Insurance/Lab Work Help!

[HLAuburn]

Just some quick background info...my doctor gave me some orders to have bloodwork done and based on my insurance company, sent me to a particular lab to have it done.

Today, I get a bill from the lab for $2300 claiming nothing was covered by insurance because it was billed as "routine" bloodwork. Since "diagnostic labwork" is covered at 100%, the insurance company implied that if the doctor attached to a medical diagnosis, it could be resubmitted and possibly approved. Of course, the doctors office was closed by the time I called.

So now I'm freaking out. We have been trying really hard to get our finances in order, and this would ruin everything. Does anyone have a similar experience or know anything about medical coding?? Should this be a quick fix for someone at the doctors office or am I really stuck paying for all of this?

Thanks in advance.

 

[Kellydelly]

Holy cow ! How many tests did they run? Was it routine physical type stuff (cholesterol, glucose, thyroid, etc.)? I hope the results were good, cause the bill would give me a heart attack !

 

[Christine]

I have lots of labwork done and I've never had that happen. However, my doctor(s) have ALWAYS put a diagnosis or two on the form.

Hopefully your doctor will call in the insurance company and clear that up.

Were you having a routine physical or were you there for specific reason. I suppose that an insurance company could deny that if they don't cover labs for physicals but MOST insurance companies allow a physical one time per year.

 

[bigbabyblues]

Sending you a PM

 

[ilovemk76]

Just some quick background info...my doctor gave me some orders to have bloodwork done and based on my insurance company, sent me to a particular lab to have it done.

Today, I get a bill from the lab for $2300 claiming nothing was covered by insurance because it was billed as "routine" bloodwork. Since "diagnostic labwork" is covered at 100%, the insurance company implied that if the doctor attached to a medical diagnosis, it could be resubmitted and possibly approved. Of course, the doctors office was closed by the time I called.

So now I'm freaking out. We have been trying really hard to get our finances in order, and this would ruin everything. Does anyone have a similar experience or know anything about medical coding?? Should this be a quick fix for someone at the doctors office or am I really stuck paying for all of this?

Thanks in advance.

What did they test for? I get the routine blood work and it have one less zero on the number.

 

[HLAuburn]

They took 12 vials of blood and did about 40 different tests. It wasn't routine, and I thought it had a diagnosis on the order sheet, but the codes on the insurance claim say "wellness" and seem to be in fact coded as "routine".

I'm really just praying it's a simple matter of changing the way they billed for it.

Thanks for the replies!

 

[golfgal]

Coding errors happen, just call your dr.'s office in the morning and have them recode and send back in.

 

[Nancy]

To me it sounds like some of the lab work ordered had procedure codes that are not considered as preventive or "wellness" labs, but the doctor used a preventive code as opposed to diagnostic and that can cause issues.. so with that scenario the insurance company will deny outright. Corrected claims can always be sent in. Health Care reform has changed how a lot of codes have to be submitted to be covered so it is possible that the doctors office was using the old ways.

 

[HLAuburn]

Coding errors happen, just call your dr.'s office in the morning and have them recode and send back in.

To me it sounds like some of the lab work ordered had procedure codes that are not considered as preventive or "wellness" labs, but the doctor used a preventive code as opposed to diagnostic and that can cause issues.. so with that scenario the insurance company will deny outright. Corrected claims can always be sent in. Health Care reform has changed how a lot of codes have to be submitted to be covered so it is possible that the doctors office was using the old ways.

Thanks! I really hope it was just a simple error with a quick fix. I don't exacty have $2300 to couugh up right now!

 

[jlewisinsyr]

Billing errors happen, and even if you did have to pay it, most companies have no issues with working out payment plans.

 

[Feralpeg]

My daughter is undergoing Lupron Depot injections for endometriosis. Before we started the process, I contacted our insurance to make sure the injections would be covered. Each injection is $2051.00. She requires at least two injections.

The insurance told me that they would be covered. After she had the first injection, I got a call from CVS Caremark. The injections were obtained by the doctor through CVS Caremark. They told me that the insurance was not covering the injections due to our deductible having not been met for the year. We do have a $5000 deductible for each of us. They said that the insurance decided to treat the injections as a treatment rather than a prescription drug, thus we had to meet the full deductible. Needless to say, that was a huge surprise. What really irritates me is that we got the okay before she started the treatment. I really dislike insurance companies! We wouldn't have such a high deductible if they'd stop raising our rates every year!

OP, don't panic. See if your doctor will resubmit for you with a diagnosis that they will consider covered. Unfortunately, that didn't work for us.

 

[jlewisinsyr]

I really dislike insurance companies! We wouldn't have such a high deductible if they'd stop raising our rates every year!

Don't blame the insurance company, they are only trying to levelize their profit (or reserves for not-for-profits) based on the increasing costs of medical care, medical care, you as a consumer have demanded.

I know it's frustrating, but it's much, much larger than just an issue with an insurance company raising rates.

 

[scrapquitler]

So now I'm freaking out. We have been trying really hard to get our finances in order, and this would ruin everything. Does anyone have a similar experience or know anything about medical coding?? Should this be a quick fix for someone at the doctors office or am I really stuck paying for all of this?

Thanks in advance.

Don't panic. Take a deep breath. Call the doctor's office in the morning and tell them what happened, they can change the code and resubmit it. My insurance routinely kicks things like this out the first time, they figure that you'll panic and pay. But don't. They almost always figure it out the second time.