My wife's doctor ordered an expensive test and the lab is charging me. What should I do?

Question

So my lovely wife went in for a regular pap and physical. A couple months later, without having received any report of the results, I get an invoive from the lab (LabCorp) that did the work for about $300.

I call up my insurance company (Aetna) and they say it's a newer more expensive pap test, that they don't cover and they're not sure why they would have ordered it.

I call up LabCorp and they say pretty much the same thing.

When I talk to the doctor, she says that it's my responsibility to know what my insurance covers and what it doesn't. But I thought it was reasonable to assume that the doc would run a regular pap and it would be covered.

SOooo, now I'm stuck and I don't know what to do. I don't want to pay $300 for what should have been a normal routine exam. Shouldn't the doctor have informed my wife and I that this would be a more expensive/thorought/whatever test and might not be covered?

It's stuff like this that make people afraid to go to the doctor...*sigh*

Thanks to everyone who's answered so far (except the guy that called me cheap).

Just a little more info: the lab is billing me directly. That seems dumb to me, as the doctor ordered the work, she should be the one billed and then she can pass the bill along to me. The lab and I are caught in the middle of this.

The thing is that a normal pap is pretty cheap and I didn't think to question it. Wife didn't ask for anything special and doc didn't mention it was a special pap. Wife is 20 yrs. old and healthy and should have no reason to need anything super new/thorough (of course I care about her health).

I've decided to try to put pressure on the insurance company to connect with the doctor and figure out what went wrong. They have the most leverage over her. I'm definitely getting rid of the doc (it was our first and last exam with her) and I'd love to see Aetna drop her from their PPO network (where we found her).

Thanks!

Answer 1

Yes the doctor should have explained to your wife that's theres new tests they do with pap smears and it is more expensive. As far as the statement that it's your responsibility to know what your insurance will and willnot cover is not entirely true. With it being a new test the doctor should know that most insurances will not cover it and tell you what type of test it is and give you the option to call your insurance first to see if it is covered and if not what your options are. You can fight this. Call your insurance company and explain to them that the doctor did not give your wife the facts and you want to contest the relevance of the test. Let the insurance company go after the doctor for explainations as to why she ordered that test and see if they don't deny paying it and then she's out the money. The doctor probably has some deal with the lab and she's making extra money off of this. Fight her.

Answer 2

Yes, the doctor should have been aware that this was a newer, more expensive test, and given you a chance to find out if it was covered by your insurance. Not telling you was an error on her part. How would you know to even ask if you weren't told they were doing that sort of test? The doctor's reply didn't make any sense, and seems like a brush-off. You are completely correct in this case. I recommend getting a different doctor, and explaining to the doctor why you're firing her. That was awful patient care!

This is actually not an insurance issue. The lab did the test the doctor ordered. They filed the insurance, and it wasn't covered. The insurance wasn't doing anything wrong in not paying ... it is completely the doctor's fault in not informing you that the test was new and possibly not covered. We caution our patients every time we order an expensive test or procedure that may not be covered by insurance. It's the doctor's responsibility to inform you ahead of time. If the lab is billing you, there's not much you can do. If the doctor's office is billing for the lab, you might be able make a complaint to the office administrator and work out a reduced payment.

In response to comments below about signing agreements to pay ... Most doctor's offices have the patient sign an authorization to file insurance, which also includes an agreement to pay whatever costs are not covered by insurance. This is a standard part of the registration process. I'm sure there was a form signed along with the new patient paperwork before your wife was even seen for the first time.

Answer 3

You're stuck. It really isn't the lab's fault, because they rely on the physician to make sure you're well informed.

For future reference, always, always, ALWAYS call the location where the test will be performed BEFORE the test date, and obtain the procedure code (HCPCS Code) they are going to use to bill for the test, and also obtain the ICD-9 diagnosis code. Call your insurance company with the code, and find out if and how much of it will be covered. THEN, at the time of the appointment, ask the billing person to put in writing the estimated patient responsibility. The office does, and don't let them tell you otherwise, verify eligibility and benefits prior to the test being performed, so they do have this information.

