Expensive med. test not covered by insurance

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midareff
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Re: Expensive med. test not covered by insurance

Post by midareff »

I would check with medicare and see what they pay (ALLOW) for those tests. When you have that offer the company the medicare reimbursement rate and tell them you thought it was covered and can't handle the full price bill. Might be your lucky day.
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Munir
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Re: Expensive med. test not covered by insurance

Post by Munir »

mojave wrote:
Munir wrote:mojave, you have received a lot of advice on this forum. Have you decided yet on a course of action?
I sent a diplomatic email to my Dr first to see what she says. I want it in writing, which is why I went the email route. I explained how I was upset by this situation and basically reiterated my initial post, asking if they have a solution in mind. I have not heard anything back yet. She usually makes phone calls after hours, so if she calls me it will be later tonight.

Next I will talk to insurance and see what they have to say, but I don't think anything will happen this route. I'll try an appeal but again, I don't expect anything from that.

If I can't get any support or relief from the above two avenues, I will contact the genetic testing company. If that doesn't work, I'll be taking the advice to go directly to the billing Manager or Director, with a letter explaining what happened and providing copies of the other bills I have to pay off. If that doesn't work, I'll see if there's anyone else there I can find that might have the ability to help if they are so inclined.

If THAT doesn't work, I will look into any support or programs the state offers.

If nothing works at all, my mom has offered to help me with roughly half of it with the caveat that I can pay her back if I win the lottery (her way of saying, I don't expect to see it again and I am doing this to help you). I did not ask for this and I don't even want it but she is insisting on it. And then I guess, just add it to every other medical bill we're trying to get rid of.
Thank you for the feedback and the sharing of your plan of action. It looks like you are covering all bases. Don't hesitate to be assertive but not offensive in your communications. Good luck.
cherijoh
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Re: Expensive med. test not covered by insurance

Post by cherijoh »

zebrafish wrote:Doctors, what would you do in a situation like this? Would you alert a patient if a group of tests could potentially cost them thousands out of pocket? Does your office call their insurance if there is a concern about coverage?

I order DNA tests costing in the range of $500 to $6000+ almost every day and it is routine for me to discuss the cost of testing whether people have to pay for it or not. I think people should be aware of what things cost. This is part of the problem-- people having no idea of what things actually cost-- this is why we have a healthcare spending problem in the USA.

I think it is very poor form that the person ordered this testing w/o discussing the cost with you. I would worry that someone who did this really doesn't understand genetic testing (and when to order appropriately), either-- because it is really common knowledge among people in the field of genetics to be aware that DNA testing may not be covered in certain instances.
I have found very wide discrepancies in what is disclosed and isn't.

I have insurance that pays for an eye exam each year. The eye doctor offers an alternative to getting your eyes dilated that is better at detecting issues (plus no waiting for hours before you can see!) They know insurance doesn't cover it and so they charge $39 at the time of the visit. This past year was the 3rd year I had this test and they asked me again which test I wanted and again reminded me of the fee. I think this level of disclosure should be mandatory. If unsure then they could at least say "your insurance may not cover it; it should be in the range from $x - $y". Then the patient can make an informed decision.

My primary care doctor recommended the shingles vaccine at my last physical - without disclosing that I was below the age were it was considered preventative. She was looking at my chart so knew my age - why didn't she mention that it probably wouldn't be covered? It also never occurred to me that a vaccine would cost over $400! Because the lab tech had me sign a very broad CYA form, I also got stuck with the non-negotiated rate. Plus she nicked me for an office visit on top of the fee for the annual physical that my insurance covered. Needless to say, I'm in the market for a new doctor.
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patriciamgr2
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Re: Expensive med. test not covered by insurance

Post by patriciamgr2 »

Neither I nor my boyfriend is a physician. It seems to me, however, that some posters are expecting too much from physicians and their offices. It's really a patient's responsibility, IMO, to understand their own insurance. Given the constant changing landscape of health insurance, if doc's reviewed every patient's plan in advance of an appointment they wouldn't have time to review medical developments.

Of course, if a doc is already aware that many insurance companies may not cover a test, I would certainly hope s/he would disclose that. Each patient has one insurance plan to understand; the doc has a lot of patients.

