Yes, we still need HealthCARE reform
By Paulette Garin | PDA Blog Contributor and Cross-posted from Paula’s Blog
As part of a recent medical exam, my doctor ordered blood work to evaluate my overall medical condition as well as follow up on a previously diagnosed vitamin D deficiency.
Prior to consenting to the blood draw, I requested a written estimate for this lab work. I have a $2,000 deductible, which meant that the $397.80 quote would ultimately be my responsibility.
When the bill arrived from the lab, it totaled to $553.50. Here is what I learned from the phone calls I made today.
Call 1 – The Lab. My question: “Could you please explain the $155.70 difference between the amount quoted and the actual bill?” Response: “Call your doctor’s office.”
Call 2 – The Doctor’s Office. Same question as above. Response: “Every insurance company has a contract with the lab as to how they bill and for what amount – a ‘contracted rate.’” The quote that I was given was apparently based upon a self-pay rate or what amount the Dr. office would bill to the insurance company, if they in fact billed the insurance company directly for the lab work. New Question: “How come my lab work was billed by the lab to the insurance company and not by the Dr.’s office?” Response: “It depends upon which insurance company you have.”
Reviewed “Explanation of Benefits” from insurance company with Dr. office billing person. Discovered that none of the total amount charged for the lab work was covered under my plan or received any sort of discount. Advised to call insurance company.
Call 3 – Insurance Company. There is no discount on “non-covered” expenses. Your lab work was coded as part of an annual routine exam and is therefore not covered.
Insurance company representative went on to explain that the lab in question does participate in an “inter-plan re-pricing network.” Had my lab work been coded differently a discount of $448.82 would have been applied and the total bill would have only been $104.68.
Advised to call lab and ask for discount, because some providers will negotiate.
Call 4 – The Lab and Insurance Company conference call. The representative from the lab said, “Your insurance company has to give you the discount our company does not negotiate” and suggested we call the insurance company together.
The original insurance company representative held her ground and said that they cannot allow discounts on “non-covered” expenses. She then excused herself from the conference call.
Pausing to catch my breath, I said to the lab representative, “I pay almost $8,000 annually for a single health insurance policy and this is the best anyone can do?’
Sensing my frustration, the lab representative displayed a bit of humanity. She placed me on hold for several minutes. She called the Dr.’s office and requested that they re-bill the insurance company for the lab work with different coding. No guarantee that they would agree. As it was now almost 5 p.m. on Friday, she advised that I probably won’t have an answer until Monday or Tuesday.
Graciously, she put a 60 day hold on the account to keep it out of collection in the meantime.
Stay tuned.
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