Medical Insurance Claim

[pravi333]

Here is the story,

Back in September of last year i went to a doctor for checkup. The doctor drew blood and sent it to the lab for analysis. Everything went well, the doctor got the test results and informed me nothing was wrong.
Both the doctor and the lab filed insurance claim individually. Lets say the doctor asked the lab to analyze 10 different things, insurance only paid for 4 items and asked the lab for explanation for rest of the 6 items.

Insurance is looking for patient history, medical necessity, lab results in order for it to process the remaining 6 items. Now my insurance sent this request to the lab because they were the one who filed this claim. The lab instead of informing me about all this or forwarding that insurance request to my doctor they straight away sent me the bill & told me its my responsibility to pay it.

Then i called up my insurance and found out they need those information which i informed my doctor about. My doctor says she never prescribed those tests and there must be some mistake and she will talk to the lab people about it. I called the lab to confirm this, but their records show that the doctor did prescribe this and they have proof to it as well. After this i have called the doctors office numerous times and have even visited them personally to try to get the information needed. The answer is always one of two, they will talk to the doctor about this and get back to me which they never do, the other being the doctor never prescribed these tests and they will talk to the lab people & make these charges go away.

In the mean time i am getting the bill from the lab every month. So two weeks back i typed out a letter in a legal format explaining all this & also attaching the lab bill to it & sent it to the doctors office on a registered post with signature confirmation. I thought this will scare them a bit and they will send me the required information. But nothing has happened so far.

The bill amount is not small ($600) for me to just pay it myself. What are my options here? can i take the doctor to the state medical board or small claims court or do anything about this situation? Can someone shed me some light because i am stuck as what to do further.

Thanks

 

[RKS]

Can you call the lab's billing office and tell them the bill is in dispute? They should be able to 'note' the account so you don't get sent to collections while the mess is being sorted out.

 

[pravi333]

Originally posted by: RKS
Can you call the lab's billing office and tell them the bill is in dispute? They should be able to 'note' the account so you don't get sent to collections while the mess is being sorted out.

I havent tried it yet, because they usually send me one bill saying this is the last bill before this get sent to collections. So i am thinking i have some more time.

 

[moshquerade]

You should go there in person and demand answers. Go to the lab and get a copy of the doctor's orders for the tests and then go to the doctor's office.

Letters, phone calls, emails.... are just easier ways for them to dodge you. Go visit them.

 

[FelixDeCat]

Who is your insurance company? I usually go to Labcorp, but United Healthcare used to be associated with Quest Diagnostics. If you read the breakdown of all your billings carefully (like I do), a typical CBC runs about $100 if you are not insured. However, because of the insurance cos muscle they negotiated that price down to $9. Of that amount, I pay nothing. And these are full blood panels.

However, when the doctor switched me to a drug that wasnt for everyone, they had to draw blood again and test for genetic compatibility. I got hit with a bill for $500. I wrote a letter back to the insurance company that the test was necessary and required to determine my eligibility to recieve a new therapy to treat my condition. I had no choice in the matter and no other course of treatment was acceptable since I had tried them all. Eventually they paid it.

What you could do is ask the company that drew your blood to provide a copy of the original bloodwork order. The doctor will have this copy as well. I know this because like I said I think I have had nearly 1000 tests since 1997. IF the doctor filled it out inaccuratley by asking for a test accidently, then HE is at fault. If either party refuses to help, consider taking it to the next level. Youll have to fight this thing.

 

[pravi333]

Originally posted by: moshquerade
You should go there in person and demand answers. Go the lab and get a copy of the doctor's orders for the tests and then go to the doctor's office.

Letters, phone calls, emails.... are just easier ways for them to dodge you. Go visit them.

Problem with that is, i called the lab asking for proof that the doctor did prescribe it. They told me that they do have the proof and they cant give it to me but they can give it to the doctor if the doctor asks for it.

Also doctors clinic is logistically not possible for me to go there often. And at times i do go, doctor personally informs me that she will talk to the lab people about it! I have even stressed her to check my file at her office to look for those blood work results!

Originally posted by: FelixDeKat
Who is your insurance company?

Principal insurance and the lab is Quest diagnostics.

I did read the items in the bill and they're all very technical terms. Quest diagnostics did not draw the blood, the doctor did and sent it to quest.

I am so frustrated about this running around they give me i will be happy to report that doctor the medical council, if it can be done.

 

[alchemize]

It this insurance through your employer? If so I reccomend you contact HR and have them call your insurance company and raise a stink.

 

[FelixDeCat]

Originally posted by: pravi333

Originally posted by: moshquerade
You should go there in person and demand answers. Go the lab and get a copy of the doctor's orders for the tests and then go to the doctor's office.

Letters, phone calls, emails.... are just easier ways for them to dodge you. Go visit them.

Problem with that is, i called the lab asking for proof that the doctor did prescribe it. They told me that they do have the proof and they cant give it to me but they can give it to the doctor if the doctor asks for it.

Also doctors clinic is logistically not possible for me to go there often. And at times i do go, doctor personally informs me that she will talk to the lab people about it! I have even stressed her to check my file at her office to look for those blood work results!

Originally posted by: FelixDeKat
Who is your insurance company?

Principal insurance and the lab is Quest diagnostics.

I did read the items in the bill and they're all very technical terms. Quest diagnostics did not draw the blood, the doctor did and sent it to quest.

I am so frustrated about this running around they give me i will be happy to report that doctor the medical council, if it can be done.

If your doctor ordered it, and Quest did the work, either company can tell you what tests where performed and their costs. You will want their answers sent to you in writing in plain English. Again, a simple CBC shouldnt cost more than $100. It will include such things as your bloodcount, platelet levels, and if you have a condition a sedimination rate. Its pretty thorough. Unless they were doing a genetic profile, $600 is outrageous and unacceptable IMO (but Im not a doctor, so take that with a grain of salt). Thats why you want a detailed breakdown of the tests performed / ordered by both parties to know where to go from there. If in the end you have to pay, at least you have a THOROUGH answer and not just a run around.

 

[pravi333]

Originally posted by: alchemize
It this insurance through your employer? If so I reccomend you contact HR and have them call your insurance company and raise a stink.

It is, i have contacted the HR regarding this, going to wait & see if they can do anything at all.

Originally posted by: FelixDeKat

Not a regular blood work but blood work related to pregnancy but yes, the bill from quest is itemized. Also that $600 is before the insurance discount is applied. Problem is, if my insurance applied the discount then they have to pay it because my blood works are 100% covered. I am sure if they applied that discount it will only be $100 or so.