I personally have told doc's that I need to check coverage before having a test done & the office was extremely accommodating about delaying the blood draw (& not charging me an extra co-pay when I returned for just the blood draw after verifying coverage). I have also asked a doc if there would be an alternate Rx I could use if my insurance didn't cover the one he was suggesting &, if so, would he note that on the chart so I could call in & ask for his office to call that medication in instead of his preferred choice (turned out my insurance did cover the preferred eye drops, with just a higher copay). I usually have a copy of my insurer's formulary with me (online) & I'm not shy about consulting it before I leave the office [obviously, I don't hold the doctor up from his/her next appointment while I'm doing that].

I also think it is reasonable to ask your doctor's office to assist you in making a case that a test is necessary and should be covered. I assume the OP filed an appeal with her insurer. If there were reasons in her specific medical history which warranted a genetics test before the age when they are typically performed, having the doctor attest to those reasons may help an appeal be successful. Please note that there are typically time periods within which an appeal must be filed.

Good Luck to the OP. That bill represents a huge amount of money & my heart goes out to your family.
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mojave
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Re: Expensive med. test not covered by insurance

Post by mojave »

Hi everyone - first, just want to give a big thank you to everyone that responded. You helped me come down a bit and look at this from a more logical angle. I received a lot of excellent advice and insight into how the system works.

Wanted to provide a brief update, my Dr's office called me back and the Office Manager is going to be working with me on this. She is out today so I'm not sure exactly what she will do, but it makes me feel a lot better knowing that they didn't ignore me and blow me off and that they are willing to at least try something. The lady I talked to that works with the Office Manager was very sympathetic.
bungalow10
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Re: Expensive med. test not covered by insurance

Post by bungalow10 »

The OB/GYN process in general is insane. I switched to a midwife and had a home birth for my third baby. Much less money, much better experience.

Pregnancy is not an illness. Neither is wanting to become pregnant. Next time ask yourself why you are being offered the test and what actionable information would come from such a test.
Last edited by bungalow10 on Sat Apr 12, 2014 12:02 pm, edited 1 time in total.
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cromwell
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Re: Expensive med. test not covered by insurance

Post by cromwell »

As a physician I am saddened to hear of such communication gaps.You will have to sort through the contractual rules between you , your insurance and the service provider.The initial pronouncements are not always accurate.You might also seek the assistance of an ombudsman or your county medical society. Good news is: you have no obvious impediment. best wishes
freebeer
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Re: Expensive med. test not covered by insurance

Post by freebeer »

munemaker wrote:...
The doctor is responsible for practicing medicine. What your insurance covers or how you finance the payment is, unfortunately, not the doctor's responsibility...
This may be, technically, true. That being said my internist is extremely clear with me about what his understanding is of what insurance companies typically do or don't cover and definitely factors that in. For example he told me that he stopped testing for Vitamin D levels because insurance companies stopped paying for it, and he diligenced the research involved (that showed lack of correlation between low test results and osteoporosis, and between supplementation and mitigating same) and got comfortable that he was not doing his patients a disservice, and for patients at particular risk he's now prescribing a specific bone density exam. So the main consideration for him was the science involved but insurance coverage was certainly a factor and surely the deciding one in nudging him to discontinue the testing. Similarly he has me on a particular generic statin, based on his survey of scientific results about efficacy and side effects, but also based on cost-effectiveness given what insurance companies do and don't reimburse for. I would be shocked if he recommended $4K of testing that was typically not covered by insurance without giving me a heads-up (and I'm not on a particularly tight budget, it's just part of his M.O.). Maybe I'm just lucky but you might consider finding another ob/gyn.
madbrain
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Re: Expensive med. test not covered by insurance

Post by madbrain »

This problem is one reason I love my Kaiser HMO insurance plan .

As long as I'm getting care in a Kaiser building, the doctor / lab / etc is always in-network.
I have never had an annual deductible on my plan, nor is there any coinsurance (percentage of cost).
Just premiums and fixed copays for services.
These copays are always billed upfront when the service is paid for. For lab tests, the copay has always been $0.
If it wasn't covered, I don't know what would happen. I would expect that they would ask for the payment upfront.
I have never received any "retroactive denial" for any service at Kaiser. I haven't got the slightest idea what any of my services actually need since the explanation of benefits only show the amount of the copays, except for prescription drugs.

