#UnexpectedMedicalBill #LabTesting #InsuranceIssues #MedicalCosts
Hi there! 😊 Dealing with unexpected medical bills can be incredibly frustrating and stressful, especially when you thought you were following the right steps by seeing an in-network provider. In situations like the one you’re facing after getting a lab test ordered by your doctor, it’s important to know that you do have options available to help alleviate some of the financial burden. Let’s dive into some steps you can take to address this issue and hopefully reduce the amount you owe out of pocket.
**Understanding Your Medical Bill**
The first step in tackling this unexpected expense is to carefully review your medical bill. Requesting an itemized bill from the provider allows you to see exactly what services were performed and how they were billed. This can help you identify any errors or discrepancies that could be contributing to the high cost.
**Contact Your Insurance Carrier**
After reviewing your bill, reach out to your insurance carrier to discuss the charges and your coverage. Provide them with the itemized bill and ask for clarification on why certain services were not covered or why you are responsible for such a large portion of the bill. Your insurance company can help you understand your benefits and potentially negotiate with the provider on your behalf.
**Negotiate with the Provider**
Don’t be afraid to reach out to the provider or lab that performed the testing to discuss your bill. Many healthcare providers are willing to work with patients to establish payment plans or reduce the overall cost of services. Explain your situation and express your concerns about the unexpected expense. You may be able to negotiate a lower payment amount or set up a payment plan that fits your budget.
**Appeal the Insurance Decision**
If your insurance carrier denies coverage for certain services, you have the right to appeal their decision. Gather any supporting documentation that may help prove the medical necessity of the lab testing ordered by your doctor. This could include notes from your physician, test results, or other relevant information. By appealing the insurance decision, you may be able to have some or all of the costs covered by your insurer.
**Seek Financial Assistance**
In some cases, healthcare providers offer financial assistance programs to help patients who are struggling to pay their medical bills. These programs may be based on income level or other factors, so be sure to inquire with the provider about any assistance options that may be available to you. Additionally, there are nonprofit organizations and foundations that provide financial assistance for medical expenses.
**Prevent Future Surprise Bills**
To avoid similar situations in the future, it’s important to be proactive about understanding your healthcare costs. When scheduling appointments or procedures, ask your healthcare provider for an estimate of the expected costs and what your insurance will cover. Consider shopping around for services to compare prices and find the most cost-effective options.
In conclusion, you’re not alone in facing unexpected medical bills, and there are steps you can take to address the situation and potentially reduce the amount you owe. By reviewing your bill, contacting your insurance carrier and provider, appealing insurance decisions, seeking financial assistance, and being proactive about understanding your healthcare costs, you can navigate through this challenging situation. Remember, it’s always worth advocating for yourself and exploring all available options to mitigate the financial impact of unexpected medical expenses. Don’t hesitate to ask for help and support along the way. You’ve got this! 💪
If you need further guidance or assistance, feel free to consult with a financial advisor or healthcare advocate who can provide personalized advice based on your specific circumstances. Take care, and best of luck in resolving this issue! 🌟
Although this deals with money, this is much more an insurance question that a personal finance question.
Try asking over in the other subs and I am sure you will get some good advice for triaging your situation.
First start off by looking at your EOB (explanation of benefits) and find out what your deductible is.
For the future, I would like to point you to the Transparency in Coverage Act which requires your insurer to provide personalized out-of-pocket costs to you for all services. Here is some text from a CMS (Center for Medicare & Medicaid Services) press release:
>First, most non-grandfathered group health plans[2] and health insurance issuers offering non-grandfathered health insurance coverage in the individual and group markets will be required to make available to participants, beneficiaries and enrollees (or their authorized representative) personalized out-of-pocket cost information, and the underlying negotiated rates, for all covered health care items and services, including prescription drugs, through an internet-based self-service tool and in paper form upon request. For the first time, most consumers will be able to get real-time and accurate estimates of their cost-sharing liability for health care items and services from different providers in real time, allowing them to both understand how costs for covered health care items and services are determined by their plan, and also shop and compare health care costs before receiving care. An initial list of 500 shoppable services as determined by the Departments will be required to be available via the internet based self-service tool for plan years that begin on or after January 1, 2023. The remainder of all items and services will be required for these self-service tools for plan years that begin on or after January 1, 2024.
[https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f](https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f)
Sounds like a deductible issue, so depending on how much care you’ll need this year it may just mean more coverage later. But always start with the EOB, make note of anything shown there suggesting there was a cap or limit on what was covered for some reason.
There’s a lot to unpack here about how your insurance works, and what happened during this visit.
To start, under the No Surprises Act, if you were not informed of and did not consent to an out-of-network lab being used while visiting an in-network provider, the law limits the amount you should have to pay out of pocket to an amount that is comparable to what you would have paid if it were in-network.
So you need to figure out if you did consent to out-of-network billing. This would have been a disclosure that you signed prior to the visit. The rules around this are pretty specific to protect you (the document can’t be bundled with others, how far in advance it has to be made available, etc). However there is still some onus on you to ask questions about in-network vs out-of-network services when scheduling or prior to the date of service.
