Page 1 of 1

Medical Lab Fees - Not Covered

Posted: Tue Feb 13, 2018 11:42 am
by cyfairslam
I and my family have had a number of medical doctor visits over the last year. I go to the medical practice that is within my plan. (Aetna)

The doctor performs his work under the cost structure of the Aetna plan.

However, I will receive bills from labs etc. months after my visit/procedure.

Is there anyway to force the labs to bill in accordance with the Aetna plan....or negotiate the bill accordingly?

Re: Medical Lab Fees - Not Covered

Posted: Tue Feb 13, 2018 11:46 am
by dm200
cyfairslam wrote:
Tue Feb 13, 2018 11:42 am
I and my family have had a number of medical doctor visits over the last year. I go to the medical practice that is within my plan. (Aetna)
The doctor performs his work under the cost structure of the Aetna plan.
However, I will receive bills from labs etc. months after my visit/procedure.
Is there anyway to force the labs to bill in accordance with the Aetna plan....or negotiate the bill accordingly?
Do these labs submit for insurance - and you get an EOB about what is and is not covered by insurance?

Re: Medical Lab Fees - Not Covered

Posted: Tue Feb 13, 2018 11:56 am
by lthenderson
cyfairslam wrote:
Tue Feb 13, 2018 11:42 am
I and my family have had a number of medical doctor visits over the last year. I go to the medical practice that is within my plan. (Aetna)

The doctor performs his work under the cost structure of the Aetna plan.

However, I will receive bills from labs etc. months after my visit/procedure.

Is there anyway to force the labs to bill in accordance with the Aetna plan....or negotiate the bill accordingly?
I'm not sure I understand your question? Do the doctor and the lab work for the same organization? These days doctors and labs are commonly separate organizations with separate billing. I had a medical procedure done in November and I have received four different bills from four different entities for their part in the procedure. All ran through my insurance but all had residual amounts that I had to pay.

Re: Medical Lab Fees - Not Covered

Posted: Tue Feb 13, 2018 11:59 am
by dm200
In several previous plans, different insurance companies required certain labs be used for their coverage. I recall that our previous Primary Care Physicians had a sign in the exam rooms listing which insurance companies covered which labs. Then, you would have to travel to that lab (the one covered by your particular insurance) to get the blood drawn.

Re: Medical Lab Fees - Not Covered

Posted: Tue Feb 13, 2018 12:00 pm
by dm200
I'm not sure I understand your question? Do the doctor and the lab work for the same organization? These days doctors and labs are commonly separate organizations with separate billing. I had a medical procedure done in November and I have received four different bills from four different entities for their part in the procedure. All ran through my insurance but all had residual amounts that I had to pay.
Yes - this has often become common.

Re: Medical Lab Fees - Not Covered

Posted: Tue Feb 13, 2018 7:13 pm
by jayjayc
I've had the same issue with medical lab billing and Aetna. Fixing a billing mistake is nearly impossible. Try logging into the Aetna site and finding the labs that are covered. I've since gone to a 3rd party lab (Quest Diagnostics) and found them to reliably bill my insurance correctly. They're also very inexpensive if you have any out of pocket costs.

Re: Medical Lab Fees - Not Covered

Posted: Tue Feb 13, 2018 7:33 pm
by Mitchell777
jayjayc wrote:
Tue Feb 13, 2018 7:13 pm
I've had the same issue with medical lab billing and Aetna. Fixing a billing mistake is nearly impossible. Try logging into the Aetna site and finding the labs that are covered. I've since gone to a 3rd party lab (Quest Diagnostics) and found them to reliably bill my insurance correctly. They're also very inexpensive if you have any out of pocket costs.
This would be my suggestion also. Quest Diagnostics and Aetna have an agreement. I must use Quest Diagnostics or be billed for the lab tests. I sometimes have doctors that want to keep me in their hospital network even though the results come no more quickly so I need to be sure I know where the specimens are going or I need to visit a Quest Diagnostics PSC.

Re: Medical Lab Fees - Not Covered

Posted: Tue Feb 13, 2018 10:11 pm
by mariezzz
Be aware: you need to know the specifics of YOUR policy. The fact that someone else has Aetna & under their policy, Quest is a 'preferred' lab, does NOT mean that you can assume that is the case under YOUR policy. You have to read your documents & try to verify (which isn't easy, and they could give you the wrong information).

YOUR coverage terms are specific to YOUR policy.

If you go to a lab outside your doctor's office: your doctor can give you the lab forms for whatever lab they have them for. You take those to Quest (or other lab) & they figure out what their codes/test name are. If they're in doubt, they will call the doctor's office. You can drop off the lab request forms at Quest a day early if you want to be sure you won't be waiting a long time while they figure out the details (it usually doesn't take a long time, but could if they have to call your doctor's office). There can also be waits at Quest (making an appointment will help).

In a way, you trade the convenience of having the test done at the doctor's office for the lower price. But at times, that savings can be significant. Another thing I'll say: in my experience, phlebotomists at Quest are better than the nurses at almost doctor office at getting blood. At Quest, they never have to try again.

============
The lab your doctor's office uses may not be 'in network' or a 'preferred provider'. In my insurance, I have 15% co-pay if I use a lab with the best coverage (Quest) and 50% co-pay if I use any other lab that is allowed at the lower coverage rate.

