Over $5K for Blood Work!?

[Spiffster]

OK so I am stressing out pretty good here about an EOB i just received from our insurance provider. My wife is pregnant and we are on a (high deductible) HSA plan with United Healthcare. We have a 18 month old and we went to the same OB with her and I never saw anything like this during the entire process.

We have THREE charges from PROGENITY INC totalling $9888 and $5437 after insurance "Discounts", all for the same (8 week) visit. Each line item says says "Laboratory Services", thats it, no details... Wife says she only had an ultrasound and blood drawn.

I certainly hope this is a mistake. Apparently the blood draw was to screen for Cystic Fibrosis and she was told it would be $25 out of pocket. Our OB is in our network, but PROGENITY INC is NOT. Has anyone seen anything like this? I know I should talk to our provider or insurance but they are both closed and I want to be armed with as much information as possible before I contact either of them. Thanks.

[disneysteve]

Sounds like some type of genetic screening. I would start with a call to the doctor's office. They may have billed or coded incorrectly. If they promised a $25 copay, that's what you should pay.

We had a similar problem a few years ago when my wife's gyn recommended she get tested for the breast cancer gene. We were told it would be covered and then got a $3,000 bill. It took a few months but we finally got it cleared up.

[Blessed]

Follow up with the office and then the insurance company. They do make mistakes on both ends. Ridiculously it was a tad under $50K in charges at Mayo Clinic before they diagnoses my spouse as celiac over a years time. I swear talking to the clinic and the insurance company because my full time job! There were quite a few coding errors on the clinics part. They had charges for lab tests sent out when they were all done there and the list goes on and on. Our part started at $5896 for all the different bills and by the time it was all said and done we owed $3801.

[breathemusic]

I would also talk to your doc office and see if there are any other labs that they use on a regular basis to try and make sure that the lab they're sending any blood work to is in network. Hopefully they do, and they can make a note in the file (or better yet, just remind them any time there are labs being done).

[Spiffster]

Thanks for the replies and suggestions. Much appreciated. I am going to get ahold of these people today and hopefully get this squared away. I am really thinking this must have been an error. My wife is a nurse and she would have known better than to agree to some strange and exotic 10 thousand dollar blood screening.

[Spiffster]

Just called Progenity and they said that we got that EOB with the insane number because thats how they process this transaction (apparently) for out of network insurance claims. They said they just "write it off" and send us a bill directly for 25 dollars. Wow... just, wow...

[disneysteve]

Just called Progenity and they said that we got that EOB with the insane number because thats how they process this transaction (apparently) for out of network insurance claims. They said they just "write it off" and send us a bill directly for 25 dollars. Wow... just, wow...

Most medical bills contain errors. It is always a good idea to go over them carefully and question anything that just doesn't seem right. The last time my wife had surgery, I found an error of over $1,000 on the hospital bill that we would have needed to pay out of pocket had I not discovered the mistake.

[Blessed]

Just called Progenity and they said that we got that EOB with the insane number because thats how they process this transaction (apparently) for out of network insurance claims. They said they just "write it off" and send us a bill directly for 25 dollars. Wow... just, wow...

Great news!

[Gailete]

My husband as well as me are on narcotic therapy. Well two months ago doctor decided he needed a blood screening, I guess to make sure his levels were consistent whit what he was prescribed. They also handed him a brochure on getting help paying the bill. He didn't have any insurance at the time (3 days later his insurance went into force but he needed his meds and they wouldn't give him the prescription until he had the blood work. Didn't think much about it until we got the bill for $907!!!!!!!!! I have filled out a form for assistance with the bill, but all I've heard back was getting another copy of the bill. Like where are people supposed to come up with a thousand dollars for lab work? Especially if you don't have insurance??? There was no mention at all about how expensive it would be beforehand. Wouldn't you think that if a lab test was going to be that much, there should be fair warning? Not of course, like any one here has any say in the matter. But certainly frustrating. He has only had trouble now that he is on Obamacare, starting with his doctor of 10 years discharging him from the practice since they don't take his brand of insurance. Highmark BC and UPMC are battling it out for customers in this area and you can't go out of network even if you wanted to since they would not take you for any appointment.

[Spiffster]

My husband as well as me are on narcotic therapy. Well two months ago doctor decided he needed a blood screening, I guess to make sure his levels were consistent whit what he was prescribed. They also handed him a brochure on getting help paying the bill. He didn't have any insurance at the time (3 days later his insurance went into force but he needed his meds and they wouldn't give him the prescription until he had the blood work. Didn't think much about it until we got the bill for $907!!!!!!!!! I have filled out a form for assistance with the bill, but all I've heard back was getting another copy of the bill. Like where are people supposed to come up with a thousand dollars for lab work? Especially if you don't have insurance??? There was no mention at all about how expensive it would be beforehand. Wouldn't you think that if a lab test was going to be that much, there should be fair warning? Not of course, like any one here has any say in the matter. But certainly frustrating. He has only had trouble now that he is on Obamacare, starting with his doctor of 10 years discharging him from the practice since they don't take his brand of insurance. Highmark BC and UPMC are battling it out for customers in this area and you can't go out of network even if you wanted to since they would not take you for any appointment.

Sorry to hear this. I just cant understand how they can justify charging such a high fee for to process a blood sample. Im sure more goes into this than I am aware of but for a routine screening, come on... Progenity is basically saying to us, yeah we did $10,000 worth of work on this screening, but we are gonna write that off (as a loss?) and charge you $25 because you are out of network and we cant milk your insurance company for the "discounted" fee... please. These sorts of companies are the one of the reasons why insurance is so expensive.

