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Hospital Added Expensive Tests Not Ordered by My Doctor

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mountever

Junior Member
For my annul checkup, my doctor ordered a stress test (CPT 93015). The hospital, however, did several expensive adds-on (CPT 78465, 78478, 78480, A9500) not shown on doctor's order form. The difference is about $7,000.

I've been trying to work with the hospital to resolve this. But it's frustrating.

I asked for a meeting, but they don't want to have a meeting.

I asked specific questions, but they always give anwers to different questions and insist that there's nothing wrong. On the other hand, they are willing to offer a huge discount and give me a few days to arrange a payment plan. Even with the huge discount, I'll still need to pay much more than what the doctor ordered for (The claim was rejected by the insurance company).

Sincerely seek advice for next step.

What is the name of your state (only U.S. law)? CO
 


ecmst12

Senior Member
Those additional codes indicate it was a nuclear stress test. What exactly was on the order form?

Also, why was the insurance claim denied? And does the hospital participate with your insurance?
 

barry1817

Senior Member
billing

For my annul checkup, my doctor ordered a stress test (CPT 93015). The hospital, however, did several expensive adds-on (CPT 78465, 78478, 78480, A9500) not shown on doctor's order form. The difference is about $7,000.

I've been trying to work with the hospital to resolve this. But it's frustrating.

I asked for a meeting, but they don't want to have a meeting.

I asked specific questions, but they always give anwers to different questions and insist that there's nothing wrong. On the other hand, they are willing to offer a huge discount and give me a few days to arrange a payment plan. Even with the huge discount, I'll still need to pay much more than what the doctor ordered for (The claim was rejected by the insurance company).

Sincerely seek advice for next step.

What is the name of your state (only U.S. law)? CO
I was just in to my doctor for a visit, and all tests that were being planned were on their coding form and I was asked to approve them, or discuss them before treatment.

Seems that if your doctor had an order for tests, and the hospital then decided to do others that were not authorized or approved by you, you might have a legitimate complaint.

It is interesting that treatments without an informed consent have would up in very interesting case situations, where even criminal complaints have been filed.

Wonder if you told them that you were paying for the tests, and not an insurance company, if they would have done this. This is a key question, because a hospital has no more right to do unrequested tests just because a third party is picking up the bill than if the person is paying for them himself.

Be on firm ground with what tests were ordered before preceding.
 

ecmst12

Senior Member
I know that sometimes if the patient is not able to achieve a sufficient heart rate from exercise alone (usually due to a co-existing condition) they will need to switch to a nuclear stress test at the time in order to complete the test and get the needed diagnostically relevent results. If this is what happened, then the change was necessary (it should have been discussed with the patient, but I find it hard to believe that she wouldn't have asked any questions when they started injecting her with contrast material and using the imaging equipment, it's not something they could do without her noticing) and appropriate. It actually would have cost MORE if they had just stopped the stress test with no results, because they still would have billed for the test and then she would have had to come BACK to be billed for the stress test again, and additional codes as well!

So the more important question is, why is her insurance denying the claim?
 

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