<p>DH has a chronic condition for which he has been taking pain control medication for years. He saw his doctor recently, and today we received an EOB from the insurance company for over $1300 worth of drug screening tests. Apparently there is now a requirement that patients on certain medications be tested to make sure they are taking the prescribed medication (as opposed to selling it on the street, I suppose) and not taking other drugs. From the list of procedure codes it seems that they tested for about a dozen substances. DH takes one medication, and he has taken the same one at the same dose for a number of years.</p>
<p>The testing lab is not a provider for our insurance company, which means that we are being billed for over half of these charges. It seems to me that these tests are not for the sake of DH’s health care, but for drug enforcement purposes. I’m not sure why we or the health insurance company should have to pay for the tests. </p>
<p>Is everyone who takes pain control medication now being subjected to these additional charges?</p>
<p>I read the policy statement, my$0.02, but it didn’t seem to say very much. </p>
<p>The medication my husband takes is not an opiod. It is mainly used for epilepsy, but it is known to be the most effective medication for the type of pain my husband has.</p>
<p>The insurance company is covering the tests, but because the lab is not a participating provider, the “patient responsibility” is about $800.</p>
<p>I read the articles you linked, but they were about opioids, and DH’s medication is not in that class. And he only takes one medication, and there were about a dozen procedure codes. I wonder why he was tested for so many substances?</p>
<p>It is fairly common to order a full drug test panel, but it would be worth asking for the specific testing indication (reason). Some drugs require specific blood levels to be effective.</p>
<p>You should also ask your insurer which labs are preferred providers for the plan so you can find out the discounted rate for the same test panel at the preferred lab provider. The discounted rate may be 50-90% off the retail rate. Once you know the discounted rate, you should ask your husband’s doc why the expensive non-provider lab was chosen.</p>
<p>There does not appear to be anything in the NY Medical Board policy mandating testing for chronic pain patients, so you may be able to dodge additional testing. At the very least, you may save money by having future samples drawn by the preferred provider.</p>
<p>Unfortunately, your husband probably signed papers ages ago that authorizes his doc to send lab specimens to any lab.</p>
<p>NY, call the lab and see if they will be willing to wiggle on the remaining figures. My aunt works in billing at a hospital and they get jipped on so many bills they are usually very willing to work with you and take what they can get.</p>
<p>NY, you might also FAX a copy of the bill to your physician and make sure he is aware of the costs.</p>
<p>DD was prescribed a new allergy regimen, very few generics and it would have been around $300 co-pay just to try it. She is recontacting the doc to see if there are other ways to proceed.</p>
<p>Well, I’ve gone around with several people at the testing lab. They will not tell us what tests were done, saying that they did the tests ordered by the doctor. I told them that if they wouldn’t tell us what they are billing us for, they shouldn’t expect us to pay.</p>
<p>I tried calling the doctor’s office, but they are closed already. I’ll try them tomorrow.</p>
<p>I have had success with getting our insurer to pay for lab work done by out-of-network providers when that lab work had specifically been handled by the in-network physician. This took multiple rounds of phone calls on my part to the insurer, but the bill was ultimately paid. Read through the policy and find out if there is a provision for out-of-network labs when they are chosen by the in-network physician and it is nothing that you could have been expected to have control over.</p>
<p>That’s a very good point. I am pretty sure that the doctor is in-network. I couldn’t find him in the online provider directory, but DH is only charged a specialist copay and there is nothing on the EOB about out-of-network.</p>
<p>I am also thinking of telling the insurance company that I can’t verify that the services they are billing were actually performed because they won’t give me any information. The insurer has a prominently displayed fraud hotline.</p>
<p>NYmom–my H, retired doc, says docs can not be mandated to drug screen (which makes sense–how can you be required to possibly incriminate yourself by getting a random screening.) He says, “doctor effed up” basically. that he either made a mistake, or did this for some reason of his own, but it’s not because he had to. Anyway, I think you needto ask doc what’s the mandate, and if you’r not happy with the answer, maybe find a new doc.</p>
<p>I really don’t understand this. The doctor is a very nice, soft-spoken man. DH has been seeing him for a number of years for pain management. He did a few things like cortisone injections, and he orders MRI every few years, but mostly he prescribes medication that is not oxycontin, or one of the drugs that is abused. It is a serious enough drug that the prescriptions can’t be called in, so DH has to pick them up every two months. He fills the prescription every two months, rather than every month, because it is such a pain. The doctor prescribes double-strength, and DH cuts the pills in half, by agreement. DH is the last person that anyone would imagine taking illegal drugs. He barely even drinks - a couple of glasses of wine a month. I can’t imagine why the doctor did this. </p>
<p>It is my experience that the Dr has no clue about how each insurance company would handle the costs. Our doctor sent my DH to a lab to get some blood tests. 2 vials of blood cost us $600 because the hospital lab was not covered. Had he taken the samples in the office and sent to lab across the street, it would have been $40. We learned our lesson the hard way with that one and now call the insurance company before doing any work. </p>
<p>(which is why I hate that my state has no HMOs)</p>