Billed for Surprise Tests From Doctor

In My Humble Opinion (IMHO)
#1

My brother-in-law went to the dermatologist because of a skin condition. The doctor diagnosed the condition and said that there was a small chance that the skin condition resulted from Hepatitis C so he would need to get a blood test for Hepatitis C.

My brother-in-law has lived a pretty clean life so he didn’t think it was likely he had Hepatitis C, but he went along with it and allowed a blood sample to be taken. He was called a couple days later by the doctor’s assistant and told that the test was negative. (Since then, we have confirmed from internet research that the guy’s skin condition is indeed sometimes a symptom of Hepatitis C.)

Later, he got a letter from his insurance company indicating that his blood had been given 5 different tests - 2 for Hepatitis A, 2 for Hepatitis B, and 1 for Hepatitis C. The tests were apparently about $100 each for a total of $500.

To make matters worse, the insurance company’s letter indicated that it was denying coverage for all the tests, even the hepatitis C test, because he did not fall into any high risk categories for hepatitis.

Needless to say, this guy feels shafted since he was never told he was going to have to pay extra for these tests. Besides which, it seems 4 out of 5 really were unnecessary. But either way, he feels he shouldn’t have to pay. Either the tests were necessary, in which case insurance should cover them, or they were unnecessary, in which case the doctor should eat them.

Any advice on what this guy should do? He doesn’t want to alienate the doctor.

#2

I’d for sure ask the doctor why he did so many tests, and if he would also explain it to the insurance company.

#3

Fuck “alienating” the doctor. It’s his office’s job to code their billing properly, and to fill out lab reqs correctly. Another vote to call and ask why the extra tests and why the proper potential diagnosis possibly wasn’t given.

#4

He should definitely call the doctor and ask why the tests were given. Maybe the doctor’s office can resubmit the paperwork to the insurance company to make sure the tests are covered, or realize that either the doctor or the lab made a mistake.

I doubt the doctor would take this personally. IANAD, but, from what I understand, wrangling with health insurance companies, making sure the lab runs the right tests, discussing patients’ bills, etc. are a basic part of the business side of a medical practice.

I hope your BIL gets this straightened out as quickly and easily as possible.

#5

The doctor ordered what is called a “hepatitis panel”, a group of labs that look for hepatitis A, B, and C. It’s very standard to do it this way–I almost never see anyone order the tests separately (myself included). A lot of the labs we order typically come in groups or panels like that.

I’m a little surprised that the lab bills for each test separately, or at least I would be if I were capable of surprise anymore when it comes to medical billing.

I think the doc and the insurance company should be able to sort it out, but he should definitely let them know about it. It won’t alienate the doc.

#6

I had something similar happen to me at the ophthalmologist last year. A second test was kind of sprung on me, without it being clear that it wasn’t even a standard test… and then I was on the hook for about five hundred dollars. I paid it, and never went back to that eye doctor again.

This is yet another reason why our healthcare system is seriously screwed up.