IMO, while it's indeed not the doctor's responsibility to check what your plan covers, at the time you went to the lab, and the blood was drawn and the test was ordered, the lab should have been able to tell if the test was covered by your insurance plan or not.
Those surprise bills that come later on because the lab misled the patient about the cost should not be able to legally stand.
toofache32
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Re: Expensive med. test not covered by insurance

Post by toofache32 »

physicsgal wrote: I agree it's really complicated, from what I've heard/read/experienced. But, why does it have to be so complicated? Can't we patients know the price before we make a decision, since we are the ones who have to pay the bills when they arrive? She could have called the lab and the insurance and still not have found out the price. On a different test I couldn't get a price quote ahead of time from EITHER the provider lab or from my insurance. I called both and they each said to call the other. That's just insane. How can I make a decision if it's worth the price if I can't find out the price ahead of time? Just agree to it and cross your fingers they don't decide to charge you $4000 for peeing in a cup or getting a blood test? That's what I did and I lucked out and didn't get screwed. Thank goodness!
Welcome to the world of insurance billing. Doctor's offices have been dealing with this for years, and now patients are finally having to get involved. I think this is good for several reasons, mainly because now they have skin in the game. It's also good because the patient (not the doctor) is the customer for the insurance company. The insurance companies will hopefully be more likely to respond to complaints from the true customers, while they have historically ignored the doctors. There are 3 parties involved here....the patient, the doctor, and the insurance company. Only 2 of these parties actually care about the patient's health.
Random Musings wrote: However, I find it lacking if a doctor doesn't convey to their patients an idea of what costs are involved with more expensive procedures/testing. If they don't know, they should find out. However, it is still up to the patient to see if their insurance covers what is being recommended.
He's only the doctor, how would he/she know? Most people don't realize that insurance companies will usually refuse to provide a fee schedule or let them know what they pay for a service. I'm not sure why it's like this. I'm amazed here at how people think that doctors should be able to keep up with the dozens of insurance plans and what they cover. Especially when they are not paid to do this.

Several people say the doctor should know this after 30 years of practice....30 years is irrelevant for the insurance industry which changes when the wind blows and thrives on being too complex for outsiders to navigate. I've only been in the business for 5 years and I have already thrown up my hands and I shrug my shoulders with how maddening it is to deal with insurance. When patients ask me how much something costs, I say I don't know because I'm only the doctor, and I direct my patients to find someone who knows how THEIR insurance works. I make sure they understand it's THEIR insurance, not my insurance. If they want to incorporate a 3rd party to pay THEIR bills then they need to be very familiar with how that 3rd party works.
patriciamgr2 wrote:Neither I nor my boyfriend is a physician. It seems to me, however, that some posters are expecting too much from physicians and their offices. It's really a patient's responsibility, IMO, to understand their own insurance. Given the constant changing landscape of health insurance, if doc's reviewed every patient's plan in advance of an appointment they wouldn't have time to review medical developments.
Amen. Why do people think it's reasonable for the doctor to do more when he's already giving a discount to everyone with insurance? Seems like people want him to do more when he/she is working for less?
Jfet
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Re: Expensive med. test not covered by insurance

Post by Jfet »

Hmmm, not sure here. When I go get my auto fixed, they usually provide me with a ballpark estimate of what the repairs will cost.

It might not be too much to ask to have a little printout you sign before a battery of tests is sent off that gives a ballpark of what these tests cost. If the facility/insurance company would rather hide that information for some reason I do not believe this is the patient's fault.
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Crimsontide
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Re: Expensive med. test not covered by insurance

Post by Crimsontide »

This was an expensive lesson that we learned when my wife was first diagnosed with cancer. Question the need for, and the cost of, everything these doctors ask you to do. We had one Oncologist that had a way with the insurance companies, knew how to code it correctly or in a manner that would prove something was absolutely needed, for instance every single PET scan or biopsy he asked for he got approved and our insurance would pay, while other DRs we used would be routinely denied CTs or other imaging or diagnostic services. So, long story short, pick your doctor wisely and make sure everything is pre-approved. Oh, and also ensure every clinic/doc/facility/service provider is in your network before agreeing to anything. This is your responsibility, no one else is looking out for you in these matters...
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ResearchMed
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Re: Expensive med. test not covered by insurance

Post by ResearchMed »

Jfet wrote:Hmmm, not sure here. When I go get my auto fixed, they usually provide me with a ballpark estimate of what the repairs will cost.