It was bad practice of them to mislead you, but there's nothing you can do about it now, unfortunately. It is possible that you can send a written dispute to the lab, and they will reverse charges to the physician who performed the test. I'd fire the physician, too. He or she already knows in advance that insurance companies will refuse to pay for tests that rule out something, without first performing a lower costing alternative and standard test. For example, If he or she "thinks" a woman may be pregnant, they don't automatically order an ultrasound unless the urine test, and then a blood test, both come back negative, while all along, the woman is still showing obvious signs of pregnancy.

Answer 4

I don't have an answer but I have a similar situation. My doctor has been told from day one to use a specific lab and when i had a test done recently, he used the wrong lab. My insurance has said they may cover the cost as a one time courtesy. I also found out he performed a separte test I said no to, never gave me the results and now I'm getting a bill for that too. What can a person do? It seems the doctor can perform and test he or she likes and we have to pay for it anyway. Even after I said no to the lab and no to the test.

Answer 5

I would contact the insurance company and the billing agency again. Most insurance companies have an agreement with doctors on procedures, that is, how much they can charge and how much the company will pay. It's really a big scam as if you don't have insurance, you're really paying out the other end. I suspect that do that to raise the cost of treatment to those uninsured so much that they can take them off their taxes or claim it to medicaid.

You aren't a doctor or an insurance adjuster, how are you supposed to know whether each procedure the doctor orders is covered without taking a policy around with you or calling the insurance company every thirty minutes. And even then, I bet you'd get wrong answers half the time.

If you pay it, I'd pay it 10 bucks a month for however long it takes.

Answer 6

Ask the Dr. to show you where they advised you of the more expensive,extensive, thorough testing they were ordering...ask them to provide your signature agreeing to the testing then let them know that you do not feel obligated to pay for something that they led you to believe would be an everyday pap test. Speak with an attorney and let the Dr. know you are doing so. They are likely not going to go through all that for $300. Then contact labcorp and let them know the same thing.
Unfortunately they are right in a really small way...you are responsible to know what your insurance cover and what is not HOWEVER, how are you supposed to choose not to have a particular procedure or test done if you are never informed of the type of test from the very beginning?

Answer 7

I don't know if you have any rights, legally. It sucks, and I don't know what you can do about it. At least you will know so it doesn't happen again in the future. It's crap like that that makes us label insurance companies as "thieves". It seems like all they ever do is try to screw people. And it was pretty sucky of your wife's dr. not to tell her the insurance company might not cover it. I didn't even know there was a new kind of pap. Maybe the answer here is to get a new dr.

Answer 8

Talk to your insurance company more. If the insurance didn't cover it, the lab had a responsbility to inform you. Fight this to the end--my insurance denied my epidural after I had an emergency c-section after 24 hours of labor.

See if you can talk them down. Sometimes you can agree to pay for half of it.

I don't believe it's the doctor's responsibilty to alert you unless the test is covered by VERY few insurance companies.

When I had to have a 24-hour urine sample tested, the lab called to tell me that my insurance wouldn't cover the $500 test. Even though the doctor ordered it from that lab, I had to performed in a lab that WOULD be covered by in insurance.

Answer 9

I would contact a lawyer and refuse to pay until I heard from him.

If your wife went to the doctor and used a health insurance plan then the doctor is responsible for treating the patient with treatments that are approved by that health insurance. If the health insurance plan doesn't cover that expense then it is the duty of the doctor to inform the patient and make them sign a consent form saying that they were duly informed and will assume the responsibility for payment.

So ask you wife what she signed and for a copy of every form that she signed, read them and then contact a lawyer to see if I am correct or not. Rules vary with the insurance plans, but I think that the doctor made a mistake and he doesn't want to absorb the costs. Regardless of the outcome you should complain to your health care plan, first for not covering the test and second for allowing a doctor to pass on the cost to you without your knowledge (assuming that your lovely wife didn't sign a consent form agreeing to pay).

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The doctor is right that you have a responsibility to know what your insurance plan covers, but if the test is new, then it wouldn't have been included on the list of things that your insurance company covers so it is his responsibility to inform you. Propose that theory to the lawyer and see what he or she thinks.

Answer 10

the doctor should have, in the least, advised that this was a new pap and not all insurances cover them!!! it is the doctors or doctors office place to notify your wife of any changes anyways!!! if this were a new pap test, was she told that this is what she was receiving???

ask a few more questions. in the very least the doctor should give you a discount due to the mix-up!!!
take care!!!!!