I discovered today that even though the doctor I go to is covered through my insurance, the Lab in her office is not.
The stupid thing is that the lab is under the same medical organization (a local University) as the doctor. And to make it even better, the doctor I went to prior to HRT was under the same university system with a lab that was apparently in network.
WTF?!
Yay! Something new every day to make life a bit more of a pain in the ass.
I wish I had known that when I was planning my FSA this year ...
Dear Epigania,
Is it possible to get your Doctor to write a script for the blood work, then take it to a lab (like quest) that is covered under your plan? After the tests are completed they fax the results to your doctor. Unfortunately, too many doctors have a buddy, brother, or their own shares in a small lab and neglect to inform you. Some Doctors just don't know what is covered and don't feel that it is part of their job to stay informed. They or the office manager will usually work with you if it is brought to their attention. Part of my job is too help our employees get the most, for the least, from their health insurance. YOU have to ask these days. Many people go in for an operation at a hospital that is covered then get huge bills from the surgeon and/or anesthesiologist who are subcontractors for independent companies that are not covered. The system is set up to screw you exactly this way. You can avoid this by writing on the admission forms that you will only be responsible for any in network co-pays and deductibles that are covered by my insurance. Use of any out of network services, or charges require my written prior approval. Put something like that right near your signature and make them sweat. Note: these people are going to put sharp objects into your body, so do it politely and don't piss them off.
I sent a note off to the office to see if I can use the lab that's near my office that is covered with my insurance company. They are all part of the same university medical system and everything is stored in an electronic file. That's one of the reasons I chose this particular doctor.
It still is a little retarded that the labs have different billing contracts.
Most doctors offices will check to make sure that their preferred lab is in network for you. Every doctor I've gone to has done that. One doctor forgot and sent my blood work to the wrong lab and I got a $800 bill. I wrote to the lab and said that I did not authorize lab work to be sent to them, and that it was sent in error by my doctor's office. I then wrote my doctors office and revoked in writing their right to discuss my medical records with anyone. I also switched doctors.
I didn't pay the $800 bill, and it never showed up as negative on my of my credit reports or anything. This was 6 years ago.
There is no reason that your doctor can't give you a bloodwork order that you can take elsewhere - they might prefer the inhouse lab, but they certainly aren't limited to it.
Strangely enough, I had a doc tell me once that a doctors orders aren't even legally required for lab work, but I'm not sure if I quite believe him.
I went to a new doctor last year who ordered a complete blood work up before prescribing injectables. He used the covered in plan lab, so that wasn't a problem. It was just that when the bill came, the charges were for $1800. but Cigna, my carrier has a contract with the lab so even though the insurance company paid $o.oo, my cost was just $350. It just shows the markups if they bill direct, rather than through the insurance co. Many Dr. (in US) have interests in pharmacies, labs, and a large number of xray places. People tend not to question their Dr. and go where told.
Bit of an Update on this episode of "As the Bloodwork Turns" ... (I was thinking of "As the Bloodwork Coagulates" ... but it doesn't have a good ring to it):
I sent an E-mail to the billing department at the office I go to and they responded saying that both clinics are through the same group and there shouldn't have been any difference in the billing.
In other words, it should have been covered as a preferred Lab visit.
Now I have to call the Lab Billing folks and find out WTF they're doing and have them fix it. :)