Medical copay rant

[jodi]

Okay, I'm app. 12 weeks pregnant and had a slew of bloodwork at my last check-up. I asked my practitioner which tests I really needed, since I'm in a monogamous relationship and didn't really want the expense of the multiple STD tests they usually do. She told me that everything would be covered under one co-pay, just to get all the tests they recommended, etc.

I got the statement from my insurance company today - over $600 in tests billed by my doctor's office and two different labs - meaning 3 co-pays for me (total: $54). Now I don't know whether to be more upset at them, since they apparently did not know what they were talking about, or at myself for not putting my foot down. I feel badly that I've created all this extra expense when I know some of these tests were unnecessary for me in my circumstances. I plan to discuss this with my midwife at my appt. next week as I'm a little put out by the whole thing. Do you think they just have to "cover their a**", as the saying goes, by insisting on all these tests? And shouldn't they know that they send their tests to different labs and that this results in multiple co-pays, or am I expecting the practitioners to know more than they should about the billing process? (and if they don't know, they shouldn't pretend to know!)

[disneysteve]

I don't understand why there would be multiple co-pays. When we draw a patient's blood in our office, they pay their office co-pay. It doesn't matter where we send the blood (though I can't really think of any situation when we would send it to more than one lab). Even if we sent it multiple places for some reason, the patient would still pay the same co-pay. I'd ask about those charges.

[jodi]

Every time we have lab work done, it seems we get multiple bills. That was one of the reasons I specifically asked at my last visit. Maybe it's something funky with my insurance - I don't know. Here's the breakdown (not that I expect it will help clarify anything though):
Laboratory Alliance
Laboratory services - three charges totalling $44, patient pays $0
A second entry for Lab. Alliance
Laboratory services - six charges totalling $215, patient pays $18
A third entry for Lab. Alliance
Laboratory services - six charges totalling $300, patient pays $0
Clearpath
Laboratory services - one charge for $58, patient pays $18
and then there's the final entry for my doctor
Laboratory services - two charges for laboratory services, one charge for 'special medical' totalling $68, patient pays $18

So I'm on the hook for $54...I do plan to bring my statement to my next appt. and discuss it, although I doubt there's much they can do since the charges are originating with labs outside of their office. So there is not usually a separate co-pay for labwork sent outside of the MD's office? It seems I always pay the regular co-pay for a doctor's visit, then get a bill in the mail a few weeks later for the lab co-pay. I just assumed this was standard practice because it's always been like this for my insurance. Maybe I ought to seriously look into switching to DH's plan (if he will ever get me the info on it from his employer).

Thanks DS - I was hoping you would see this post and comment

[Seeker]

Actually I think you need to call the number on your Insurance card and ask them why the breakdown exists as it does. It's rare for the practitioner to keep track of each individual company and how they do these breakdowns.

My GP referred me to a specialist a few years ago that was not in my plan. I essentially had to call the Insurance Company and get another specialist in order to not be charged some out-of-plan outrageous charges. So I did. Since then, I always check with them first.

[disneysteve]

jodi - I thought you meant your doctor was charging you multiple co-pays. There could be charges from the lab itself. That would depend on your insurance plan and what is covered with the lab work. Your doctor's office probably has no way of knowing exactly how a specific test would be covered.

[jodi]

Yes, but shouldn't the doctor know that they are sending their bloodwork out to multiple labs? Or, at the very least, when I tell them I don't want to pay multiple co-pays, shouldn't they refer me to my insurance company rather than assure me there will only be one co-pay, or am I simply expecting them to know too much?

Still kicking myself, though, because I really should have known better... This happened with my last pregnancy too - I had to pay for tests that I didn't need because I didn't know how to say no.

Thanks, Seeker. I may do that just so I can understand in the future how this works for my company.

[disneysteve]

I actually don't know, jodi. I'll have to ask at the office on Monday. We don't send things to multiple labs. Most insurance companies have one lab that we are required to use. Some use Quest. Others use LabCorp. It is always either one or the other. I don't think we ever send part of a sample to one and part to the other.

