Left with a huge diagnostic lab bill

January 26, 2016 5:30 AM

What are my options when faced with a large medical bill?

Last month I took my kid into the doctor with a cough. As part of the visit, they ordered up some labs.

I just got an invoice from the lab asking for $1,600!

The EOB from the insurer says that they paid the prevailing rate. The test done is coded as 87633. A little googling tells me that this is usually billed at about $300. The lab billed this at $1950, and my insurer paid about $325. The lab wants me to pick up the difference.

I'm pretty sure there's something wrong with this picture, but I don't know what the next step is. I called the dr, and they said to call the insurer. The insurer said they'll look into it, and give them 30 days. The lab says I need to pay within 14 days.

Nb this is not a copay or deductible; this was at the end of the year, all deductibles were well exhausted, and copays from labs are always clearly marked as such. I received a bill the week before from the same lab, where the remainder after my insurance company covered about $150 was $17.

posted by mhz to Health & Fitness (10 answers total)

Are you sure you didn't hit your deductible? This happened to me once and it was because I hit my deductible. If you call the number on the back of your insurance they should be able to tell you if you've hit the deductible or not. 30 days seems like a really long time. Just keep calling and being annoying until they connect you to someone up the chain of command.
posted by deathpanels at 5:36 AM on January 26, 2016 [1 favorite]

Don't worry about paying the lab, it's in dispute.

It might be that the doctor's office coded the labs wrong. It might be that your doc sent them to an out-of-network lab. I had a thing that I went back and forth on for months.
posted by Ruthless Bunny at 5:37 AM on January 26, 2016

I had an in-dispute charge* get turned over to a collection agency. I think it happened because the large provider was doing something sketchy. If this concerns you, then make sure the lab acknowledges that the item is in dispute so it won't get turned over and confirm what will happen after 14 days. (I've never seen anything get turned over within 14 days. If they tell you that it will be turned over after 14 days then I'd ask to speak to a supervisor.)

*(- very suspicious re-coding of services by provider that no one there would admit to doing because it was only the actual person doing the service who can change a code and she did not -)
posted by RoadScholar at 5:49 AM on January 26, 2016 [2 favorites]

I had a bill go back and forth for over 6 months because the provider didn't bill my insurance correctly. I called the insurer and the provider multiple times, and it eventually got sorted out. The provider marked my account that the transaction was in dispute so it wouldn't get sent to collections. In my experience, it is SUPER rare for any provider to send anything to collections under 90 days, and it's usually longer than that. I would call the lab's billing department and tell them you're working with your insurance to correct the issue, and while you're at it, ask them to check that they billed the correct code.
posted by bedhead at 5:59 AM on January 26, 2016 [1 favorite]

Best answer: This sort of thing is called "balance billing" - if they're an in-network provider for you, they're generally not allowed to bill you for the balance of what your insurance doesn't cover (other than deductibles and co-pays, that is). Check if they're in-network; if they are, ask your insurance company if their providers are allowed to balance bill.
posted by okayokayigive at 6:13 AM on January 26, 2016 [8 favorites]

Absolutely check in with your insurer on whether the lab is allowed to balance bill you.
posted by ThePinkSuperhero at 6:18 AM on January 26, 2016 [2 favorites]

Agreed that this may take a while to sort out (I once had a medical bill end up taking over a year to resolve...it was clear I was right, but insurance kept messing things up on their end every single time I called. ARGH.) Talk to the lab about what's going on and get them to mark the bill as being in dispute so you can take the time to deal with this. The long timeline should not be a shocker to anyone working in the medical industry -- to the contrary, I would be pretty surprised if everything really does get resolved within the 30-day framework you were told.
posted by rainbowbrite at 7:56 AM on January 26, 2016

Sounds like that may have been out of network or not a preferred provider for your insurance company. Same thing happened to be a few years ago where my PCP sent me to an our of network lab and I ended up with a large bill as well.
posted by Sara_NOT_Sarah at 8:22 AM on January 26, 2016

Are you sure that the lab was in-network? I had a doctor have labs sent to an out-of-network lab once (frustratingly, the samples were drawn at an in-network lab but unbeknownst to me the doctor requested them sent to specialty lab for testing) and my insurance wouldn't cover it.
posted by radioamy at 12:54 PM on January 26, 2016

Response by poster: Followup:

The insurer confirmed that I should have had only a $40 co-pay, and that they had sent an updated EOB to the lab. The lab hadn't updated the invoice, but when I contacted them, they said a new one was on its way.

I got an answer from the insurance company within 24 hours, and the lab within 48 (just got an answer now!). All via web form/email.

Thanks!
posted by mhz at 5:06 AM on January 29, 2016