Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

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EnjoyTheJourney
Posts: 106
Joined: Sat Nov 17, 2018 8:36 pm

Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by EnjoyTheJourney »

After an eight month long battle with our insurance company, it looks like we won't get a vitamin D test previously done covered by insurance after all, even though the test showed the presence of a vitamin D deficiency and a symptom of a potentially out of range vitamin D value was present. The grounds for a claim of medical necessity were narrow, which ended up being the key obstacle.

So, now the bill needs to be paid. By us. Unfortunately, the bill is about triple or quadruple the going rates that I've found online for vitamin D tests (the invoice is for slightly over $240).

Advice / experiences about negotiating the bill down for a test like this to be more in line with prevailing rates would be helpful and most appreciated.

Thank you in advance for any assistance offered.
runner3081
Posts: 3822
Joined: Mon Aug 22, 2016 3:22 pm

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by runner3081 »

Yes, call and ask them if they will offer a prompt-pay discount.

If they say no, ask for a payment plan. At a minimum, the payment plan will give you an interest free loan. However, we are talking about such a tiny amount, a payment plan likely wouldn't be offered.
Topic Author
EnjoyTheJourney
Posts: 106
Joined: Sat Nov 17, 2018 8:36 pm

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by EnjoyTheJourney »

As a resource some might helpful, I found a recommendation to visit two different websites to check on fair prices for different health services: Health Care Bluebook and FAIR health. I checked on both websites and by entering the CPT code and the description of the test I found helpful information.

Here is a link to the Healthcare Bluebook information for the test in question:

https://www.healthcarebluebook.com/ui/p ... tails/L885

The short summary is that we're being billed almost five times the listed "fair" price ($51) and almost twice the highest listed price ($128) for the same procedure, for providers in our zip code. I also noticed that the insurance company got about a 90% discount on the price listed for other tests done together with the vitamin D test; the provider is highly likely to be making money on those tests, even at a 90% discount. But, no discount is being offered for the vitamin D test for us.

Typically, we take pride in always paying our bills and our credit rating reflects having a perfect payment record. We virtually never bother with negotiating over bills, as long as we don't see errors. But, the level to which we're being overcharged for this procedure is quite disappointing. I'll be negotiating with the provider about this bill.

In case some are curious, and want to know which provider to be careful about, it was Quest Diagnostics that sent us the inflated bill.
jmorgans
Posts: 83
Joined: Mon Nov 03, 2008 9:53 am

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by jmorgans »

It’s not just Quest. It’s almost every provider of medical care in this country. The business model is to give a fair deal only to insurance companies. Everyone else they attempt to price gouge. Your best position to negotiate is before the test is done. Of course at that point you may not know whether it’s covered or not.

All of that said, I’m surprised your insurance is refusing to cover a vitamin D level. This is not an uncommon, unusual, expensive, experimental, or exotic test!

It is possible they would change your mind if your physician changed the diagnosis code on your lab order...
Hiker-Biker
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Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by Hiker-Biker »

I cannot provide any advice on negotiating the price. However, once my Vitamin D deficiency was controlled by taking daily Vitamin D 2000 IU supplements, my primary care physician and I agreed that testing was no longer necessary as insurance did not cover it.
Colorado13
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Location: Colorado

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by Colorado13 »

I sense your frustration and would ask for a discount and if this is not granted, just pay it and move on. I don't like spending "extra" money either but you received a service so should pay for it. I am guessing this will not have a substantial impact to your net worth? Your time is likely worth more than the time and frustration you could spend on this. Good luck!
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8foot7
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Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by 8foot7 »

I have almost zero tolerance for being screwed and my credit rating is nice but not something I will allow to be held hostage in order to get bent over.

I would offer to pay double the going rate in a nice but firm letter explaining your situation and the research on price you have done, not admitting in any way the amount you have been billed is legitimate. I’d offer to pay it immediately upon acceptance of your offer in writing. Perhaps put a 60 day time limit on your offer. If they do not accept or do not respond, I would pay nothing.

You can dispute any eventual credit reporting and ask for validation.

Others may recommend a different approach but I simply refuse to just pay extortionate amounts because of the threat of what is essentially regulated blackmail. You may well have a different risk tolerance.
sport
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Location: Cleveland, OH

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by sport »

My doctor told me to get a vitamin D test a few years ago. When I went to the lab, before they took the sample, they told me that the test would not be covered by insurance and it would cost about $96 IIRC. They also had me sign a paper that I agreed to pay that amount if insurance would not cover it. So, I knew up front what might happen. It seems the OP needs to use a different lab going forward.
Topic Author
EnjoyTheJourney
Posts: 106
Joined: Sat Nov 17, 2018 8:36 pm

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by EnjoyTheJourney »

Colorado13 wrote: Fri Jul 10, 2020 12:20 pm I sense your frustration and would ask for a discount and if this is not granted, just pay it and move on. I don't like spending "extra" money either but you received a service so should pay for it. I am guessing this will not have a substantial impact to your net worth? Your time is likely worth more than the time and frustration you could spend on this. Good luck!
Thank you*

In the end I took your advice. It looks and feels less than pleasant to pay rip off prices for a commodity service. But, our "to do" list is too extensive to have this specific issue taking up even more time and energy.

