[dee777]

Lab costs and insurance coverage

by dee777 on Sat Dec 21, 2013 10:57 am

When I went for a bone marrow biopsy November of 2012, my then oncologist sent my labs out to a lab in California, I am in Virginia. I had not even been told my diagnosis, and he did this and they were out of network. I just received my explanation of benefits from my insurance, and I don't know why a year later. They are not covering most of the costs. It shows I will be owing $20,855.03.

Once I was diagnosed, I went to another doctor and am being treated by a doctor in New York City. I called that oncologist's office and asked them what the labs were and for, and they said they don't know. I asked why they were sent out of network, and they said they don't know. They asked if I had something to show these costs, and I sent them copies and they said the oncologist has them. I asked if I would get a call back, they said they don't know. They don't know anything. I don't know what these charges are for. My new doctor doesn't have these labs. She doesn't know what they could be or feel she needs them.

When we get the bill we will have to file for bankruptcy.

Has any one else experienced this? How can a doctor just do whatever with my money? How can I not even get the labs or results for what was done? How is it no one knows anything?

[Dianem]

Re: Lab costs and insurance coverage

by Dianem on Sat Dec 21, 2013 2:04 pm

Hi dee 777,

Sorry to hear what you are going thru. I had a similar problem in January 2012 when diagnosed with MGUS. The bone marrow biopsy was over $20,000 and our insurance covered what they believed was 'reasonable and customary.' At the time, our deductible was about $5,000, and insurance didn't cover some of the testing. Found lots of mistakes and some tests run 3 times. The billing department at the lab didn't understand my questioning of the tests / costs / duplications and offered no explanation and didn't return calls, but kept sending bills stating if we didn't pay they would contact a bill collector. Eventually we just paid it. Lots of dysfunction.

In our case since the passage of the AHCL, our premiums, copays, deductibles are much higher. Now, insurance covers less of the costs than before. If I need another bone marrow biopsy, I will make sure the doctor only orders what is reasonable / customary, and confirm with insurance what they will cover. Or, maybe just go to Canada and pay out of pocket!

Good luck, Diane

[Multibilly]

Re: Lab costs and insurance coverage

by Multibilly on Sat Dec 21, 2013 2:17 pm

Dee,

I'm so sorry to hear about this situation.

First, under US federal law, you have the right to copies of all medical lab reports. Doctor's offices have 30 days in which to respond to a request for records.

I'm afraid you might be out of luck on the bill for the lab tests. Ultimately, it is the patient's responsibility to get pre-authorization for any procedure.

HOWEVER, given that the doctor's office hasn't been responsive in getting you a copy of the lab tests, I might suggest contacting a lawyer before you take any further action. You might be able to parlay this lack of response into an overall case against them regarding going out of network without so much as a heads up from them, especially if the specific tests may not have been warranted in your particular situation and/or the doctor didn't tell you that they were performing these tests.

If you have any further communications with the doctor's office, I'd also suggest recording those conversations.

Lastly, if you are low-income, many cities have great free legal services available to their citizens. One of my relatives used such a service in a California city and the lawyer he worked with was just a godsend and was extremely competent and caring.

Best of luck to you.

[dee777]

Re: Lab costs and insurance coverage

by dee777 on Sat Dec 21, 2013 4:51 pm

Thank you. Well, I don't know how I can get preauthorization when I was in recovery from the bone marrow biopsy. By the way, these costs are not related to the bone marrow biopsy, we paid the hospital. We don't know what the labs are for. I called the hospital and they said he wanted them to do something they couldn't and he ordered them to be sent away to California, and I can't find what they were for. Yes, if I am paying for them, I should have copies and told what they are and they won't give me that information.

Right now I filed a complaint with the health Insurance bureau in our state since he was in network and trying to get them pay for it. It will take a while till I hear back from that, but they did state I may need to get a lawyer.

There is no way we have that kind of money, and I am not paying for something I have no record of and no one knows what it was for and the insurance company told me it was unnecessary labs. Like I said, there is always bankruptcy, let them get the money from that doctor.

[dee777]

Re: Lab costs and insurance coverage

by dee777 on Sat Dec 21, 2013 4:59 pm

You know, it is a shame to get a diagnosis of cancer and then a doctor see dollar signs and run up the tab and force some one in bankruptcy. I am sure he was planning to treat me and he saw the money rolling. Cancer is big business isn't it?

[dee777]

Re: Lab costs and insurance coverage

by dee777 on Sat Dec 21, 2013 5:13 pm

Multibilly, how do you set up for preauthorization? Do you tell the doctor the first visit and have him sign something?

[Multibilly]

Re: Lab costs and insurance coverage

by Multibilly on Sat Dec 21, 2013 6:28 pm

It's not something one signs up for, at least in my experience. It's just whenever I have had any sort of expensive procedure (MRI, PET/CT, x-ray survey, colonoscopy, bone marrow biopsy, or surgery, etc), the facility I've used always has done a pre-authorization. In reality, I think they probably do this just to be sure that they get paid in the end as opposed to being a service to the patient. And it isn't mandatory or required that they do a pre-authorization. In the case of the more expensive procedures, most of these facilities also ask for my expected co-insurance payment based on the pre-authorization when I show up for the procedure.

If there is ever a question on whether insurance would cover something, I also ask for a pre-authorization. As an example, I recently asked if my oncology clinic could do a pre-authorization on a DEXA scan I am going to get next month. I asked for this because I had one done a year ago and want to be sure that insurance doesn't have some sort of a limit on the number of DEXA scans one can have done in a certain period of time.

I know this doesn't help you in your current situation, but I hope it can help you or somebody else going forward.

[dee777]

Re: Lab costs and insurance coverage

by dee777 on Sat Dec 21, 2013 8:09 pm

I did that Multibilly with the hospital when I had the bone marrow biopsy done, I paid the co pay up front. This is something he did separate and did not alert me of it or the hospital. I think I have a good lawsuit.

[dee777]

Re: Lab costs and insurance coverage

by dee777 on Sat Dec 21, 2013 8:13 pm

You know the more I think about it, we haven't received a bill all year, no one knows anything about it, what are the chances the lab is trying to defraud the insurance company? That may be why the doctor's office doesn't know anything about it. Hhmmmmm.

[Sheila Morris]

Re: Lab costs and insurance coverage

by Sheila Morris on Thu Jan 12, 2017 4:23 pm

You have every right to get copies of those lab tests, which, by the way, should have been bundled into your bone marrow biopsy. There is something strange with this, as the hospital where I work gets a maximum payment of maybe $3,000 to $5,000 max. Also, all of the cancer testing done off of that biopsy is included.

Stay on this and maybe get an attorney? Yikes!