Got screwed over by my insurance

[PackManDan]

So back in October I went to my doctor for a physical because I was just feeling sluggish and my stomach was hurting a lot frequently. He tells me he wants me to get a blood test as the first order of business just to check some things out. This is a "routine" blood test, nothing special, nothing crazy.

I get a referral to the blood laboratory. They verify that they accept my insurance and I give them my doctor's referral. They take my blood and BOOM, I'm done.

Well weeks later I receive a bill from the laboratory in the amount of $500. And it says I'm being billed for my blood test. I call up the laboratory and say what the hell is this, I have insurance and you guys told me you accepted my insurance. They say that yes, the blood test was $750, but my insurance only covered $250, and so I owe the remaining $500.

I call my insurance company and they tell me that the doctor's billing code that he referenced is a billing code not covered by my insurance and that is why they aren't covering it. I tell them that it was a routine blood test, a test that people get all the time, and they tell me that they still won't cover that billing code.

So I call the blood laboratory back and complain some more, my doctor's office and ask them if they can just change the billing code, to which for whatever reason they say they can't, and my insurance company back. This goes on for several weeks.

Now I'm on my third notice from the laboratory stating they want their $500 or they will take action against me because I'm already 90 something days overdue.

At this point I've exhausted my options. My doctor's office can't/won't change the billing code, my insurance won't cover it because the billing code is unique, and the laboratory wants their money.

If it was $100 or something I'd bite the bullet and just pay it. But it's $500!! Do I have any other options? I don't want this to affect my credit and have collections put on me or something like that.

[mickss]

I`m not certain in your state but in some cases you can have the disputed bill resolved in small claims court. In can`t hurt to see if that is an option in your case and whether the dollar amount falls into a small claims court action.

[pyroguy]

That’s bull that the doctors office won’t change the code. They just don’t want to. I’d be hounding them harder.

[Mydivorcegift]

Not trying to be a dick...I get it...but...

You are looking at buying a 60k car.

You are worried about it affecting your credit.

It’s $500.....pay it and move on. Does it suck because it appears to be caused by an error from someone else? Yes. But in the end it’s $500. Probably not worth the heartache and stress that YOU are allowing this to cause yourself.

But if you insist...

Get on a $25 a month payment plan with them and contact the insurance commissioner.

[HDRDTD]

A 'blood test' can be anything from a simple test of one aspect of the blood such as a test called 'INR' which only tests to see how thin your blood is. People on blood thinners get this test done every month and it costs very little.
Or the 'blood test' can be a complete blood panel test that includes tests for many items such as cholesterol, glucose, iron, etc, etc. This is another common type of test used to check overall health status of a patient and can cost upwards of $750 easily.

As far as insurance coverage, you would have had to ask your insurance company if THAT PARTICULAR blood test that your doctor asked for would be covered AND how much of it would be covered IF you get it done at the place where you went.

It could be that your insurance would indeed cover certain blood tests and told you so, but the particular set of blood panel tests that you needed would only be partly covered.

It could also be that once the work was done, it wasn't possible for the doctor to go back and change the code.

Just pointing out some possibilities.

Regardless, it is very common for hospitals and labs to offer a payment plan for patients.

Sorry it didn't work out for you the way you thought it would.

[Tajefe Couple]

Last time this happened to me I asked the insurance company what code was needed to receive coverage on the test. Then I simply called billing at my clinic and requested they use the code insurance provided that would be covered. Since it was the correct code for the test done insurance then covered it. I have had this happen on more than one occasion and insurance acted as if it was something they where use to. My clinic just indicated that sometimes the codes just need to match what that particular insurance company has it as. Don't know that this will help you since seems whomever your dealing with does not want to change the code and bill insurance again. It also seems as if your insurance company has paid something the way it is coded and is probably why the facility does not want to change it. Should also mention the way mine where coded the first time it was completely denied by insurance. Therefore insurance paid nothing until the clinic sent it back with the proper code. GL

[lightsOUT]

From what I read you’re not getting screwed. It’s just that you have a limited amount of coverage and you maxed it out in this instance. It’s just that simple.

Why would or should the doctors office change the code to something incorrect? Wouldn’t that be insurance fraud?

As for a fix.... I had limited coverage once and as fate would have it I had a pretty serious accident/ injury. I was on the hook for a lot of money from various doctors. What worked for me was to simply call them and explain to them that you are out of insurance and that you have to pay cash and you have limited funds. They will usually work with you on negotiating a price and payment schedule.

