Is it a Hidden Scam at Your Doctors Office?

 All the hype about insurance, ObamaCare, Medicare and Social Security you would think the doctor's office would at least TRY to make it easier for people but instead I think they are doing the opposite.
I have learned alot about how the insurance company covers claims so when I get my EOB (Explanation of Benefits) I actually read them. I know plenty of people that do not even open them up much less read them.

Here is a story you all need to read and hopefully you can avoid it happening to you.

Recently my husband went to see his primary care doctor who is In-Network with our insurance for his yearly check up. He usually has to have blood work done to check his blood sugar, cholesterol and other basic stuff and this trip was no different. You would think a doctor that requires blood work would have a lab company that is in the same network as his patients. That is not always the case AND they don't always inform the patient that the lab company is not in-network until you get a bill for $1000.
That's right $1000. After getting the EOB I called the Dr.'s office to find out why the lab company was out of network. They inform me that it really didn't mean anything except that the insurance will send us the check instead of sending it to the provider. Well my experience tells me that is not true. If you use a out of network provider yes the insurance company sends the check to you but it also means that you have to pay this outrageous deductible plus the benefits are not as good. Let me break it down for you.

Lab Company charged $1088.66 for the blood work. EOB states $156.01 will be applied to the $1000 out of network deductible, amount you may owe provider $1088.66. What this means is the insurance covered $156.01 but it was applied to deductible and since they are out of network we owe the whole amount.
IF they were in network we would only be responsible for the co-insurance amount which would be about $31.00 and they could not charge the difference.
It is totally just plain stupid that a doctors office that does blood work like a family doctor would have a lab company that is not in network with their patients insurance. When I talk to someone at the doctors office their solution was setting us up on a payment plan. WHAT? NO YOU WILL NOT BECAUSE I WILL NOT PAY FOR SOMETHING I DID NOT APPROVE. I should have a choice whether I want to use a lab that is out of network and I did not. So if they choose to have a lab that is not covered then they will be the responsible party.
So a word of advice if you go see a doctor and they want to do blood work be sure to ask them one do they send it out of office and if so does the lab company in-network with your insurance. It is not fun to get a $1000 surprise unless it is to your benefit.


Karrie S said...

That doesn't seem right. Is this insurance fraud? Blood work doesn't cost $1000 for a glucose test even if its A1C. I think you should do a little more investigating. And why is this the first time you are getting this bill? Is it a new doctor?

Daily Woman (Lacey) said...

Thanks for reading and commenting on my blog, I really appreciate it. It is not a new doctor but they have a new lab company that does the blood work. We didn't really get a bill yet but I did get the EOB from the insurance stating what is getting paid. I think in a way is is wrong for the lab to charge this crazy amount even if we don't have to pay it because they get to write off the difference. I am just going to wait and see if we actually get a bill then I will do something.