clear that unnecessary uncovered procedures should not be performed. </p>
<p>I will have a careful worded conversation with DD’s doc and with DD. She is very informed on these issues and has her own point of view.</p>
<p>I’d still try to get the price reduced. We were successful at some reduction when we persisted, which reduced our out-of-pocket costs. Insurers and billers assume folks will just fold and pay when they say this is your portion to pay. It’s the squeaky wheel, etc. ;)</p>
<p>Appeal the cost. My over 18 year old was seen in an emergency room at a hospital,that accepted our insurance by a doctor who was not a participating doc. I called them, and said I was not paying the bill. The LAST thing someone in the ER does when the doctor comes in is ask if they participate in their insurance. It’s a no choice situation. The insurance company paid. </p>
<p>I think it helped that my kid was admitted to the hospital 30 hours later and the admitting doc said they NEVER should have let her leave the ER.</p>
<p>ETA…my insurance also tried to weasel out of paying for a life star helicopter ride for DH.,they claimed it was not essential. Ahem…DH was NOT given a choice about this. The ER called Lifestar. I told the insurance company that I was not given the option of driving him myself. They paid.</p>
<p>Good advice. I will wait and see how the appeal goes and then deal with the lab. The knows that their services are often not covered or inadequately covered and they have a procedure in place to appeal. If they did not I am sure they would have almost no business. This was a $2500 test. I got the impression they are very skilled at contesting the denials and underpayments. I will see how it goes.</p>
<p>Yes, I successfully contested the pediatric anesthesiologist that was used for my S. He was in a participating medical center and the surgeon was participating & preferred with BC/BS. It was really not up to me as a parent to question the personnel in the room as to who was and was not participating and preferred. Both the BC/BS and the anesthesiologist clinic worked with us. Bottom line, we paid no more out of pocket than we would have if they had been participating & preferred; between the two of them they worked it out.</p>
<p>Op,
MD here. The physician does NOT know the costs of each lab that is ordered because the lab is a separate company from the physician and the lab contracts with different insurance from the physician. As a pt, before you get your blood drawn you should check out the out of pocket price competing labs. Since it is after the fact, you can try to negotiate a lower price with the lab. All of this applies to radiology studies as well.</p>
<p>As for anesthesiologists being out of network, unfortunately there is nothing that can be done preemptively about it. The anesthesiologists are usually assigned to the cases the day before surgery. They can’t switch with other anesthesiologists strictly due to insurance because it would be too complex to piece this insurance puzzle together (multiple anesthesiologist, hospitals or Surg centers, insurances, pt’s schedules and surgeon’s schedules). The surgeon’s day might be filled with a Medicare, BC, BS, medicaid, HMO pts all in the same day. The Anes can’t be changing out for every case. </p>
<p>The only way that these things would ever be able to be straightened out is if we went to a one payer insurance system, which is unlikely to happen.</p>
<p>btw- a vitamin D level costs almost $250! My insurance covered it but I certainly would not order one for an uninsured patient. I can see how measuring this could be complex but- wow…</p>
<p>Pretend you can’t pay it, like you don’t have the money. If someone has $100 but they have a $1000 charge they probably won’t pay anything. If someone has $100 and a $100 charge, they’ll probably pay it. That’s the mindset they’re running with, they’d rather collect $100 than $0. So pretend you ain’t got much. </p>
<p>Though for a bill this low that might not work. Realistically, if someone shows up and isn’t obviously homeless looking, they’ll probably assume that they can come up with $750 one way or another. But the life hack says to pretend you don’t have any money. </p>
<p>I’m sorry but I think it’s ridiculous to expect that the patient be responsible for checking that every test and every procedure and every specialist involved in a procedure is covered by their insurance. There should be a liaison who clears all of that.</p>
<p>This is one of the dumbest things I have ever heard. Along with the anesthesiologist possibly being out of network. This system could not be any more broken…</p>
<p>The patient has to consent to it. You can argue that it’s unreasonable from a “good service” perspective, but it’s going to be pretty hard to argue that it’s unreasonable from a legal perspective. </p>
<p>The problem is that the patient may have to decide on the procedure with anesthesia before knowing whether the anesthesiologist is in-network for his/her insurance.</p>
<p>It really makes no sense the way the system currently is. I was shocked to have to argue about the anesthesiologist for my S. I was glad that things worked out, but it was not fun having to argue about it and the anesthisiologist practice seemed used to having to fight to get reimbursed. They ended up with a LOT more than they would have if that had been participating & preferred, which was why they decided to stop particpating & being preferred with BCBS, even with the added hassles, for them and everyone else.</p>
<p>I don’t believe it makes sense to put the onus on patients to go around asking about competing prices and which tests and labs are particpating and preferred. Maybe when you’re out of town and need to get some work done and don’t know which places are participating and preferred, but otherwise, I generally have ASSUMED that most of the work I have done at participating and preferred labs are covered as such and generally the doc will warn us when it isn’t. </p>
<p>Recently, as I mentioned, we had blood drawn with the doc treating D. The tests they ran on us were NOT covered well by our insurance, to our surprise, but the doc & lab opted not to bill us for more than whatever they recovered from insurance and Medicare for H. I thought that was very nice of them, as we were prepared to pay, since we hoped it would help with D’s treatment.</p>