[ZEN357]

Originally Posted by PackManDan

So back in October I went to my doctor for a physical because I was just feeling sluggish and my stomach was hurting a lot frequently. He tells me he wants me to get a blood test as the first order of business just to check some things out. This is a "routine" blood test, nothing special, nothing crazy.

I get a referral to the blood laboratory. They verify that they accept my insurance and I give them my doctor's referral. They take my blood and BOOM, I'm done.

Well weeks later I receive a bill from the laboratory in the amount of $500. And it says I'm being billed for my blood test. I call up the laboratory and say what the hell is this, I have insurance and you guys told me you accepted my insurance. They say that yes, the blood test was $750, but my insurance only covered $250, and so I owe the remaining $500.

I call my insurance company and they tell me that the doctor's billing code that he referenced is a billing code not covered by my insurance and that is why they aren't covering it. I tell them that it was a routine blood test, a test that people get all the time, and they tell me that they still won't cover that billing code.

So I call the blood laboratory back and complain some more, my doctor's office and ask them if they can just change the billing code, to which for whatever reason they say they can't, and my insurance company back. This goes on for several weeks.

Now I'm on my third notice from the laboratory stating they want their $500 or they will take action against me because I'm already 90 something days overdue.

At this point I've exhausted my options. My doctor's office can't/won't change the billing code, my insurance won't cover it because the billing code is unique, and the laboratory wants their money.

If it was $100 or something I'd bite the bullet and just pay it. But it's $500!! Do I have any other options? I don't want this to affect my credit and have collections put on me or something like that.

Same exact thing happened to me. I told them they'd get $50 a month until it was paid off. Otherwise take me to court. They took the $50 a month. Now when I go in for any type of "routine" tests or blood work, I tell them to bill it out first before it's done to see what I may have to pay. If they won;t, then I tell them that the tests aren't happening then. Amazing how they can figure out what I owe after saying that.

[Mydivorcegift]

Originally Posted by ZEN357

Now when I go in for any type of "routine" tests or blood work, I tell them to bill it out first before it's done to see what I may have to pay. If they won;t, then I tell them that the tests aren't happening then. Amazing how they can figure out what I owe after saying that.

Yeah it's really all a racket and for some reason the government/police turn a blind eye to it. What they are basically doing is theft by deception/insurance fraud.

My son many years ago twisted his ankle/hurt his achilles playing basketball. Took him to the doc....they took xrays, etc....in the end, of course, he had to be referred to an ortho. They said they would send the xrays over to them so they could look at them and figure out what is next. Here's the theft by deception/insurance fraud part.....

We get to the ortho and go back. Doc comes in and says "he's going to order a round of xrays". I tell him that he just had some done and the doc at the hospital said he would send them over and that you should have them. He said "we can't find them so I am going to just order another set if that's ok with you". I told him...

"That's fine as long as you are paying for them". (Yes we had insurance but 20% is still 20%).

He said "well that's not gonna happen". I said "I don't know what to tell you then but you do NOT have my permission to order another set of xrays for my son".

He left and came back about 20 minutes. Miraculously, the "other" xrays showed up.

[pyroguy]

Not to sound like an a$$, but of course pay day loans are quick and easy. They stick it to you with unreasonable interest rates and absurd fees if you're late or miss a payment. That's how they get people. They prey on the middle and low income class people and keep them from getting ahead. I'm not sure how old your daughter is, if she's still a dependent of yours of if she's on her own and you were helping her out, but if she's still under your room budget throughout the year for this expense by setting a little aside every month for this expense. If she's on her own, have her do the same thing. You'll pay FAR less for your insurance than adding a pay day loan's interest rate on top of it.

[BMR Sales]

Sorry, I'm not clicking on any Link that someone with 4 Posts is providing!

[pyroguy]

Originally Posted by BMR Sales

Sorry, I'm not clicking on any Link that someone with 4 Posts is providing!

Oops. Hopefully I didn't just virus my computer. I didn't give any information other than a zip code to see if I could find their rate. No luck so I posted what I posted based off of "common" financial sense.

[Camaro_QC]

I reported that post cause it was pretty suspicious and all his other 3 posts were similar with links to other shit...

Seems like the admin have removed his posts.

Hope you didn't get anything on your computer.

But still, I agree 100% with your comments above

[BMR Sales]

Originally Posted by Camaro_QC

I reported that post cause it was pretty suspicious and all his other 3 posts were similar with links to other shit...

Seems like the admin have removed his posts.

Hope you didn't get anything on your computer.

But still, I agree 100% with your comments above

Thanks!