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Spending a 'penny' costs a fortune!!

Hey guys! Please, can anyone help? Coming from England the insurance system in the USA can be beyond confusing...

Yesterday I received a $1000 invoice from a lab that processed a urine test I did back in January. I contacted my insurance company & was informed that the in-network doctor sent my sample to an out of network lab!! This seems very wrong!!

I only went to this doc a couple of times. It was a big mistake. Anyone who's followed my story... This is the 'dealer doc' who offered to write any prescriptions I wanted so long as I agreed to regular procedures like ESIs even though I'd been advised they couldn't help in my situation. I'd only gone because he claimed to be an expert in natural & alternative treatments. As soon as I realized the 'truth' I ran. I left on a bad note. Ugh!!

The lab offers payment plans but that's not the point! Do I really have to pay? Has this happened to anyone else?
Osteoarthritis & DDD.


  • I only heard about scams like that, this is awful! I would like to know how to protect ourselves from something like that. I assume the Dr. knew who is your insurer. With something as common as a urine tests, it should not be so difficult to find a within network provider. I would start by calling the Dr's office and ask them. If they are not responsive, I would call something like a medical board, or insurance commissioner, or something like that. You may need to ask around, maybe your own insurance company can give you some leeds. I sure hope you can find a solution, rather than pay that outrages amount.
    Good luck, and keep us posted!
  • i had the same thing happen, i went to the lab i always go to, then i got a letter in the mail saying it was sent elsewhere, i did not authorize this, and i did not have to pay. give it time, or call them, you did not give them permission to do that, do not pay.
  • Thank you so much guys. I'm still trying to contact the doctor. I should of mentioned that's $1000 after my insurance has paid their out of network portion! My current docs PA says the average lab cost is around $700 in this area. Why would a doc send my sample to the most expensive, out of network lab in the area?? She's going to look into the lab for me. She'd never heard of them.

    When we go to a new doctor there are so many pieces of paper to sign. I've always had to sign the 'I agree that I'm liable for all costs' standard type form. I just think this is so wrong. Why would a doctor do this to a patient? I'm just so frustrated! We pay a lot of money for insurance... Sorry, I know I'm preaching to the choir but coming from a free national health service this is just blowing my mind! It's a complete waste of $1000 of my money I can't really afford.
    People have told me that the lab might let me pay less or spread the cost out but that's not the point. I shouldn't be paying for this. I was very careful to make sure that he was covered by my insurance.

    This invoice is hot on the tail of my scan which was denied as "Not medically necessary". (After being pre-approved on the phone before I had it!) That's the scan that showed my dead gallbladder was leaking gangrene. The scan that saved my life! It took me a week to sort that one out!

    Ugh!!!! I know I'm just venting now! Thanks guys. ;-)

    Thank you Kinpain. I'm not going to let this drop...
    Osteoarthritis & DDD.
  • dilaurodilauro ConnecticutPosts: 9,842
    with In and Out of Network situations . I have had something like that, but not as bad.

    My wife's insurance has always been through the hospital and a major insurance company. When I have gone to my PCP for check up's, physicals, etc they like to do the blood work in the office. But then they send the samples to an outside lab.
    The cost is about $250 to do this. So, now, I insist that all bloodwork be done through the hospital which has no charge for members in certain plans.

    We have no recourse with the insurance company, it is what is they told us. But we did have words with the doctor's office.

    So now whenever we have medical services rendered, we ask all the questions up front.

    • Who's doing the procedure ? In or Out of Network on Plan "A"
      Where will samples be taken? In or Out
      Is the equipment (ie back brace) from a company that is In or Out
    Its getting to the point where you almost have to ask every time about In and Out of Network
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Thank you Ron. I will ALWAYS ask in future! This urine sample was taken back in January. I'm now trying to think of everything I've had done this year. This completely blind-sided me. The total bill (before insurance payments) was for about twice what my PM docs office thinks it should be in this area. They're suspicious so they're looking into the lab for me. Fingers crossed they can get me some ammunition to work with!

    Lesson Learned... I wasn't comfortable with this specialist from the moment I walked into the filthy, broken-down, packed waiting room. Too many patients looking well & paying cash! He asked me what prescriptions I'd like him to write & told me that we needed to get some ESI's scheduled (he'd already agreed with my PM that they wouldn't be helpful in my case) I ran but obviously not fast enough!! I'm angry that I got caught like this. It won't happen again but it's a very expensive lesson to learn!
    Osteoarthritis & DDD.
  • Greg1978GGreg1978 Posts: 28
    edited 09/25/2014 - 5:28 AM
    I'm sure that doctor is getting a kick back which is sad. I once had a old employer counter retro Deactivate my insurance ya EDITED I didn't think that was legal. So I was on standby status with my employer or as I would call it laid off. I started PT in jan and had a few chiropractor sessions each month I called my insurance and asked if it was still valid and each month they said yes. Well I couldn't afford to be laid off anylonger and in march I got a new job. When I started that new job I no longer used the services threw my insurance. Shortly after getting that job my old employer called me back and I informed them I ended up getting a new job well I started getting all these calls from my doctors saying I owe thousands of dollars and every bill I owe was at the cost of having insurance if you guys no you get a good cash break if you don't have insurance. So with out insurance a doctor visit cost my 80 bucks with insurance I see on the bill they are charged 173 and I cover the copay. I asked how do I owe all this money I had insurance and they said they retro deactivated it as of JAN one of the ladies at the front desk said she had never seen that ever. Our insurance system is a joke it's all about money. So in the long run I set up payments for over 5 grand worth of bills lucky my chiropractor copay is like 5 bucks less then what the insurance charges so I didn't owe to much but the physical therapy appointments and my wife's crown killed me.

    Post edited for language . Use of foul language in any form is not permitted.
  • OMG Greg I'm so sorry. I didn't even know that could happen! The thing that really, really offends me is when they use the word 'only'....insurance paid some so you ONLY owe $1000!!! Wouldn't it be nice to live in a world where $1000 for nothing is 'only'??
    Osteoarthritis & DDD.
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