Medical office misinformed me about coverage

[CJ2008]

I am so upset about this...

A couple of months ago I had a very detailed blood test done and the office told me several times, at different times and by different people, that I was responsible only for a certain amount (about $200). When I got an invoice from the laboratory several weeks later, I called immediately and again, the medical office told me to not worry about it, that I would get 2 more invoices because that's the "process" that the laboratory goes through, but that then that would be it, and that they "write them off."

I received a couple of more invoices and the last one I got warned me that if I don't pay it by a certain date, it would go to collections. I was alarmed about this and figured I'd better check again...so I faxed over the invoice to the medical office with a note asking them to call me, that I had been reassured by them previously I wouldn't have to pay it, but just wanted to make sure again.

I called them today and they told me I myself would have to call the laboratory to see why that's happening. Lab tells me the medical office gave me the wrong information, and that I am responsible for the almost $700 that this test cost.

Medical office is wiping their hands of it.

And I see what's coming...they're going to say that I am always ultimately responsible for making sure services are covered. They may even say they never told me I would only be responsible for a certain amount.

And in doing research, I see that I am on the losing end here, that I should have double checked with my insurance.

I am so angry and upset and sad about this. I would never ever have done this test had it not been for the fact that they repeatedly told me it would cost me $200. Each person seemed so certain of that it didn't even cross my mind to double check with my insurance.

I don't know what to do and I don't know what recourse I could possibly have. I am hoping someone here can give me some pointers or ideas. The only thing I am sure of is that I shouldn't let it go to collections and deal with the aftermath later.

 

[Skippy123]

CJ, that is awful!!! do you have insurance? have you talked to your insurance company?

Okay, if you do have insurance talk to them. Find out the amount the insurance company allows and what your responsibility is? are they the same or different. If different then have the ins company talk to the Lab.

 

[CJ2008]

Hi Skippy,

It is awful. I can't even begin to describe how I feel about it.

And what's worse is the cavalier attitude from the office.

Yes, I have insurance but I haven't called them yet because I want to be smart with how I proceed. And because I have a feeling I'm going to hear the same thing "Ultimately, it's up to you to verify coverage."

They're not going to care either.

I have a feeling this will be a very lonely battle and I won't get any sort of satisfaction because the office knows the laws. No matter how hard I try, if I scream, if I cry, ultimately, they know they can just say "oh well, we're sorry about that" and there's nothing I can do about it.

Awful.

 

[enbcfsobe]

Did you check with the lab to make sure they had even tried to apply your insurance coverage? Every once in a while I get a lab slip where they simply haven't bothered to apply the insurance policy.

Other than that even when you get advice from someone at the insurance company that is incorrect and rely on it there is sometimes little recourse since the underlying policy (which is nearly impossible to get a hold of) is what they claim always controls. I would contact your insurance company and march up the supervisory chain there to see if they can help you.

 

[CJ2008]

I found out the lab didn't bill it because they "know" it's not going to be covered because my plan stopped covering that test in November.

Nonetheless, one of the options they gave me is to file the claim myself using each of the codes from the test.

The people at the lab have been the nicest and most understanding to deal with - much better than the medical office itself. I spoke to someone there yesterday who suggested I speak to a particular person in billing to see if they can help.

My insurance company was understanding but at least the person I spoke with didn't seem alarmed about this office passing out the wrong information - all she kept saying is that if a claim wasn't submitted, she can't help me. Perhaps I can try calling someone else though.

I am not holding my breath that this is going to go any differently...but I will do something to inform the doctor/owner/anyone who will listen at that medical office that their employees are irresponsible in dishing out information - and when they make a mistake, they could care less. They are conveniently located to me and it's a nice looking office and they offer many different services - I've been going to them for years - so I don't know that I could find another office to replace them that I can be happy with - but for all intents and purposes, they've lost a patient.

 

[Skippy123]

CJ have them bill your insurance even if it is turned down. You might get a discount through the billing. I had over a million dollars in medical bills so I am kind of familiar with the craziness. You have to be your own advocate because the collecting agents suck and they can ruin your credit. Good luck and sorry you are dealing with this.

 

[enbcfsobe]

I agree with Skippy -- it may not work but it is worth a shot to submit the claim. Also I would either speak to the doctor directly about this matter and particularly about the attitude you got when you pointed out the mmistake or put something in writing to the doctor. Unfortunately doctors offices don't always have the most up-to-date info about changes to insurance coverage -- at least now you know there is some reason that they may have been confused, though that doesn't forgive their attitude. Good luck!!

 

[mayachel]

So sorry you are having to deal with this nonsense. FWIW, I highly recommend putting in writing why you don't believe you are obligated beyond the discussed $200. About 7 years ago, I had something similar occur while seeking medical care out of state (but just over the border from the state I lived in.) I very clearly and explicitly asked if they took my insurance to which they seemed to think "yes" included "sure we'll take your card, photocopy it and hand it back to you, but we aren't actually in your network..." I wrote a letter after receiving one of those collections warning letters about how I felt they had deceived me and that I was not to be held responsible for anything more than my co-pay which had already been paid...and it worked. They forgave the rest of the bill. This included lab work and an ultrasound, not just an office visit. Fight the good fight!

 

[katamari]

CJ, hopefully you have this figured out by now and got it scheduled in your favor. I did want to share, if you do end up having to pay and if you live in the U.S., you are able to finance medical expenses without interest or fees though your insurance provider. It won't help with the ridiculousness, but it might help ease the financial burden.

And, yes, it is completely unacceptable for patients to not get information about costs. I am not sure that the burden of this should be upon the providers, but accurate information should be easy to come by. It is infuriating.