It might not be too much to ask to have a little printout you sign before a battery of tests is sent off that gives a ballpark of what these tests cost. If the facility/insurance company would rather hide that information for some reason I do not believe this is the patient's fault.
Not a physician, not an insurer, but at least three problems with the above comments, as nice as it would be...

First, if you want to pay cash, and not depend upon an insurer, *some* of this problem goes away.
(But even wth autos, ever had car work done that was covered by insurance? Lots of back and forth, in many cases.)

Second, each insurance policy (and there can be many from each insurance company) will have a different schedule of benefits, under the current byzantine system with multiple insurers and levels of policies/coverages.
So there really often is not actually "a" price that could be quoted.

And that's separate from the worst problem (in our minds), which is that insurance-paid tests/services are often LESS than the charge to some poor soul without coverage for that particular test/service. And typically no one will (easily) provide the "cash price" or any "negotiated rates" that are charged to/paid by insurers.
We've seen the suggestion here - and elsewhere - to try to find out what a "negotiated rate" is, and try to pay that, if one must pay out of pocket, rather than the often much higher cash price.

RM
toofache32
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Re: Expensive med. test not covered by insurance

Post by toofache32 »

Jfet wrote:Hmmm, not sure here. When I go get my auto fixed, they usually provide me with a ballpark estimate of what the repairs will cost.

It might not be too much to ask to have a little printout you sign before a battery of tests is sent off that gives a ballpark of what these tests cost. If the facility/insurance company would rather hide that information for some reason I do not believe this is the patient's fault.
Nor is it the doctor's fault. He is only the one trying to provide services.
Jfet
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Re: Expensive med. test not covered by insurance

Post by Jfet »

toofache32 wrote:
Jfet wrote:Hmmm, not sure here. When I go get my auto fixed, they usually provide me with a ballpark estimate of what the repairs will cost.

It might not be too much to ask to have a little printout you sign before a battery of tests is sent off that gives a ballpark of what these tests cost. If the facility/insurance company would rather hide that information for some reason I do not believe this is the patient's fault.
Nor is it the doctor's fault. He is only the one trying to provide services.
I would not say it is the doctor's fault in the same way I would not say it is the mechanic's fault, unless the mechanic is the owner/operator of the shop. It is the fault of the manager of the clinic/hospital. The doctor is just trying to diagnose and treat, he is not (usually) a bean counter.
toofache32
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Re: Expensive med. test not covered by insurance

Post by toofache32 »

Jfet wrote:
toofache32 wrote:
Jfet wrote:Hmmm, not sure here. When I go get my auto fixed, they usually provide me with a ballpark estimate of what the repairs will cost.

It might not be too much to ask to have a little printout you sign before a battery of tests is sent off that gives a ballpark of what these tests cost. If the facility/insurance company would rather hide that information for some reason I do not believe this is the patient's fault.
Nor is it the doctor's fault. He is only the one trying to provide services.
I would not say it is the doctor's fault in the same way I would not say it is the mechanic's fault, unless the mechanic is the owner/operator of the shop. It is the fault of the manager of the clinic/hospital. The doctor is just trying to diagnose and treat, he is not (usually) a bean counter.
I would agree when discussing the doctor's fees, but he has no control over what insurance pays, and is often not even told how much insurance pays. The doctor is no longer "Captain of the Ship" and is only another cog in the giant wheel of healthcare.
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archbish99
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Re: Expensive med. test not covered by insurance

Post by archbish99 »

I suspect the lab that did the tests is used to this and has a policy. Pre-conception testing is rarely covered, though I personally think it ought to be. See what they actually bill you before you freak out too much.

In our case, they did a general panel on my wife, found that she was a carrier for something, then did the detailed test on me to make sure I didn't have any form of the same disease. The lab (Counsyl) billed insurance a bit over $5k for the two of us, and insurance sent us an EOB saying they didn't cover that (not medically necessary to avoid conceiving a child whose care will cost millions over their lifetime, hm?) and we were responsible for the whole $5k.