Be aware that lab companies frequently initially bill at rates much higher than what is 'allowed' by insurance companies who have negotiated rates with that company.

In recent years, I've had a lot of lab tests (dozens of different tests) & started keeping track of what Quest bills initially, and what is 'allowed' by my insurance company. I pay 15% of the 'allowed' amount.

The initially-billed rate (which is what anyone would be expected to pay, if their insurance company hasn't negotiated lower rates) is on average, EIGHT times the amount allowed by my insurance company (I've had 2 different insurance companies in the time since I started keeping track of this). The actual different varied as a function of the test conducted - the lowest initially billed amount was about 3 times the 'allowed' amount; the highest was about SIXTEEN times.

A lot of people aren't aware of how much higher the initially billed amount is, compared to the amounts some insurance companies negotiate with the lab company. It also pays to have an insurance company that negotiates well. I've had friends in HMOs who think their coverage is fabulous because they only ended up paying $15 for a test that was billed at $100, whereas I paid something under $3 for the same test done through Quest, with 15% coinsurance on the lower 'allowed' amount negotiated by my insurance company.

It's a bit of a scam that lab companies can bill cash payers so much more than what they negotiate as 'allowed' amounts with insurance companies.

Re: Medical Lab Fees - Not Covered

Posted: Wed Feb 14, 2018 12:55 am
by toofache32
mariezzz wrote:
Tue Feb 13, 2018 10:11 pm

It's a bit of a scam that lab companies can bill cash payers so much more than what they negotiate as 'allowed' amounts with insurance companies.
It's not a scam. It's negotiation. When I was an in-network doctor, cash patients would sometimes ask for "the insurance rate". I told them I would be happy to give them the insurance rate if they give me what insurance companies give me....10+ new paying patients each week.

My neighbor owns a car dealership. There is a local business that buy 3 new pickups every month so he gives them a lower negotiated rate. I cannot get that rate because I don't buy 3 trucks every month.

I bet if you give blood every week to the lab they will happily give you a lower rate.

Re: Medical Lab Fees - Not Covered

Posted: Wed Feb 14, 2018 1:23 am
by Pajamas
mariezzz wrote:
Tue Feb 13, 2018 10:11 pm
Be aware: you need to know the specifics of YOUR policy. The fact that someone else has Aetna & under their policy, Quest is a 'preferred' lab, does NOT mean that you can assume that is the case under YOUR policy. You have to read your documents & try to verify (which isn't easy, and they could give you the wrong information).
Agreed, review your in-network provider information and confirm with the insurance company. You can always tell your doctor that the lab he or she is using isn't giving you the best price and that you would prefer to use another lab contracted under your health coverage.

There has been a trend towards splitting off facility and lab services into separate bills and even assigning them co-pays when they were included in one bill previously even in-network. It can come as a surprise. I am even thinking about switching to a different health care system because of problems with this.

Re: Medical Lab Fees - Not Covered

Posted: Wed Feb 14, 2018 9:07 am
by jeffyscott
toofache32 wrote:
Wed Feb 14, 2018 12:55 am
It's not a scam. It's negotiation. When I was an in-network doctor, cash patients would sometimes ask for "the insurance rate". I told them I would be happy to give them the insurance rate if they give me what insurance companies give me....10+ new paying patients each week.

My neighbor owns a car dealership. There is a local business that buy 3 new pickups every month so he gives them a lower negotiated rate. I cannot get that rate because I don't buy 3 trucks every month.
I doubt that you will pay double what that business pays for the same truck. In addition, you will know what you are going to pay before you decide to buy the truck.

Re: Medical Lab Fees - Not Covered

Posted: Wed Feb 14, 2018 11:24 am
by Mitchell777
Of course check your own insurance policy. I thought that went without saying. I think you'll find Quest is the national pref lab for all products, but there are other in network labs. You just need to know the effect on your out of pocket

Re: Medical Lab Fees - Not Covered

Posted: Wed Feb 14, 2018 11:34 am
by patholoraptor
Believe me, virtually every lab *wants* to be in network with every insurance company. The insurance companies won’t allow certain labs into their network based on a number of stated rationalizations about quality, but the actual reason is that it is simply more costly for them to have more labs in-network, and they prefer to work with one or two giants (LabCorp, Quest) who can afford extremely low negotiated rates because of economies of scale. This is called a “narrow network” strategy if you’re interested in looking into it further.

If the lab work has already been done, your primary recourse is to contact the lab and attempt to negotiate your bill. This is actually helpful in many cases. There are strict legal limits on what the labs can write off—they cannot legally simply make your bill disappear—but in most cases they will *want* to help you avoid an exorbitant lab bill, and have various strategies to achieve that. I would also recommend complaining directly to your insurance company, to your employer (assuming you have employer-provided insurance), and to your elected officials.

Re: Medical Lab Fees - Not Covered

Posted: Wed Feb 14, 2018 12:37 pm
by dm200
Mitchell777 wrote:
Wed Feb 14, 2018 11:24 am
Of course check your own insurance policy. I thought that went without saying. I think you'll find Quest is the national pref lab for all products, but there are other in network labs. You just need to know the effect on your out of pocket
With a previous Endocrinologist, I had several choices (under my insurance) of labs. That Endocrinologist felt very, very strongly pressed me to use Quest because she believed their test results were more reliable.