I'll settle for never doing business with Quest Diagnostics again.

* as well as others with differing perspectives to offer
jjbiv
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Joined: Sun Sep 18, 2011 8:23 pm

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by jjbiv »

Here, Quest is one of the most transparent health care companies i have dealt with. They provide the cost of each test up front and attempt to collect payment for the portion the patient is responsible for at the tine of service.

Does your insurance not have a negotiated rate for this test? You should still get the benefit of paying that rate even if you are paying and the insurance company is not. For instance, we have a high-deductible insurance plan with UHC and this test would cost us $26 in our area. It sounds like Quest billed you the full rate for this test, not the discounted rate. Is Quest an in-network provider for your insurance?
BogleMelon
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Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by BogleMelon »

I had a similar experiance where my primary doctor ordered Vitamin D test for having a history of low levels of it.
Insurance denied the claim and said it is no longer covered. I don't remember how or who told me this (back then), but I remember I learned somehow that the primary doctor's office team must have screwed up the medical code and should have used another code that would have been approved (they should put some kind of diagnostic code rather than checkup). I then called back the doctor's office, explained it to them, and in couple of days or maybe a week the problem was fixed and they resubmitted to the lab under a different code so the lab got his claim approved.
Try to call your doctor and explain to his team that you have a deficiency and make sure they used the right code, not the "regular checkup" code.
"One of the funny things about stock market, every time one is buying another is selling, and both think they are astute" - William Feather
Mapmaker
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Joined: Sat Aug 25, 2018 10:16 am

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by Mapmaker »

I’m not taking any medication, and since my PCP has a waiting time of four months for a routine visit, I order the basic cholesterol, thyroid, etc. bloodwork for myself every year from DirectLabs and have the work done at Quest. Cost is around $110. Results in a few days. It’s worth it to me.
https://www.directlabs.com/mobile/Home/ ... fault.aspx
They have eight Vitamin D tests ranging from $49 to $129.
JPM
Posts: 171
Joined: Sun Aug 19, 2018 2:29 pm

Re: Looking to negotiate a price reduction for a vitamin D test invoiced about triple or quadruple the going rate

Post by JPM »

Was the test a 1,25 dihydroxy vitamin D determination (pricey) or a 25-hydroxy vitamin D determination (should be inexpensive, $40-60 range)? The 25 hydroxy vitamin D level is commonly done and is generally covered once or twice yearly if vitamin D deficiency is the matching diagnosis on the lab order, but often not if a preventive service is the matching diagnosis. Medicare allows the 25 hydroxy vitamin D to be covered once yearly for the followup of an established vitamin D deficiency diagnosis or an osteomalacia or osteoporosis (bone disorders that may involve or be aggravated by vitamin D deficiency) diagnosis. There are other less common diagnoses that will match the 25 hydroxy vitamin D test for coverage.

When a doctor orders a medical test, the order has to attach an alphanumeric diagnostic code that matches and justifies the test. The doctor generally does not know what specific insurance plans do or do not cover at a particular time. When a private clinic, our clinic dealt with over 600 plans with each having shifting coverage policies. Large multistate integrated systems (e.g. Mayo, Intermountain, Advocate-Aurora) and their employed or affiliated doctors may deal with perhaps many hundreds more of different plans. If the diagnosis code does not match the test, the test is generally not covered and once notified of the coverage problem, the doctor usually will resubmit the test order with a corrected diagnosis to obtain appropriate coverage. In some offices, the doctor does not do his/her own diagnostic coding to finish the order and it is done by an assistant or nurse, allowing for communication failures between the doctor and assistant in regards to what is meant by "vitamin D level" when as mentioned previously there are multiple iterations (each iteration carrying a different price) of "vitamin D level".

The 1,25 dihydroxy vitamin D level is seldom ordered and is ordered only for a limited and unusual set of diagnoses. It is seldom ordered except for certain disorders of vitamin D metabolism. If OP had this test ( or another uncovered iteration of the vitamin D level) ordered and performed, the problem probably originated in the doctors' office and not the lab.

If the lab specimen is drawn in the doctor's office, the phlebotomist may catch the testing or coding error/mismatch and the doctor, once notified, can change the test order or the matching diagnosis code on the spot, but if the specimen is drawn at an outside facility or hospital lab, the doctor will generally not be alerted to the problem by the phlebotomist.
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