The lab billed us $399, which is their standard "flat rate" to mark down the tests when insurance won't cover it.

Our doctor appealed with the insurance (wife's family history, my test necessary because wife is a carrier); our insurance company ultimately paid out $2k and said the other $3k was ours. The lab said we still owed them $399 because that's what they mark down the uncovered portion to. We paid it, but sent their customer service folks a letter pointing out that it's a little backward to initially say $399 is full payment but then say $2k isn't enough. They agreed, refunded our $399, and I got a nice apology e-mail from their CEO.
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archbish99
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Re: Expensive med. test not covered by insurance

Post by archbish99 »

bungalow10 wrote:Pregnancy is not an illness. Neither is wanting to become pregnant. Next time ask yourself why you are being offered the test and what actionable information would come from such a test.
What actionable information? Let's see -- "Mrs. Bungalow, this test shows you're a carrier for disease X. We should test your husband. Oh, Mr. Bungalow, you're also a carrier for disease X. Between the two of you, there's a 25% chance your child would need millions in medical care and still die before his/her high school graduation, plus a 50% chance your non-sick child would be a carrier and expose your grandchildren to the same risk. Have you considered adoption?"

Like many things, a negative genetic test doesn't tell you much, but a positive test tells you a ton.
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soccerdad12
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Re: Expensive med. test not covered by insurance

Post by soccerdad12 »

madbrain wrote:This problem is one reason I love my Kaiser HMO insurance plan .

As long as I'm getting care in a Kaiser building, the doctor / lab / etc is always in-network.
I have never had an annual deductible on my plan, nor is there any coinsurance (percentage of cost).
Just premiums and fixed copays for services.
These copays are always billed upfront when the service is paid for. For lab tests, the copay has always been $0.
If it wasn't covered, I don't know what would happen. I would expect that they would ask for the payment upfront.
I have never received any "retroactive denial" for any service at Kaiser. I haven't got the slightest idea what any of my services actually need since the explanation of benefits only show the amount of the copays, except for prescription drugs.

IMO, while it's indeed not the doctor's responsibility to check what your plan covers, at the time you went to the lab, and the blood was drawn and the test was ordered, the lab should have been able to tell if the test was covered by your insurance plan or not.
Those surprise bills that come later on because the lab misled the patient about the cost should not be able to legally stand.
I was in the military when I was younger and my wife was pregnant. I consider military medicine similar to Kaiser. In the military hospital, everything is in-network and free. The problem with that model is that they can just not mention/do all the expensive testing that maybe should be done. It happened to my wife when she was pregnant with our first child. Based on what we know now (and what a doctor friend of ours said at the time) she had a high risk prenancy, but they treated it just as a normal one. We were very lucky that nothing really bad happened. Since then I have vowed to always be on a PPO where we have much more choice and control. We have to research the tests being done alot more so we don't get into the situation the OP did, but to me it is worth it 1000x.
toofache32
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Re: Expensive med. test not covered by insurance

Post by toofache32 »

soccerdad12 wrote:
madbrain wrote:This problem is one reason I love my Kaiser HMO insurance plan .

As long as I'm getting care in a Kaiser building, the doctor / lab / etc is always in-network.
I have never had an annual deductible on my plan, nor is there any coinsurance (percentage of cost).
Just premiums and fixed copays for services.
These copays are always billed upfront when the service is paid for. For lab tests, the copay has always been $0.
If it wasn't covered, I don't know what would happen. I would expect that they would ask for the payment upfront.
I have never received any "retroactive denial" for any service at Kaiser. I haven't got the slightest idea what any of my services actually need since the explanation of benefits only show the amount of the copays, except for prescription drugs.

