I would love to hear from anyone who knows about insurance. I’m confused about whether I’m being unfair or if the hospital just doesn’t understand me.
I had a telehealth chat for a second opinion, and they told me to get lab work done. I asked if I could use my usual lab that’s at my job, as I’ve never paid there. The PA said no because the samples might be messed up if sent from there. I traveled 40 minutes to their lab and ended up with a $1200 bill. They forgot to get a prior authorization, but my insurance took care of that. My insurance stated that fixing this issue falls on the facility.
I contacted patient relations and clearly explained the situation. I also let them know that my previous assumption about transporting the samples was wrong. They replied saying that the $1200 is my co-pay and deductible, and that I have to pay it. I don’t think I owe anything since I requested a location that was denied based on incorrect information. With my background in risk management, I find it sketchy for patients to pay for a provider’s mistake. Working in mental health now, I worry about how this could hurt my vulnerable patients. Should I keep pushing back on this? Or am I missing something?
You didn’t say what tests were done, but usually, if you don’t receive lab bills, it’s often because preventive services are covered.
If it wasn’t preventive and you needed a second opinion, expect to pay your usual co-pay or deductible.
Check with your insurance to see if the tests are covered 100%. Your Summary of Benefits will show you what you and your insurance will pay for lab work.
Read your explanation of benefits carefully to know if the tests were covered. For instance, my insurance may not cover certain preventive services even if they’re standard for certain age groups.
@Darcy
These tests are not preventive; they are for specialty diagnostics. What’s confusing is I pay nothing for some of the same tests at my regular place. Plus, the reason I didn’t go there was based on bad information. So while technically the charges exist, it seems ethically wrong for me to have to cover them. Shouldn’t the provider and hospital bear the responsibility instead of the insurance?
I suggest you keep fighting this. On principle, consider taking them to Small Claims Court.
I don’t understand their reasoning. If you have a lab, they should do the work there or know how to transport it safely. Even non-labs use medical couriers to transport blood safely.
You acted like a knowledgeable consumer by asking for your tests to be done at a convenient lab in-network. This isn’t typical since you were specifically told to use a lab that was less convenient without valid medical reasons.
@Remy
That’s what I was thinking too. But I want to make sure I’m not just being indignant. I feel like it’s not fair to blame the insurance. The hospital should be the one to write off these charges since the patient should have a say in choosing a site based on accurate info.
@Remy
Small claims court sounds like a solid option! More people should take action in cases like this instead of letting these companies profit off miscommunication.
Try talking to their office manager first. You might get the chance to negotiate the bill since they required you to visit their lab. If that doesn’t work, go public on social media or reach out to your local news. Bad publicity often gets results faster.
What’s your deductible? What about your co-pays or coinsurance? Do you have a high-deductible health plan? Have you checked if what you consulted about is covered under your insurance? Often, diagnostic tests that aren’t annual preventative may involve co-pays or coinsurance.
@Valen
It sounds like your case is pretty unique. I don’t see how these tests wouldn’t count toward your deductible, regardless of the provider you chose.
It would help if you shared parts of your plan summary that explain why your past services were not included in the deductible. Typically, you need to meet a deductible before insurance starts covering anything unless it’s a few preventive services.
You mentioned that your usual provider is within your workplace. That might indicate it’s an employer-run health center covering your out-of-pocket costs as a perk.
@Valen
Since you already went to the lower-tier provider, there’s probably little you can do about the bill now. If it happens again, contact your insurance beforehand and explain the situation to see what they advise
You might also reach out to your state’s Attorney General about the provider potentially breaking regulations regarding patient choice and cost transparency, but I can’t guarantee it’ll help with your current bill.
@Adley
I believe the bill I have is itemized. I posted details in the comments. Since I’m in MA, I have to tell them when recording. It’s a neat idea though. The insurance has been supportive, saying the hospital’s billing department needs to handle this.
@Valen
Even if they’re helpful, you need to keep a record for yourself. I’ve recorded 12 hours of conversations because of how mistreated I felt. I wish I’d started recording sooner.
I think the provider who ordered the testing failed more than your insurance did. Your insurance will process all claims based on your plan’s benefits. They usually won’t make exceptions based on wrong information from the provider.
It doesn’t change that this situation is frustrating, but you might expect too much from your insurance company, which I think you already sensed when you fought so hard to get these tests done elsewhere.
@Adley
That’s exactly how I’m feeling. The charges come from the hospital, and money spent there is for services since I was told to use a lab that isn’t tier 1. This situation seems like a mistake on the PA’s part, which should be their loss, not mine. The insurance cleared them of any prior authorization fee. They suggested I report this if the charges aren’t wiped out.