Bills, bills, bills
January 15, 2012 7:11 PM   Subscribe

My doctor ordered medical lab work that I did not ask for. Now what?

Last month I went to see my doctor and she asked if I would like XYZ panel test done. I said my insurance only covers A and B so I only want those done. I received a statement from my insurance saying that the lab will bill me directly for claims not covered under my plan but didn't specifically say what wasn't covered. I spoke with my doctor last week on the phone and she told me my results for A, B, and C. I did not ask for C. I actually didn't even think about C until just now, realizing that C is probably what I will be receiving a bill for. I haven't received a bill yet but I will be seeing my doctor again this week. Should I mention this or wait until I actually receive a bill?

A, B, and C were not related to my original office visit.
posted by showmetheway to Human Relations (8 answers total)
Mention it now. You want to head this off at the pass. If she steps in now, then you may not get a bill ever. It avoids one more level of bureaucracy you will have to face. If your doctor acts like it is no big deal, point out to her that it is a violation of medical ethics to provide treatment or tests to which the patient has not consented and that you expect the charges to be reversed immediately.
posted by Ironmouth at 7:19 PM on January 15, 2012 [3 favorites]

You're being very vague. C may well be something that is routinely tested given your age or history or other details. Unless you asked her to order only the things that you wanted, you would have a hard time challenging her decision to include it.

The patient is (in my experience) always given some kind of slip that identifies what is being ordered. If there was a concern, that would have been the time to ask about it.
posted by megatherium at 7:19 PM on January 15, 2012 [2 favorites]

Did she have you sign something beforehand that says that you'll have to cover whatever is not covered under insurance?
posted by anniecat at 7:24 PM on January 15, 2012

A and B are part of the XYZ panel she asked if I wanted to have done. C is related to A and B and XYZ panel but not routinely tested unless the patient presents with a specific complaint. I was in there for a yearly exam. The lab work sample was collected in the office and sent to Labcorp.

When I went to check out and pay, the receptionist noticed that my doctor had not filled out the billing form (reason for visit, tests done, etc) but said I owed nothing at the time and they would bill me if necessary. In fact, when I was in the middle of my exam, the nurse came in and asked the doctor to fill out the form for the previous patient.

The doctor's office and the lab are two different entities. My insurance has sent me a statement saying I owe the doctor nothing. I received a different statement from my insurance about the claims relating to the lab work.
posted by showmetheway at 7:35 PM on January 15, 2012

The doctor needs to help you appeal to your insurance company. They will often cover things only after being given a considerable amount of shit from the doctor/patient. Sorry.
posted by the young rope-rider at 9:06 PM on January 15, 2012

This is showmetheway. On my visit of xx/xx/xx, I chose not to have the C test. It looks like it may have been done anyway. Can you tell me what's up with that? Be calm and very polite, and explain that you told the doctor you did not want test C.
posted by theora55 at 9:51 PM on January 15, 2012

Routine lab work is routinely discounted 80-90% on insurance company contracts. So even though they don't cover it on your plan, it is very possible that the charge to you will only be a few bucks, in which case paying it will be far less hassle than spending a lot of time and energy disputing it. Obviously if is $100 that is different. However, every time I see the EOB for labwork I feel sorry for the poor people that get billed $100 for a CBC when my insurance company is paying $6 for the same work.
posted by COD at 5:57 AM on January 16, 2012

Hi, I'm a med student and learned a few things I thought might be helpful to you. Firstly, you should absolutely talk to the physician about the charge being debated, but also listen to why it was ordered. chances are there is a reason why it was ordered, and knowing that will help you both formulate a plan about how to proceed. For example, if this was a routine lab, there are loads of labs that you can find online that will process samples on the cheap. It sounds wierd, I know, but I have seen them used, and physicians that I've seen are willing to work with you and your budget. If it was not a routine lab, it may be that you may not need it again and you and your physician can just work on a way to resolve the bill together.

Regardless, it is always the best option to keep your physician informed of all relevant information. After all, the degree to which your insurance covers labwork is but one socioeconomic variable that impacts health. Most importantly, never cease to be your own advocate!!!
posted by gijoedo at 6:57 AM on January 16, 2012 [1 favorite]

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