IMO, while it's indeed not the doctor's responsibility to check what your plan covers, at the time you went to the lab, and the blood was drawn and the test was ordered, the lab should have been able to tell if the test was covered by your insurance plan or not.
Those surprise bills that come later on because the lab misled the patient about the cost should not be able to legally stand.
I was in the military when I was younger and my wife was pregnant. I consider military medicine similar to Kaiser. In the military hospital, everything is in-network and free. The problem with that model is that they can just not mention/do all the expensive testing that maybe should be done. It happened to my wife when she was pregnant with our first child. Based on what we know now (and what a doctor friend of ours said at the time) she had a high risk prenancy, but they treated it just as a normal one. We were very lucky that nothing really bad happened. Since then I have vowed to always be on a PPO where we have much more choice and control. We have to research the tests being done alot more so we don't get into the situation the OP did, but to me it is worth it 1000x.
This is why many doctors (myself included) believe it is unethical to participate in HMO plans. Some contracts with the doctors even have gag clauses that forbid doctors to discuss treatments that are not covered by the HMO. There is also an incentive to undertreat....the doctor is paid a low flat fee for every patient assigned to him, regardless of the services or amount of time spent with the patient. It's in the doctor's best interest to accept the fees and avoid spending any of it by treating patients. In my observation, most HMO plans come from government agencies where cost is everything and the only thing.

http://www.managedcaremag.com/archives/ ... thics.html
http://www.alllaw.com/articles/health/article2.asp
http://www.nytimes.com/1995/12/21/us/do ... ients.html
johnubc
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Re: Expensive med. test not covered by insurance

Post by johnubc »

This is a very tough topic with how our healthcare system, insurance and reimbursement are set up in the US.

Was the test medically necessary? Then I would fault the insurance company for failing to pay. IF it were not, I would fault the physician for ordering a non necessary test without disclosing that it was not really needed. I had a similar issue when the OB wanted to test for Down's Syndrome - I asked why as the result would not change the result, ie, there was going to be a baby born with or without Down's Syndrome either way - so why do a test that had no bearing on the outcome. She was none too happy about that cause she said it would be better to know ahead of time and we could be prepared.
toofache32
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Re: Expensive med. test not covered by insurance

Post by toofache32 »

johnubc wrote:This is a very tough topic with how our healthcare system, insurance and reimbursement are set up in the US.

Was the test medically necessary? Then I would fault the insurance company for failing to pay. IF it were not, I would fault the physician for ordering a non necessary test without disclosing that it was not really needed. I had a similar issue when the OB wanted to test for Down's Syndrome - I asked why as the result would not change the result, ie, there was going to be a baby born with or without Down's Syndrome either way - so why do a test that had no bearing on the outcome. She was none too happy about that cause she said it would be better to know ahead of time and we could be prepared.
I often see confusion on this. "Medically necessary" is an insurance company designation. The insurance companydefines what is medically necessary, not the doctor. When patients ask if something should be covered because it's "medically necessary" I tell them they have to ask their insurance company, because it doesn't matter what I think.
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mojave
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Re: Expensive med. test not covered by insurance

Post by mojave »

Update:

My OBGYN's office manager put me in touch with their rep at the lab. To make a long story short, the most I'll have to pay out of pocket is $25. Yes, $25. And, it doesn't even matter that this is a pre-pregnancy screening.

I won't celebrate until I actually get the bill (which won't get to me for a few months I guess) but she said if for some reason something's not right with it, a letter is always included with the bill to give them a call with concerns and they'll drop it to $25. Funny, the rep I talked to is actually out on maternity leave, she had the screening done as well and also had a frightening EOB.

I have learned my lesson with this one :shock:
Rodc
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Re: Expensive med. test not covered by insurance

Post by Rodc »

mojave wrote:Update:

My OBGYN's office manager put me in touch with their rep at the lab. To make a long story short, the most I'll have to pay out of pocket is $25. Yes, $25. And, it doesn't even matter that this is a pre-pregnancy screening.

I won't celebrate until I actually get the bill (which won't get to me for a few months I guess) but she said if for some reason something's not right with it, a letter is always included with the bill to give them a call with concerns and they'll drop it to $25. Funny, the rep I talked to is actually out on maternity leave, she had the screening done as well and also had a frightening EOB.

