Unknowingly Billed for Test

[rob91]

State: California

I saw a physician a few months back and ended up having my urine analyzed, however they didn't do it at their office they shipped it out to a third party. At the time I wasn't made aware that this test would cost me a dime. A month or so after the visit I was surprised to receive a bill from the third party for $160 and to find that my insurance didn't cover any of it. Nobody in the doctor's office made me aware of how much this test would cost me, let alone that my insurance wouldn't cover it. Is it common practice for doctors to not inform you of costs before running tests? Is there any way for me to fight this? Thanks.

[lealea1005]

State: California

I saw a physician a few months back and ended up having my urine analyzed, however they didn't do it at their office they shipped it out to a third party. At the time I wasn't made aware that this test would cost me a dime. A month or so after the visit I was surprised to receive a bill from the third party for $160 and to find that my insurance didn't cover any of it. Nobody in the doctor's office made me aware of how much this test would cost me, let alone that my insurance wouldn't cover it. Is it common practice for doctors to not inform you of costs before running tests? Is there any way for me to fight this? Thanks.

No one in the Physician's office has control over what the lab may or may not charge for a test or, for that matter, whether your individual insurance policy will pay for said test. Did you receive an explanation of benefits from your insurance company and what was the reason given for not covering the test?

[paleolith]

Unfortunately, yes, this is common and standard practice. In the future, try to remember always to ask "what is this going to cost me". Usually the doctor or the doctor's staff will say "I don't know". In that case, tell them you insist it be done be a provider who is in-network for your insurance or that you know the cost in advance. It can be difficult to remember to do this, and often the providers will say "it depends". Sticking to your guns can be hard when you're sick, so think about it in advance.

Labs are especially bad about charging a great deal more out-of-network, often ten times as much as in-network. I know this response probably comes too late to help in this case, but with very large discrepancies, it's worth calling up and saying "I can give you a credit card right now if you'll settle for xx dollars", where xx is perhaps half the billed amount. Some will take it, some will not. However, the billed amount is like the rack rate at the hotel: they don't expect many people to pay it.

Edward

[lealea1005]

In that case, tell them you insist it be done be a provider who is in-network for your insurance or that you1 know the cost in advance

That is just peachy fine, but it's the patient's responsibility to know whether the lab their Physician uses is in network with their insurance plan. I'm sure the Physician will be more than happy to give the patient an RX for the bloodwork/urine test at whichever lab the PATIENT wants to use. The fact is...the Physician's office has no idea what the lab...a separate entitiy not related to the Physician's practice...charges for their services.

By the by, Edward, this thread is several months old. I really don't think OP is still looking for an answer....especially since they already got one. Have a nice weekend.

[paleolith]

That is just peachy fine, but it's the patient's responsibility to know whether the lab their Physician uses is in network with their insurance plan.

Technically yes. But many physicians (and their staffs) do nothing to help the patient know that this question even has to be asked. Note that the OP said he was not informed that the test would be sent out. It's easy to say oh, you should know that. But how is a person supposed to learn this? It isn't taught in school. It was one of the OP's questions. He was here, among other things, to learn about that, since no one had told him.

I'm sure the Physician will be more than happy to give the patient an RX for the bloodwork/urine test at whichever lab the PATIENT wants to use.

Good grief. You are hopelessly naive about modern medical practice. They will do this if the patient absolutely insists, but in most cases not willingly. It takes them more time, and they don't like that. The cost to them is actually growing with the move to electronic records, because if the patient goes to a lab which doesn't send the results back electronically, they have to enter the results manually.

The fact is...the Physician's office has no idea what the lab...a separate entitiy not related to the Physician's practice...charges for their services.

And that's a huge problem for patients who have to pay out of their own pockets. The physician's staff CAN call the lab and ask in advance, or determine whether the lab is in-network. They WILL NOT do this unless the patient at least asks, and will often try to get out of it unless the patient insists.

By the by, Edward, this thread is several months old. I really don't think OP is still looking for an answer....especially since they already got one.

One of the OP's questions was whether this is common practice. That question had not been answered and was what I was trying to answer. If he had only made one post, I wouldn't have bothered, but he had made two posts, making it a lot more likely that he would receive the notification.

Cheers,

Edward