[disneysteve]

Sorry to hear this. I just cant understand how they can justify charging such a high fee for to process a blood sample. Im sure more goes into this than I am aware of but for a routine screening, come on... Progenity is basically saying to us, yeah we did $10,000 worth of work on this screening, but we are gonna write that off (as a loss?) and charge you $25 because you are out of network and we cant milk your insurance company for the "discounted" fee... please. These sorts of companies are the one of the reasons why insurance is so expensive.

TIME magazine had a great story about a year ago about hospital billing and the price guide they use. They detailed how that guide has absolutely no basis in reality and is in no way tied to the actual cost of providing the services. It's really quite insane when you study it.

As for those without insurance especially, but even those who are insured, it is really YOUR responsibility to ask how much something will cost BEFORE consenting to testing or treatment. Yes, the provider should tell you that upfront - I'm not excusing that - but as a physician, I can tell you that anytime I order a test or medication for one of my uninsured patients, the first question they always ask is, "How much is this going to cost?" Even many of my insured patients will ask, "Does my insurance cover this?" You need to be your own advocate. You can't assume that if the provider doesn't mention the price that it must not be that expensive.

An analogy I've used with my patients is that of the nightly specials at a restaurant. When the server rattles them off, they almost never tell you the prices. If you order one of those specials without asking the cost, you may be in for a nasty surprise. I've made that mistake myself and learned my lesson. Now I always ask the price before ordering a special. Sometimes those meals are twice the price of the most expensive thing on the regular menu.

[Spiffster]

TIME magazine had a great story about a year ago about hospital billing and the price guide they use. They detailed how that guide has absolutely no basis in reality and is in no way tied to the actual cost of providing the services. It's really quite insane when you study it.

As for those without insurance especially, but even those who are insured, it is really YOUR responsibility to ask how much something will cost BEFORE consenting to testing or treatment. Yes, the provider should tell you that upfront - I'm not excusing that - but as a physician, I can tell you that anytime I order a test or medication for one of my uninsured patients, the first question they always ask is, "How much is this going to cost?" Even many of my insured patients will ask, "Does my insurance cover this?" You need to be your own advocate. You can't assume that if the provider doesn't mention the price that it must not be that expensive.

An analogy I've used with my patients is that of the nightly specials at a restaurant. When the server rattles them off, they almost never tell you the prices. If you order one of those specials without asking the cost, you may be in for a nasty surprise. I've made that mistake myself and learned my lesson. Now I always ask the price before ordering a special. Sometimes those meals are twice the price of the most expensive thing on the regular menu.

Very good advice. I guess we really learned the easy way... we got lucky. I know we will be much more careful going forward.

[Gailete]

As for those without insurance especially, but even those who are insured, it is really YOUR responsibility to ask how much something will cost BEFORE consenting to testing or treatment.

Goodness the gremlins are at work today eating up what I'm writing! My husband's test, a 'pee in the cup' one which meant no one needing to poke him for blood etc., so that should have kept some of the cost down. If he didn't take the test which according to his drug contract that he had signed with the doctor, his refill of narcotics wouldn't be refilled and he would go into immediate withdrawal. So it didn't matter the cost, he had to get it.

But under normal circumstances we are always very careful about costs, even when Medicare will pay and my supplement will cover the rest, we check the cost vs. benefit. One of my biggest problems when I started to get Remicade IV's was the cost especially once I saw what MC was covering. Over $2K and anyone on MC knows that they pretty much never pay that amount! So I had to really determine if I was getting enough benefit to be getting this IV (I decided yes). I think if more people did this with their Medicare, Medicaid, insurance, etc. some of the costs would go down AND people would understand more about their disease process which would help with learning how to take care of themselves and hopefully lead to healing or at least feeling better.

[disneysteve]

If he didn't take the test which according to his drug contract that he had signed with the doctor, his refill of narcotics wouldn't be refilled and he would go into immediate withdrawal. So it didn't matter the cost, he had to get it.

I'm willing to bet that his doctor has no idea that the test costs patients $900. I also have my narcotic patients sign a contract and have regular drug tests. The lab we use doesn't charge anywhere near that much or else I wouldn't use them. I'd bring this to the doctor's attention.

I think if more people did this with their Medicare, Medicaid, insurance, etc. some of the costs would go down AND people would understand more about their disease process which would help with learning how to take care of themselves and hopefully lead to healing or at least feeling better.

This is a huge factor in the rising cost of healthcare. For the most part, patients are compeltely removed from the cost of their care so they simply aren't concerned. "My insurance covers it so I want it." Twist your ankle? Get an MRI. Have a twinge of pain in your belly? Get a CT scan. Have a headache? Have another MRI. Have a pimple? See a dermatologist. If the system could be changed so that patients were somehow more tied in to the costs, I guarantee we wouldn't see the inflation that we keep seeing.

[Gailete]

I'm willing to bet that his doctor has no idea that the test costs patients $900. I also have my narcotic patients sign a contract and have regular drug tests. The lab we use doesn't charge anywhere near that much or else I wouldn't use them. I'd bring this to the doctor's attention.

You are so right! I had my doctor appointment yesterday with the doc we both went to until the insurance fiasco. When she finished with me I asked her outright if she knew how much the drug screen costs. She said 'well I know it is expensive'. When I told her $907 she about had an MI! She said I thought maybe $2-300. But she also immediately knew where a drug screening while not the same as the one for $907 but adequate and much cheaper could be gotten. I doubt she ever sends anyone off to get that other test unless they are very much seeming to break the rules of narcotic use. Since she hadn't ask a drug screen from me, I did confirm with her that she hadn't because it takes me usually 2 1/2 months to go through one of my narcotics that is normally a month's supply and my other pain meds have to be used strictly on schedule.

Than you for the encouragement to check with her. I probably would have anyhow, but it helped to have a professional tell me that there are cheaper screenings out there!