I have learned my lesson with this one :shock:
Nice. My fingers are crossed that this closes out at $25.
We live a world with knowledge of the future markets has less than one significant figure. And people will still and always demand answers to three significant digits.
jeanpierremelville
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Re: Expensive med. test not covered by insurance

Post by jeanpierremelville »

Mojave,

As mentioned in the previous posts:

1. Talk to your physician's office and make a polite yet firm complaint. I also do not have the time to know exactly how much a certain test will cost for one of my patients but I DEFINITELY have a general idea.
Your doctor's office needs to help you with this (if not the physician, then at least the office staff). I am sure this laboratory gets a good amount of work from this
doctor's office and would be willing to negotiate. Explain your situation. Your interpretation of the insurance contract is completely understandable.

2. If the first option doesn't work, then call the lab directly and negotiate for a reduced price. I have had $1500 bills reduced to $0 (but only once). The lab companies will often agree to a reduced price ESPECIALLY if you agree to pay a certain amount in cash upfront. If you cannot get a reduced price, then negotiate for a payment plan. They will accept even a small amount like $10/month (but make sure there is no interest charge).

Hope this helps.
texashelp
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Re: Expensive med. test not covered by insurance

Post by texashelp »

I hate to Necro this post but the same thing just happened to me and this is the only forum I found that helped address the issue.

I visited a neurosurgeon back in July he recommended that I get some genetic testing done so that the pharmacy can make me some custom pain medicine that would work based on my genetic data. He mentioned that the medicine would be a sample and that it would be free. However, subsequent ordering of the medicine would be charged. I thought sure why not free medicine for my back I will take it! The kicker was that he did not mention that there would be a costs to do the genetic testing and I alter received a bill for over 6,700 dollars. He never mentioned anything about this costs and it was done by an outside dermatopathology lab (I did not consent to these fees). However, I did sign the standard forms in the beginning before seeing the doctor that basically give your soul to the doctor.


If I cannot afford to pay can I take the credit hit? Will the debt + interest follow me around forever?


Is there anything else I can do besides reach out to the doctor and the lab?

Do these test costs seem reasonable?

[Link removed by admin LadyGeek]
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Re: Expensive med. test not covered by insurance

Post by LadyGeek »

texashelp, Welcome! It's certainly not a problem to "Necro" (raise from dead, a zombie thread) if it helps answer your question.

I removed a link which provided medical test details. Although it's just a bill, details of the condition are clear. Please bear in mind that medical issues are off-topic. See: Medical Issues
Medical Issues

Questions on medical issues are beyond the scope of the forum. If you are looking for medical information online, I'd like to suggest you start with the Medical Library Association's User's Guide to Finding and Evaluating Health Information on the Web which, in addition to providing guidance on evaluating health information, includes lists of their top recommended sites in the following categories: consumer health, cancer, diabetes and heart disease. They also provide a larger, but less frequently updated, list called Top 100 List: Health Websites You Can Trust.
Please try to state your concerns without describing the medical details.
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White Coat Investor
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Re: Expensive med. test not covered by insurance

Post by White Coat Investor »

mojave wrote:A few months ago I had my annual checkup with my OBGYN. I mentioned that my husband and I may try to conceive soon and she recommended genetic testing to see if I was a carrier of any genetic diseases. I thought it over a bit, weighing the possible emotional outcomes, and then made the appointment. Everything turned out fine.

I just got the explanation of benefits and my insurance is covering a whopping $0 and they are saying that the do not cover those tests. I am going to be charged $4200 out of pocket.

I talked to my Doctor and several nurses about this test while I was thinking about it and not once did anyone recommend calling insurance or caution me about the costs associated with this. Clearly they didn't call on my behalf to make sure such an expensive test was covered. Additionally, when I was there to get the test, while the nurse was prepping me I asked for a rough estimate of what it would cost. She told me about $15 per test.

I now know I should have called myself, hindsight is 20/20. I was under the impression that this was just a simple blood test.

Doctors, what would you do in a situation like this? Would you alert a patient if a group of tests could potentially cost them thousands out of pocket? Does your office call their insurance if there is a concern about coverage?

We already have other medical bills from last summer when my husband was in the hospital with Meningitis.

Thanks for any feedback you have. Of course, I will be calling both my insurance and my Doctor tomorrow but I'm in need of a little hope.
Hmmm....it seems obvious to me that test would not be covered by an insurance company (since it is pretty much optional and has little to do with your own health), but I work in the field. However, I would have no idea what the price would be (and apparently neither does your doctor or nurse). I can assure you that pretty much no test I order is $15.

