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  1. #1
    Join Date
    Oct 2013
    Posts
    3

    Default Balance Billing for Blood Tests

    My question involves collection proceedings in the State of: California

    My son is autistic and we have HMO. We took him to see a doctor (not contracted with the insurance company) in Los Angeles, who specializes in treatment of autistic kids. As part of his evaluation, we had to run several blood tests on our son. The doctor's office told us that we could pay them for the lab work there, in addition to a blood draw fee, which we agreed to. The office would then send the blood samples to Quest for testing. We paid the lab fees at the time and returned home. Two weeks later - today - we got a bill for $1000 from Quest - a bill that we thought we had already paid. I called the doctor's office in panic towards the end of the day. The receptionist told me that their staff was getting ready to leave for the day and would help me the next day. She did confirm that that we should not have received a bill from Quest, but that they would look into it tomorrow.

    Some digging around reveals that I may have been balance billed by Quest. This doctor is quite famous in the autism community and I think he has a sharply discounted rate with Quest for patients who don't have insurance or whose insurance wont cover his fees and his tests (which maybe many of his patients as he isn't contracted with any insurance company). The lab fees he charged me was around $500 which included a $90 blood draw fee. I think Quest accepted this payment from his office, but also then billed me an additional $1000 which they feel they are owed ? I was told that "double billing" is not permitted in California but don't know how to fight this if the doctor's office cannot help me settle this. My insurance is not involved at all. They don't believe in biomedical treatments for autism so the whole visit - including the doctor's consultation fee - has been out of pocket. And, no, I am not confusing the doctor's fee with the lab fee. I paid for both.

    Please help ! How do I fight this ? Should not Quest only get their contracted rate with the practice is ? I cannot afford this. My son's therapies are already a huge drain on our finances and this is back breaking. Please, please, please help me fight this monster bill. Thank you.

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Huge Bill from Quest Diagnostics

    You said the doctor is NOT contracted with your insurance company? Then the insurance limits do not apply and neither does a prohibition against balance billing.

    If you've already paid the bill, do you have the cancelled checks or the bank statement showing the payment? I completely understand that you don't want to pay twice, and you shouldn't. But on an HMO plan, any HMO plan, if the doctor is not in the insurance network it's not covered, and it's quite likely (though I'd have to read the plan directly to be certain) that any lab or other tests done in association with the non-network visit would not be covered either. (While I'd have to see the insurance plan to be sure, it's FAR more likely that such tests would not be covered in this case than that they would be.) And in that case, the contract rate with your insurance wouldn't apply either.

  3. #3
    Join Date
    Oct 2013
    Posts
    3

    Default Re: Huge Bill from Quest Diagnostics

    Quote Quoting cbg
    View Post
    You said the doctor is NOT contracted with your insurance company? Then the insurance limits do not apply and neither does a prohibition against balance billing.

    If you've already paid the bill, do you have the cancelled checks or the bank statement showing the payment? I completely understand that you don't want to pay twice, and you shouldn't. But on an HMO plan, any HMO plan, if the doctor is not in the insurance network it's not covered, and it's quite likely (though I'd have to read the plan directly to be certain) that any lab or other tests done in association with the non-network visit would not be covered either. (While I'd have to see the insurance plan to be sure, it's FAR more likely that such tests would not be covered in this case than that they would be.) And in that case, the contract rate with your insurance wouldn't apply either.
    So, technically, Quest can charge me thousands of dollars for these tests & get away with it ???

    Also, if the doctor's office has negotiated rates for their patients with Quest, shouldn't Quest honor it ? Is there no way that I can fight these charges ?

  4. #4
    Join Date
    Sep 2013
    Posts
    244

    Default Re: Huge Bill from Quest Diagnostics

    right now they are looking into a possible doubling billing right? post back with those results. $90 just to draw blood? very high.

  5. #5
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Huge Bill from Quest Diagnostics

    You are free to take the matter up with Quest's billing office. In fact you should. You also can, and should, contact your insurance carrier and ask them if, when a non-network doctor sends you to an in-network lab, are the lab charges payable under the policy.

    But the thing is, the doctor's office is not the one that negotiates rates for the patient. That negotiation is done by the insurance carrier, not the doctor's office.

    What matters here is whether lab charges associated with a non-covered doctor visit are or are not covered under the your specific health insurance plan. Only your insurance carrier can say whether they are or not. It's unlikely, but I'm not going to say it's impossible.

    If lab charges associated with a non-covered visit ARE covered, your insurance carrier will be able to help you sort this out. If that is the case, the negotiated rate that your insurance carrier (not the doctor - as I said above, the doctor's office is not the one that negotiates rates for patients with the lab) most likely would be in force, though your insurance carrier will have to say for sure and also say what that rate is. It would be best if you could come up with some form of proof of payment; either your cancelled check, your bank statement showing the payment, or a receipt. I am not even remotely questioning you when you say you pre-paid, but if that pre-payment did not get posted properly, you are going to have to prove that you've already paid. Mistakes do happen; records of payment do get lost, and if Quest does not have a record of the payment (even if that means their records are wrong) it is in your best interests to show what payment has already been made and not rely on Quest to have that record. BTW, this assumes that Quest is an in-network lab on your insurance. If Quest is not an in-network lab on your plan, see below.

    If lab charges associated with a non-covered visit are NOT covered, which is what I suspect you will find to be the case (though I do hope for your sake that I am wrong) then the rates the carrier negotiated are out the window and Quest can charge you whatever their normal rates are, minus what you can prove you have already paid. This is also the case if Quest is not a covered lab on your plan.

    In my experience (and we are talking close to 35 years worth here) Quest is a reputable lab and honest, but they do occasionally have problems with their billing. They cannot keep adding on new charges but from what you've said I don't think that's what they're doing; I think that they've lost or mislaid the record of your prior payment and are charging you the full amount again because your insurance carrier didn't pay. I have no doubt that if you can show that evidence of prior payment you will be credited with that. But whether or not you are entitled to the rate negotiated by your insurance carrier remains to be seen.

  6. #6
    Join Date
    Oct 2013
    Posts
    3

    Default Re: Huge Bill from Quest Diagnostics

    Hi,

    I have an invoice and proof of payment for lab charges from the doctor's office. Thing is, if this doctor has negotiated charges for his patients with Quest (which is my understanding that he has), can Quest still disregard that understanding / contract with the doctor and go ahead and still bill me in addition to what I paid into my patient account at the doctor's ? (Quest was supposed to be paid through this account). The doctor's office staff claimed that I should not have received a bill from Quest, and seemed surprised that I did, but I paid around $400 - $500 into my son's account (which seems to be the rate they negotiated with the lab) but the bill I received was for $1000 (which seems to be what Quest bills people who just walk in without insurance but just a script from a random physician for blood tests. Thanks !!

  7. #7
    Join Date
    Sep 2011
    Location
    OH10
    Posts
    17,019

    Default Re: Balance Billing for Blood Tests

    Quest will either be in or out of network for your insurance. Your doctor might have a contract to provide similar rates. If he does, his billing office needs to clear the issue up with Quest per their contract. I also frequently use Quest and have no problems.

  8. #8
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Balance Billing for Blood Tests

    Since the doctor has no authority to negotiate Quest's rates yes, Quest can disregard that "understanding".

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