Doctors office told me I was covered, then sent me huge nil for lab services

[Chuck Gee]

What is the name of your state (only U.S. law)? Delaware
Should say"huge bill" in title...sorry

I went to a doctor covered by my plan. While there, he said he would like to run tests. They had a separate room and a technician set up just for this. I asked, "Are the tests covered by my same insurance, please be sure?" The lab tech went away for a few moments and returned saying, yes they are. Now I am receiving large bills for numerous tests from a lab I never heard of and never authorized. I was fully under the impression the doctor's office had their own testing organization within their practice. Do i have recourse?

 

[Zigner]

What is the name of your state (only U.S. law)? Delaware
Should say"huge bill" in title...sorry

I went to a doctor covered by my plan. While there, he said he would like to run tests. They had a separate room and a technician set up just for this. I asked, "Are the tests covered by my same insurance, please be sure?" The lab tech went away for a few moments and returned saying, yes they are. Now I am receiving large bills for numerous tests from a lab I never heard of and never authorized. I was fully under the impression the doctor's office had their own testing organization within their practice. Do i have recourse?

Your recourse is to pay the bill. You are responsible for knowing the terms of your insurance.

With that said, you can TRY appealing to your insurance company. Review your policy, etc., for information on how to do this.

 

[cbg]

Unless your insurance company specifically and in so many words says that the provider is responsible for determining what is covered, then you are. Look at your policy because just a few do have that language, but you are responsible for knowing what is covered unless your policy says you are not.

I want to make sure this is quite clear. The policy does not have to say that you are responsible for knowing what it covered. You are responsible unless it says, expressly, that you are not.

 

[ShyCat]

A common mistake is to ask "Do you take my insurance?" when the more precise question is "Are you in my insurance network?" One may correctly answer Yes to the first and No to the second because they did not enter into a contract with the insurance company to accept their adjusted payment, agreeing to not balance bill the patient.

 

[commentator]

In the first place, I'd be in touch with my insurance company to make sure that these charges have been properly submitted to them, the decision making is complete, and that they have officially refused to cover them. I'd know the exact reason why they've refused to do it. I'd find out if there is any appeal process.

In some cases, a medical services facility will send you a gosh-awful bill, and if you check carefully the insurance company has not refused to pay yet. either it has not been properly submitted or it is incorrectly billed or simply that it has not yet been paid.

When I worked with social services, we would frequently have clients come in and have an invoice from the service provider saying they owed something like $12000 or something, and when we researched it for them and read the small print, we'd find the bill had not been submitted yet to insurance, had not yet been processed or something else of this nature was wrong. Their explanation would be something like, "Well we bill the responsible party every month, whether the claim is settled or not!"

I agree, you cannot expect the physician's office to be fully on the mark about exactly what is covered by your insurance, and they are not liable if they told you it was covered and it wasn't. I wouldn't ever take their word for it, though many people do, automatically assuming they can expect their physicians office to be full of experts on THEIR medical insurance. b

But they tend not to just bald faced lie and make you take testing that is not going to be covered, because they have a huge interest in getting paid for their services, as does the medical lab that did the testing. If you have insurance of any kind, they're going to want to milk them thoroughly as well as get money from you. The insurance company is much more likely to be able to pay than a private citizen.

But some have the practice of sending out huge bills to the patient, just to "keep you informed" while they're still dealing with the insurance company. They hope you'll be lazy enough to not do the research and just pay the bill. After all it is much easier to hold your money that they're not owed than it is to try to collect it after the insurance has paid its part.

 

[justalayman]

Ask your Dr's office where you were provided notice that an outside lab is or may be used for any given tests. If you were given notice, you owe. If you were not given notice, you would have an arguable position that the doctors office is responsible for the bill.

 

[cbg]

But not a slam dunk position, since it is still the responsibility of the patient, much more often than not, to ASK.

