In the case I mentioned, I had taken a paper with me from the doctor's office which ordered several blood tests which are routine in early pregnancy. The nurse who wrote the order asked me if I wanted genetic testing, and I said no, but somehow the genetic tests were done anyway.

Typically I only know about diagnostic services (lab tests, ultrasounds, etc.) that are performed without my knowledge because those are the services that my insurance doesn't cover.

Another example was when I called a lab to ask about a particular blood test, and was told a certain price, and when I got the bill it was for four tests instead of one. They call that "reflex testing," because if they get a certain result from the first test, they automatically do other tests, without asking the patient first. Of course nobody had discussed this "reflex testing" policy with me when I first asked about the price. I wrote a strong letter to the lab's main office complaining about that, and in the end the charges for the other three tests were removed.