doc visits & lab billing: is this normal?

[ijack]

who drew the blood?

[IIOY]

Oct 2, 2014 13:40:40 GMT -5 mr+ms said:

Mr. visited the doc and he ordered a couple of blood tests (pretty simple - Vit. D and something else). Mr. checked off Quest as the preferred lab since that was in network and the blood draw was at the doc's office. 

So the blood draw was at the doc's office and then submitted to Quest by the doc?

I have to go to the lab to get blood drawn, and there is zero charge.  I've never had blood drawn at the doctor and then submitted to a lab.

[bcv513]

I've had blood drawn and the doc's office and sent to an outside lab for processing (Prometheus labs). My insurance covered everything, but it was billed for every. single. step. The blood draw, the nurse's time taking it, an office visit, shipping to the lab, the lab processing it, etc. I think they charged over 1k and the insurance knocked it down to a couple of hundred. I paid nothing out of pocket

[Deleted]

I just looked at DH's last outpatient statement to see how his draws are billed and the actual blood draw itself is billed as 'Venipuncture' and is $28.

I would call your insurance company and see what billing code the doctor's office used and if that code is the one they're supposed to use for a blood draw. If it's not I'd get the doctors office to resubmit with the correct code for the procedure.

[IIOY]

Oct 2, 2014 13:52:51 GMT -5 bcv513 said:

I've had blood drawn and the doc's office and sent to an outside lab for processing (Prometheus labs). My insurance covered everything, but it was billed for every. single. step. The blood draw, the nurse's time taking it, an office visit, shipping to the lab, the lab processing it, etc. I think they charged over 1k and the insurance knocked it down to a couple of hundred. I paid nothing out of pocket

They do this precisely because they know the insurance company will cut the bill.  This right here is part of the insanity of our system.  

FWIW, lawyers who do insurance defense work do the same thing because the payments get reduced so significantly.

[bcv513]

Oct 2, 2014 13:55:23 GMT -5 IIOY said:

Oct 2, 2014 13:52:51 GMT -5 bcv513 said:

I've had blood drawn and the doc's office and sent to an outside lab for processing (Prometheus labs). My insurance covered everything, but it was billed for every. single. step. The blood draw, the nurse's time taking it, an office visit, shipping to the lab, the lab processing it, etc. I think they charged over 1k and the insurance knocked it down to a couple of hundred. I paid nothing out of pocket

They do this precisely because they know the insurance company will cut the bill.  This right here is part of the insanity of our system.  

FWIW, lawyers who do insurance defense work do the same thing because the payments get reduced so significantly.

Of course they do. The entire system is crazy.

[Stingyshark]

.... not a reg, but saw your post from the main page.

Does it give specific codes on the bill? (I just ask because I'm wondering what  code was billed that could have come up as an outpatient procedure vs. a venipuncture)

I think most Dr. charge a draw fee, but, from what I've seen it's like $5-$10, and not typically billed to the insurance. The reasoning, from what I remember when I worked in an urgent care, was that the lab charges your Dr. for the blood draw and so your Dr. is recouping some of, or all of or more than, they are being charged by the lab.

I would contact your Dr office about this. Something seems..not right.
They can bill for the venipuncture, but it's not even reimbursable for my local medicare, and many insurances will follow suit of your local medicare.

[ijack]

some offices have phlembologists that work for a lab inside their office, so I was wondering if that was maybe the case and they weren't in network.

[IIOY]

Oct 2, 2014 14:04:18 GMT -5 Catlawdy said:

All I can add is that medical billing is infuriating.

Call the insurance, find out how it was billed and if that was a correct way to bill it, and put them on conference call with the doctor's office if you have to. I don't tolerate the doc's office and the insurance blaming each other for crap, I will conference call them from my own phone.

I HATE medical billing.

Am I permitted to pile on with a short story of general insurance fuckwittery? I had to change my kids' dentist because our new dental insurance doesn't cover their dentist (never mind that they apparently paid the bill back in the Spring because WTF). It took three phone calls over the course of 2.5 hours to find out who in my area we could use and to have that office added to our info as our "primary" dentist.

[orangeblossom]

I would call. I have paid for blood work, but I was never billed for it from the doctor's office as a separate procedure.

[Stingyshark]

Oct 2, 2014 14:04:18 GMT -5 Catlawdy said:

All I can add is that medical billing is infuriating.

Call the insurance, find out how it was billed and if that was a correct way to bill it, and put them on conference call with the doctor's office if you have to. I don't tolerate the doc's office and the insurance blaming each other for crap, I will conference call them from my own phone.

I HATE medical billing.

Me too, yet it's what I do for a living. 
Currently my eyes are glazing over while I read through various code books looking for a surgical code. kill me.

[niemand88f]

My doctor's office does the blood draws and sends out the samples under exactly the circumstances you describe, it has never been billed as an outpatient procedure. Definitely call.

I had my own bit of medical billing fuckery this week. I went to the ER in July. Claims were submitted, the doctor and the hospital were in network. I paid my copays and portion of the hospital bill, all fine. But the doctor's special billing office, even though they submitted it to my insurance and it was listed as submitted on the bill, decided to bill me for the whole amount because why not? Thankfully my insurance was having none of that when I called them, and they're sorting it out for me. But still there was a good hour of panicking and stress before I could talk to my insurance and another 20-30 minutes actually talking to them and generally wasting my life on their mistake.

[IIOY]

Oct 2, 2014 14:18:27 GMT -5 Catlawdy said:

Oct 2, 2014 14:09:54 GMT -5 IIOY said:

Am I permitted to pile on with a short story of general insurance fuckwittery? I had to change my kids' dentist because our new dental insurance doesn't cover their dentist (never mind that they apparently paid the bill back in the Spring because WTF). It took three phone calls over the course of 2.5 hours to find out who in my area we could use and to have that office added to our info as our "primary" dentist.

Absolutely.  I'll add on the time that I went to an outpatient appt with a GI doc, paid a copay, and got a bill for $500.  My appt confirmation email said to double check on billing with my insurance company.  The insurance company website had a list of doctors, and had little symbols beside the names of the docs that billed outpatient ($$$) v. billing a copay ($).  The insurance company said to ask the receptionist how they billed (WTF on that one but that's another issue). 

I got caught in this weird loop with our current pedi dentist, where they said our insurance included them if it was a PPO, and our insurance company said we have a PPO/HMO combo, and it depends upon how the dentist bills, so ask the dentist how they are going to bill.  So the dentist tells us it sounds like we should be fine, but ask the insurance company.  And back and forth.

[Deleted]

Sounds like the office submitted the wrong code.