If you didn’t sign anything and weren’t given any notice or opportunity to ask, then the next thing you need to figure out is whether this out of network bill actually was already reduced to protect you.
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>I’ve already asked for an itemized bill and received it.
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What was the CPT code for the procedure? You can find this on the itemized bill, or it might be on the Explanation of Benefits document generated by your insurer for the visit after the claim was submitted and paid.
For example, looking at my insurer’s estimation tool, if it was an allergy test submitted as;
“Other allergy or clinical immunology service or procedure (CPT 95199)”…
the in-network cost for that under my plan would be $2250. And since I haven’t hit my deductible yet for the year, that would be my out of pocket cost. Other complex or unusual tests could have similar pricing.
Which is to say, you may have just had an expensive test, whether in-network or not.
Sadly this is how healthcare works here. I recently had some testing done. I arranged everything beforehand, with insurance and the hospital, got full up front pricing, and PREPAID for the entire procedure. It was supposed to be $1,500, total out of pocket cost to me based on my insurance and deductible verified by multiple people.
What did the hospital bill my insurance? $17,000. That’s not a typo. The bill showed a bunch of “adjustments” and the full cost was $7k after all that, 2 paid by my insurance and 5 to me, so they came after me for the balance after what I’d already prepaid.
Nothing went wrong, nothing was unusual, and the procedure went exactly as they expected. They just decide to bill whatever the F they want.
Healthcare here is BROKEN.
call your insurance company and tell them you were not offered a choice of where to get the lab tests done.
And that you want to know if you can fill out a form declaring that, and then they can tackle the issue.
There are provisions for when a patient isn’t offered a choice, but you have to declare that to be the case.
Also, if after the insurance company deals with them, they come back and bill you for the balance (“balance billing”), you should absolutely contact your insurance company again and ask them what comes next. Because there’s a plan for THAT as well.
(The biggest place I see it is in anesthesia, because almost no anesthesiologists are members of a plan.)
If all else fails, call the lab and ask for a payment plan. For me and my family, what it would mean is simply that I am closer to hitting my deductible. It would be a cashflow issue.
You need to understand how they are covering things . Look at your explanation of benefits . Either you have a very high deductible, or very poor coverage for labs . For in network it is extremely unlikely that of the 3000 billed all 3000 is the allowed amount. The contract rate for labs is a fraction of what is billed. The only way I can picture the lab billing for the full amount is if some portion of your services was completely not covered – or deemed medically not necessary and you are being fully billed for the service . More info is needed .
Was the cost related to it being out of network?
If so, speak with your insurance. You may be able to file a surprise cost form if you have laws in your state protecting you
Did you get a bill or an EOB?
I will also recommend applying for financial assistance to help lower your cost. If you get denied, you lose nothing and can set up a payment plan. If you get accepted, at least a portion of your bill will be forgiven and you can set up payments on the rest. You may be surprised how high the income caps are.
Also check with your insurance whether it would have made a difference if you had gone to a particular lab they use. For example my old health insurance used to use Quest Labs and if I went there I did not get a bill. But if I had a test done at a doctors office that had their own lab that was “in network“ I would get a bill.
Even with a large deductible, your insurance carrier would have negotiated rates. You shouldn’t have to pay a “full” remaining balance when they are in network. I would call and ask your insurance to look up your fee schedule for the provided codes and see what it says. Also, did you know you can negotiate? Look up the Medicare allowed amounts for the same codes. Tell them you won’t pay more. Look up the Medicaid fee for service allowed amounts. If they will accept those amounts from them, why not from you? 😉
Ask your insurance how much you are supposed to pay for blood draws like this. My immediate assumptions are that one of two things happened. Either 1) you still needed to pay your deductible for the year or 2) your coinsurance is very high for lab tests. It’s good to be familiar with how much you pay for different services with your insurance prior to getting services. It could also be a mistake that could be rectified.
> I suspect I’ve learned a costly lesson about asking up front what the estimated cost of any treatments will be
Medical care providers often don’t know what the costs are.
> I suspect I’ve learned a costly lesson about asking up front what the estimated cost of any treatments will be
Medical care providers often don’t know what the costs are. This is something to ask billing or insurance.
> I suspect I’ve learned a costly lesson about asking up front what the estimated cost of any treatments will be
Medical care providers often don’t know what the costs are. This is something to ask billing or insurance.
Also medical debts has a ton of legal limitations on how it can affect your credit and the ways people can try to collect on it.
In my area, the hospitals were considerably more expensive for lab and diagnostic work than private labs. It took calling around and asking for prices to figure that out when I needed some imaging done. And then insurance changed my benefits and some hospitals got cheaper for me and private labs got more expensive. It’s exhausting to keep track of and an expensive lesson to learn, but it’s where we are at with healthcare in the US. So, before any procedure you have to ask the provider about the cost to you. If it’s exorbitant then you can look elsewhere, assuming it’s not urgent.