I find it bizarre that your doctor would recommend genetic testing prior to conception. Do you have family with genetic issues or some kind of unusual body type or illness that would worry the doctor?

At any rate, you probably have a reasonable case to negotiate the cost with the test provider way down. $1000-2000 sure beats $4200.

Good luck. Be sure to complain to the doc and tell them your experience. At least you'll be helping someone else.
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Re: Expensive med. test not covered by insurance

Post by patriciamgr2 »

The original thread has been necro'd. I think Texashelp's situation (doc emphasized initial dose of pain medicine would be free & it appears doc's office sent specimen for testing) is different from OP.

Perhaps EmergDoc or others could PM Texashelp with their thoughts: Is it mainstream practice to order expensive genetic tests to formulate a pain med??? [I'm not a med professional, but this whole situation bothers me. Disclosure: I'm usually pro-doc/hospital, but I'm cynical about a lot of pain relief clinics, so I may be biased. Is the lab owned by the doc???]

1. Contact the dr's office (follow-up in writing) to emphasize that you can not pay for these tests & (if true) your insurer is balking. Reiterate your claim that you relied on doctor's promise of a free trial dose in agreeing to try the course of treatment. Insist firmly on their help in (1) formulating supporting documentation for an appeal to your insurer; and (2) getting the lab charges eliminated or greatly reduced. Copy the lab on that letter.

2. File an appeal with your insurer-if applicable.

Let the Forum know of developments; my thoughts & prayers are with you on the back pain. Good Luck.
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Re: Expensive med. test not covered by insurance

Post by sawhorse »

My doctor recommended a test that was not covered by insurance. He said it would be $200. I got a bill a few months later for $4100. I called the doctor who was very surprised and said it must be a billing mistake. Then another patient called saying the same. And two more.

In the span of three months, the testing company had raised the price from $200 to $4100, and they didn't notify my doctor of the new prices.

My doctor was livid and contacted the testing company. The testing company relented.

So it's possible that your doctor didn't know. A bit unlikely, but worth mentioning if it seems out of character for this doctor to order a test s/he knows the patient can't afford.

Whatever the list charge is almost certainly higher than they will demand if taken to task for it. Try to see what they charge insurers and get as close to that price as you can. You can also look at whether they give income based discounts.

Good luck with this. It's an awful feeling. When I got the bill from the testing company, my doctor was away, and it took a few days before he could respond. Those days were nerve wracking and seemed to last forever even though we had enough in our emergency fund to cover it.

Please keep me updated.
Allixi
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Re: Expensive med. test not covered by insurance

Post by Allixi »

texashelp wrote:I hate to Necro this post but the same thing just happened to me and this is the only forum I found that helped address the issue.

I visited a neurosurgeon back in July he recommended that I get some genetic testing done so that the pharmacy can make me some custom pain medicine that would work based on my genetic data. He mentioned that the medicine would be a sample and that it would be free. However, subsequent ordering of the medicine would be charged. I thought sure why not free medicine for my back I will take it! The kicker was that he did not mention that there would be a costs to do the genetic testing and I alter received a bill for over 6,700 dollars. He never mentioned anything about this costs and it was done by an outside dermatopathology lab (I did not consent to these fees). However, I did sign the standard forms in the beginning before seeing the doctor that basically give your soul to the doctor.


If I cannot afford to pay can I take the credit hit? Will the debt + interest follow me around forever?


Is there anything else I can do besides reach out to the doctor and the lab?

Do these test costs seem reasonable?
I find this kind of odd, because (at least in residency) if we prescribed a medication or ordered a test that wasn't covered, we'd get a call from the clinic staff, insurance company, or pharmacy. At least in the outpatient clinic world, it seemed like everyone had to be sure a service would be covered before a patient could get it, unlike inpatient settings where you do things first and ask questions later.
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Re: Expensive med. test not covered by insurance

Post by testing321 »

Wow, this is an old thread that someone revived.

I once had a charge denied and then called the insurance company and got them to at least run the charges through the system so that I could get the discount. The lady said "oh, you just want to get the discount? Ya, we can do that." They still paid nothing, but at least I paid next to nothing after the discount.
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