Do I owe this money?

March 14, 2008 3:15 PM

Should I really owe the hospital $400 for tests I was unaware of?

I had a terrible skin rash and I went into a dermatologist to get it checked out. He diagnosed it by sight as a strep infection of the skin, gave me a prescription for antibiotics, and sent me on my way. I got a call the following week from a nurse, who asked how I was doing--my antibiotics were finished, I was fine and I told her so.

Today, a month later, I got a $400 bill from the hospital for four different tests/cultures. (My deductible is $1k, so apparently they weren't covered). The doc didn't ask me whether I wanted them run. I had no idea he was going to run them and I had no idea that he had until I got this bill.

Am I 100% on the hook for paying this bill? It seems wrong to me that I'm being charged way more money than I have right now for stuff I was not told about. Can I resolve this with the hospital, and if so, how? Do I write a letter, and to whom? I contacted their billing department as soon as I got the letter and they are going to conduct an investigation into it, but the lady said it could be 45 days until they get back to me; am I going to get screwed by some statute-of-limitations-like loophole?

I am more than willing to pay the $100 for the doctor's visit, but I'm quite steamed about the rest. Aah, my first foray into the seamy underbelly of the health industry!

posted by sian to work & money (9 answers total)

So, to clarify, you were aware he was taking the cultures, but just didn't know they were going to the hospital to be tested?

Think back to all the paperwork the dermatologist had you fill out when you went to his office (presumably for the first time). Was there anything in there about using a separate lab at the hospital to perform tests? I'm sorry to say that if you signed any permission slips without reading them, chances are they dealt with the labwork and where the tests would be sent. Unless you are POSITIVE that nowhere in any of the paperwork were you informed that tests would be sent out to a lab and you would be responsible for payment, you will have to scrape up the $400--as the insured, it's really up to you to go to an in-network doctor or specialist or go out-of-network, and it sounds like either this doctor was out-of-network or the hospital lab was.

The only other thing that might save you would be if the insurance you have was not properly submitted, and the tests should have been covered, in which case you could try resubmitting.
posted by misha at 3:30 PM on March 14, 2008

First, you need to figure out if this is an error or if it's just charging you for something you were not aware was being done. You shoudl be able to contact the doctor to clear this up.

"Hi, this is sian, I was in the office on X date. I just received a bill from the billing department which says I received $400 worth of test cultures. I was not aware tests were being run. Can you please verify that these tests were performed and explain why they were done when I was diagnosed visually and prescribed antibiotics on the spot?" You may need to speak to your doctor or leave a message with your doctor's assistant.

The response to that query -- and be polite and civil, the people who you are talking to have no ability to change the past and probably had little or nothing to do with the events you are asking about -- should help you determine what the next step is. You're not going to get caught in a loophole, they won't force you to pay or send something to collections until it's been verified as accurate and honestly yours (in almost all cases) However, if the tests were run you may be on the hook for the amount.

You should be able to talk to the billing department and do one of two things

- ask for a deduction due to your inability to pay - check other AskMes about this, people suggest it for uninsured folks with large hospital bills all the time
- ask for a payment plan allowing you to pay over a longer period of time - sometimes hospitals will ask you to just pay with a credit card and then have THAT be your payment plan, but you may be able to work something out.

The usefulness of this plan will really depend on your ability to remain calm and get answers and not jump in with your own "this is totally fucked!" opinions. Medical tests are expensive and it would have been nice if someone had told you what was going on, if that is actually how it went down, but there's a terrible disconnect between receiving medical services and paying for those services. I'm always amazed at how little my health care providers know about how much things cost or what will or will not be covered by insurance. Good luck dealing with this.
posted by jessamyn at 3:36 PM on March 14, 2008 [3 favorites]

The only thing I signed was a paper giving them permission to take photos for research purposes. The doctor was a PA-C (physician's assistant) and according to my insurance, is covered and in-network. I assume the labwork was done in the hospital, but I may be wrong--this will be something to check out.

He did not say he would do any cultures. It was a very basic in-and-out appointment, with him knowing instantly what the problem was (I guess it's common) and a quick prescription write-up. For now, I'm going to wait until the hospital gets back to me with the itemized bill and investigation, and if it's still borked, I'll write a letter and call the doctor I saw.
posted by sian at 3:54 PM on March 14, 2008

To misha's point: We had a problem similar to this a few years ago. When our son was born a doctor sent some blood samples (jaundice) to an out of network lab. As a result the insurance claim for the lab tests was denied. I politely contacted my doctor's billing folks, explained that my insurance didn't cover that lab, and asked why did they send to a non-contracted lab? They admitted the mistake, they should have sent it to another lab based on my insurance requirements. The doctor's office agreed to eat the charge themselves.

And just because a doctor believe it to be one infection doesn't mean they wouldn't send the culture to a lab. I think that its perfectly reasonable both from a treatment standpoint as well as a liability standpoint to confirm what the rash actually is.
posted by uaudio at 3:55 PM on March 14, 2008

I'm thinking you'll probably be responsible for this bill unless the doctor sent them to a lab that is not in your network. Like uaudio mentioned, it sounds like your dermatologist sent samples to be cultured in the lab. He may have diagnosed it on site, but this is a perfectly legitimate and appropriate thing to do from your doctor's standpoint. The 400 dollars is probably the cost to run the tests and for the pathologist to read them.
posted by LoriFLA at 6:17 PM on March 14, 2008

The way I'm reading this (and please correct me if i'm wrong, sian) is not that the claim was denied for being out of network or some such, but rather that sian has yet to meet their deductible, so the $400 would be out-of-pocket.
posted by spinturtle at 6:26 PM on March 14, 2008

This happened to me recently, and the doctor's office was very willing to help me out. I'm not sure exactly how it went down, but they basically just resubmitted the claim to the insurance company, coding it differently, and then my insurance covered it in full, deductable aside. It was something like they initially billed it as "medical," but once they switched it to "routine," my insurance was willing to pay. YMMV, but it's certainly worth a call to the hospital to ask them to resubmit.
posted by TurkishGolds at 6:49 PM on March 14, 2008

I once went in for difficulty swallowing, had an upper endoscopy done, and ended up with several pages (1000s of $$$) of charges that my RN mother identified as likely coming from someone with leukemia (bone marrow biopsies, etc.).

So first question whether this is an actual mistake, i.e. whether the tests were done at all and whether they were done to/for you. You don't even remember them taking a sample to culture?

Once you're past that you can question whether you're responsible for paying for them if no one asked/told you about them.
posted by madmethods at 7:22 PM on March 14, 2008

He did not say he would do any cultures.

Did he swab your skin or otherwise take any sort of sample (gauze pad, blood draw, anything?). If he did not, then the culture is probably not yours, since there wouldn't be anything to run the culture on.
posted by anastasiav at 8:05 PM on March 14, 2008 [1 favorite]