And as others have said, contact the hospital to question the charge and not being told the cost (they won’t care but it’s nice to let them know it’s a shitty thing to do to people), and inquire about relief and/or a payment plan. (Insane that this is our system and we have people fighting tooth and nail to keep it this way.)
Call the hospital and ask them what the payoff amount would be if you paid that day. Odds are they will come back to you with a much lower number, maybe even $200-300 dollars. Stress to them it is a massive hardship and they tend to be fairly reasonable. You’ll want to speak to someone in payments or the business office.
even if you had asked the cost of any medical procedure or test, nobody would give you an answer anyway, unless you find someone in a hidden accounting room that would even tell you.
This exact thing cost me $1500 out of pocket unexpectedly several years ago as well! I came back to the doctor and tore them a new one for not warning me. The doctor confessed that they have no idea what things will cost…
I see these way too much. Is it too much to ask to REQUIRE providers be up front with the expenses we will incur. They already have our insurance and coverage details. Nobody should be shocked at a bill like this. Ridiculous
Ask them if you can setup a payment plan?
Can you clarify if the lab was also in network? if the bill is high because of not being in network you may have rights under the no surprises act since your provider was in network.
contact your insurance company and ask.
Medical is a huge Burden. Tey to get a payment plan
I’m surprised your ENT office didn’t give you any information about allergy testing re: insurance coverage. My ENT had a whole packet about it, with procedure codes and everything so that you could check with your insurance company prior to testing. I think I had to sign paperwork and everything saying I understood. Hope you get everything figured out and don’t end up owing all that. My allergy testing was only $350-450 after insurance.
Also the provider could be in network but the convenient lab in the building is not. My doctor has a lab corps in the building but I have to go to a quest
>I suspect I’ve learned a costly lesson about asking up front what the estimated cost of any treatments will be
Just remember that neither the health care vendor nor the insurance seller can tell you how much <*something_here*> is going to “cost” you or anyone else. Exceptions: you’re at the VA, you’re a Medicaid enrollee in “[blue](https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/),” you’re a traditional Medicare enrollee under some very specific conditions for now but not for long, or you’ve already managed to maximum OOP yourself on buying necessary, “IN covered services …” health care for the coverage period.
Your concerns and focus in trying to receive necessary health care are:
1. How much am I required to deduct and spend in USD, from my pockets of my money, on necessary, “IN covered services …” health care before the insurance seller does $.01 worth of the same with its revenue?
2. How much maximum OOPing in USD am I required to achieve in a coverage period before I can receive necessary, “IN covered services …” health care that is 100% pre-paid at the point of sale?
The insurance seller doesn’t care if you achieve one or both with a one-time, one-off purchase, or 365 purchases over 365 days of the coverage period.
>I’ve already asked for an itemized bill and received it
And then? “Itemized bill” spell doesn’t work as well as its touts say it does or believe it does. What it does do is save professional, 3rd party, retroactive, retail health bill fighters a first punch if you’ve already hired those in or plan on hiring them in to fight the insurance seller, the health care vendor(s), or both simultaneously on your behalf.
They’ll appreciate you for it because consumer-driving in reverse gear is slower and harder than consumer-driving in a forward gear, and forward gear consumer-driving only works in 2 scenarios anyway: inelastic markets and the marketing materials that drive you toward them.
For the future – your doctor and your lab are two different providers. Was the lab that you went to in-network? For example, at my primary care doctor’s office, there is a tiny closet of a room where they do blood draws. The “lab” is LabCorp and they rent the space from my doctor’s office. LabCorp is not an in-network provider from my insurance company. So even though my doctor is in-network, I can’t use the lab in the office; I have to go to Quest Diagnostics which is the in-network lab under my insurance.
Also, again too late, but blood tests for food allergies are not the most accurate. The scratch test is a much better indicator.
That being said – make sure that the lab tested for only the items on the lab order. A friend had to get blood tests for allergies done (she was having weird reactions to the scratch test and the allergist couldn’t rely on the results) and the lab order form only included 4 things to test for. The lab tested for every single food allergy that they could (30+ food items). The nurse at the allergist’s office caught this when the lab results came in and immediately called the lab and told them not to bill for that. In my insurance portal I could see that they submitted a bill and then withdrew it and resubmitted (presumably for only the 4 things on the lab order) and I ended up paying like $50.
I have BCBS. Is it STD bloodwork? Billing should have coded it as “Routine”, then it is free. At least that’s what I did for my last STD test. I paid $0.
It sounds like you have a $1500 deductible. I’m surprised it was $3,000 after the negotiated rate. If this is indeed the case, then you’ll have your deductible met at least for future medical care this year.
Check your eob for any verbage that might point to coding error. My doctor ordered blood work when I brought up a health concern during a well visit. The insurance company denied the claim, stating that the tests ordered were coded preventative instead of diagnostic. Many many phone calls over the course of a year to get the procedures recoded properly. 🙄