 

[justalayman]

But not a slam dunk position, since it is still the responsibility of the patient, much more often than not, to ASK.

It most likely isn't. I believe every medical provider I have been to has provided such notice one way or another. Just something for the OP to check into but I definitely wouldn't put much promise in it.

 

[Chuck Gee]

Yes, this is the case

Ask your Dr's office where you were provided notice that an outside lab is or may be used for any given tests. If you were given notice, you owe. If you were not given notice, you would have an arguable position that the doctors office is responsible for the bill.

Yes there was never any hint of sendin g it outside, and I was never given any choice of labs, and indeed they went further to assure me it was covered.

From the AMA medical ethics code opinion: "The physician who disregards quality as the primary criterion or who chooses a laboratory solely because it provides low-cost laboratory services on which the patient is charged a profit, is not acting in the best interests of the patient. However, if reliable, quality laboratory services are available at lower cost, the patient should have the benefit of the savings. " I certainly should have been given a choice for standard tests to get the benefit of savings.

 

[justalayman]

It's not a matter of being given a choice. It is a matter of being informed that the doctors office was sending the labs out.

 

[cbg]

So, at what point in the procedure did you speak up and say, please make sure that a lab is used that is covered on my insurance? (HINT - "is it covered by my insurance" is a completely different question)

Why is it that you evidently feel everyone else has all the responsibility for keeping your costs low and you have none?

 

[TinkerBelleLuvr]

In the past, I went to a doctor IN-network. I knew WHICH of the labs was covered. Doctor's office said they were sending it to the correct lab - they didn't. I appealed to the insurance because I had done everything right and they did cover the bill. Talk to your insurance provider and find out the appeal process.

 

[Chuck Gee]

Excuse me?

So, at what point in the procedure did you speak up and say, please make sure that a lab is used that is covered on my insurance? (HINT - "is it covered by my insurance" is a completely different question)

Why is it that you evidently feel everyone else has all the responsibility for keeping your costs low and you have none?

I am in a doctors office half dressed, they want to do a test. I say only if it is covered by my insurance. They say yes. I say please check for sure before we proceed. He comes back in 5 minutes and says yes I checked. As far as I knew they were part of my doctors office organization. On the way out they asked me to get a CT scan and handed me a glossy ad for a local supplier, which I said no to, because I said I have to be sure it is network.

Your arrogant accusation that I take no responsibility is ridiculous when I am blatantly lied to. They could have said "I don't know" or "you need to check yourself," but they said said "I checked, you are covered." Your attitude that the patient is always wrong does not fly with me.

What do you expect patients to be able to do when they are in a doctors office half dressed beyond that? I feel there may be some type of reciprocity going on between the medical office ant the lab and the imaging company they were pushing.

 

[Ladyback1]

When my youngest son was born, I had an epidural. I wasn't given a choice of what Dr. performed epidural. The procedure was covered. However since the Dr. who performed was a contract provider (a member of a private practice), the professional portion was not covered by insurance fully because the Dr. was not a network provider.) And yeah...I was in no position to quiz the dr. as to what networks he was attached to!

I disputed with the Dr and the insurance company that because I was not given a choice of a network provider, it should be covered. It took a few calls and letters, but I prevailed.

If you did not know, and were not told that an outside lab would be involved, I believe you should dispute the bill will the provider and your insurance company.

 

[Chuck Gee]

When my youngest son was born, I had an epidural. I wasn't given a choice of what Dr. performed epidural. The procedure was covered. However since the Dr. who performed was a contract provider (a member of a private practice), the professional portion was not covered by insurance fully because the Dr. was not a network provider.) And yeah...I was in no position to quiz the dr. as to what networks he was attached to!

I disputed with the Dr and the insurance company that because I was not given a choice of a network provider, it should be covered. It took a few calls and letters, but I prevailed.

If you did not know, and were not told that an outside lab would be involved, I believe you should dispute the bill will the provider and your insurance company.

Thank you.