[Daylily]

Jodi,
Same thing with my insurance. If I have a visit that requires labwork, I pay a copay to the doctor's office and a copay to the lab. I think it is pretty common. Although I've never had your situation of multiple labs involved.

[cschin4]

It really isn't up to the doctor's office to know what your insurance pays for. That is your responsibility and if you are unsure, you will need to call the insurance company yourself. None of the tests would have been needed immediately and you could have taken the time to call them yourself and then have the tests done.
However, I think insurance companies make things confusing for everyone and when you call them, half the time they don't even tell you the right thing or know the answer.

[76Chick]

...but since your doc assured you - kindly let her know, you will be taking that $54 dollars off - as a discount- from her bill! <<smiles sweetly>>

GL, and congrats!!

I had my million dollar baby in Dec 06 (he was born @ 28 weeks) - cost me a fortune! worth every darn penny!

[PrincessPerky]

Unfortunately the Drs office never really knows what is covered and what isn't (for one thing they hear covered and stop asking, even though covered could mean only 80% covered, or 40% covered, or covered except for lab fees)

But I have on rare occasion found that a Drs office tried to bill for something 'funky' like bill twice for one thing, or asking me to pay above what they agreed with the insurance to charge. So it may be worth calling your insurance company to check.

And to aid in to saying no, take the bill with you, so when they say 'oh the insurance will cover it' you can show them the bill and point out covered isn't cheap. I did that with one of my pregnancies and was able to skip the test.

[disneysteve]

I've said various times before, you should always double check medical bills. Errors are common from doctors, hospitals, labs, etc. Before I pay virtually any medical bill, I call and verify that it is correct, the insurance was billed properly, they aren't balance-billing, etc. Hospital bills are the worst. Last year, I found over $1,000 in errors on my wife's bill after surgery.

And always make sure your doctor has your latest insurance information. I can't tell you how many times a patient comes in complaining about a bill and it turns out they changed insurance plans and never informed us.

[Scanner]

Yes, but shouldn't the doctor know that they are sending their bloodwork out to multiple labs? Or, at the very least, when I tell them I don't want to pay multiple co-pays, shouldn't they refer me to my insurance company rather than assure me there will only be one co-pay, or am I simply expecting them to know too much?

Forget the impending financial crisis our healthcare system is in. . .it's this assumption (and I don't mean to pick on the original poster) is why our medical system is in the dire straights we are in.

I am quite sure DisneySteve didn't take Health Insurance 101 at medical school and I know I didn't have PIP Insurance 101 at chiropractic school.

Yet, the public now expects their local doctor's office to act as some kind of "advocate general" for the patients. More energy into insurace = less energy into healthcare/preventing errors/improving quality.

This is why it's a 2 hour wait - trying to resolve these issues day in and day out.

Our office has called and verified benefits and is still quoted wrong by the $8.50/hour customer service rep. and the patient ends up with a bill.

[disneysteve]

Originally Posted by Scanner

Our office has called and verified benefits and is still quoted wrong by the $8.50/hour customer service rep. and the patient ends up with a bill.

That's true, too. We've often called an insurance company and gotten incorrect information. Customer service at the insur. companies isn't any better than it is everywhere else. Call 3 times and ask the same question and you are likely to get 3 different answers.

[jodi]

Wow, I hadn't checked back in a few days. Thanks for all the great posts. And now, for the update: I did ask the office about my bill and showed them the insurance statement. It actually confused them for a moment, but then she pulled up my account history and was able to find out why. Turns out that one lab was for my Pap test and the other was for my bloodwork. In addition, although my regular pregnancy visit was covered by one co-pay (which I've already paid), my insurance company required the doctor's office to take a separate co-pay for performing the Pap - hence the three co-pays. The lady I spoke with said it was strange that my insurance company required a separate co-pay, but that she had had issues with them in the past. Anyway, I feel better knowing the cause. I took a few minutes to chat with her about the office co-pays I should expect, which basically are none unless I have any complications, come into the office for non-preg. related concerns, etc. So at least that was good news!