I have some questions about the US Health care system. I’m feeling frustrated and confused about a recent experience. I thought I understood the billing process, but now I’m not so sure. I went to a new doctor for a physical, and I was told some services would be billed separately. However, I’ve never faced such a high bill before after a physical, and I want to make sure I get this right moving forward.
During my visit, the doctor prescribed me a new medication after I asked some questions. I got blood work done and left thinking everything was fine. But then, weeks later, I received a bill for around $700. It included a new patient charge and lab tests that weren’t covered by my insurance.
I’m trying to figure out if I should have been charged for the new patient visit and whether I can contest the lab fees. I feel like I didn’t consent to those tests, and I’m unsure what my options are. Can I appeal these charges? I’m really worried about how I’ll manage healthcare costs in the future. Thanks for any advice!
A lot of doctors won’t do a preventative visit for a new patient because they need to get a full history and discuss any issues you might have. They should have explained this to you when you made the appointment, though.
Just to clarify, surprise billing laws only cover emergency room visits and out-of-network providers at in-network hospitals. So, you might still be billed unexpectedly. You can keep contesting the charges, but it might not lead anywhere. I get your frustration, but putting off health care can end up costing more in the long run.
@Nye
Thanks for clarifying. I wasn’t aware of the specific details around surprise billing. I just feel so untrusting of the system, and now I worry that if I have a problem, the insurance won’t help at all.
I can imagine how frustrating this must be for you. Since new medications are usually given for medical concerns, this visit might be considered a problem visit rather than just a wellness check. It’s likely that the lab tests were run to rule out issues related to your symptoms.
When it comes to consent, you might not have been forced for the blood draw, so it’s tricky. Some labs might run additional tests automatically based on initial results. This could be hidden in the fine print of the documents you signed. I know this feels messy, but looking ahead, it’s smart to check with your insurance before getting tests done to see if they’ll be covered.
I’m not an expert, but it seems like 99204 isn’t the right code for an annual preventative visit. There’s another code, 99402, that applies if you receive preventive medicine counseling for about 30 minutes. It’s possible the doctor used the wrong code, but it’s also likely your questions and lab work changed it from preventive to an evaluation and management visit. You can ask the doctor’s office for a review to check the coding.
@Zion
I’ll double-check the billing details. I thought it listed both a physical and a joint visit, but now I only see it labeled as a new patient visit.
Flynt said: @Zion
I’ll double-check the billing details. I thought it listed both a physical and a joint visit, but now I only see it labeled as a new patient visit.
They can bill both if you discuss medical concerns during the visit, as they can charge for both the 99204 and the preventive visit. Not sure if they can be coded as new patient visits though.
The codes you mentioned are procedure codes, or CPT codes. What diagnosis codes were used?
For instance, 80050 is a general health panel and is usually considered preventive if coded with the right diagnostic code. But if they used a non-preventive code, like I10 for primary hypertension, it won’t be covered under preventive benefits.
If you went for a physical and didn’t ask questions or reject the prescription, would it have been completely covered by insurance? Or is it standard to incur a new patient fee with a high deductible plan?
I’m just saying, if no medical issues were listed, there’s a chance you still could be charged the 99204 because many providers don’t do physicals for first-time visits. They may not meet all the criteria for preventive visits.
You said you didn’t consent to the lab fees. But honestly, when they took your blood, that implied consent to run tests. I get you’re upset, but it’s not quite that simple.
Regarding surprise bills, that’s a specific situation when you unexpectedly see higher charges after a procedure at an in-network facility.
And calling the billing office every day might not be the best approach. You could risk not getting any help while possibly hurting your credit if it goes to collections.
@Mckinley
Thanks for matching my frustration. I feel like if this keeps costing me $700 for visits, they might as well take more blood! I don’t think just taking blood means they can run whatever tests they want. If I set limits, and they run extra tests, I would find that dishonest. It’s like a mechanic charging for extra repairs without consent.
Honestly, it feels like you have to work full-time just to understand health insurance. If I’m not completely dedicated, I end up getting hit with huge bills. So now I think I’d rather avoid doctors until I really need them, and that shouldn’t be the case.