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Recently I had a doctor perform an elective preventative procedure and we had an agreement about how much I would be charged for that procedure because my insurance is bare bones and I would not have done it otherwise. However he made a mistake in coding the procedure when he sent it to the independent lab and now I am stuck with an excessive bill that I will not be able to afford. This has happened before in the past and I was able to get it correctly adjusted, however the doctor's billing assistant was unable to do the same thing this time because of something about my insurance picking up a portion of my office bill this time. My question is: what can I do to get my lab bill lowered to the point where it's affordable? My income is limited and even a payment plan on the full amount would put significant stress on my budget. I need to know when I can do to negotiate with them a more reasonable payment that is closer to what the doctor and I had agreed upon.
I woud think if doctor can not correct then it goig to be between you and lab. Bascially it sounds like Lab did what was ordered and its the doctor who should compensate on his fee for mistake.
I woud think if doctor can not correct then it goig to be between you and lab. Bascially it sounds like Lab did what was ordered and its the doctor who should compensate on his fee for mistake.
Yeah I'm wondering if there is any way to negotiate with the lab, though? Anything I can say or do to get them to be more reasonable with me?
The doctor has already offered to give me free appointments or procedures in the future until we're "even," the problem is that because of the size of the bill that could take a while and I may not even be seeing him frequently enough to realize the savings.
The doctor has already offered to give me free appointments or procedures in the future until we're "even,"
Huh?!??!! That doesn't sound legit. What kind of doctor is this? He sounds like a con artist.
Coding for a higher priced procedure is insurance fraud called "upcoding." It's against the law. An error in billing should be an easy fix via his billing assistant changing it. It doesn't matter that it already went through the insurance. Call your health insurance provider and tell them that it was coded incorrectly. Tell them you didn't have the procedure that was coded. The insurance company doesn't want to pay more than it should. Calling the insurance company will put the ball between the billing assistant and the insurance company. If you don't want to get them in trouble for insurance fraud, then confront them about it first and give them one more chance to fix it. You're being played. Bills can always be adjusted after the insurance company pays a portion of the bill!
Recently I had a doctor perform an elective preventative procedure and we had an agreement about how much I would be charged for that procedure because my insurance is bare bones and I would not have done it otherwise. However he made a mistake in coding the procedure when he sent it to the independent lab and now I am stuck with an excessive bill that I will not be able to afford. This has happened before in the past and I was able to get it correctly adjusted, however the doctor's billing assistant was unable to do the same thing this time because of something about my insurance picking up a portion of my office bill this time. My question is: what can I do to get my lab bill lowered to the point where it's affordable? My income is limited and even a payment plan on the full amount would put significant stress on my budget. I need to know when I can do to negotiate with them a more reasonable payment that is closer to what the doctor and I had agreed upon.
A "mistake" can be corrected by sending a corrected claim. What did he send to the lab? Blood? Tissue? If it was tissue, the diagnosis really would not affect the charge unless it was something unusual, but I am wondering what kind of elective procedure would cause something to need to be sent to a lab. How big a charge are you talking about?
Huh?!??!! That doesn't sound legit. What kind of doctor is this? He sounds like a con artist.
Coding for a higher priced procedure is insurance fraud called "upcoding." It's against the law. An error in billing should be an easy fix via his billing assistant changing it. It doesn't matter that it already went through the insurance. Call your health insurance provider and tell them that it was coded incorrectly. Tell them you didn't have the procedure that was coded. The insurance company doesn't want to pay more than it should. Calling the insurance company will put the ball between the billing assistant and the insurance company. If you don't want to get them in trouble for insurance fraud, then confront them about it first and give them one more chance to fix it. You're being played. Bills can always be adjusted after the insurance company pays a portion of the bill!
A doctor who waives fees for a patient is a con artist? Really?
There is nothing in the OP about coding for a higher priced procedure. The procedure code would be sent to the insurance company. A diagnosis code would be sent to the lab. Those are two entirely different coding systems. The lab fee is based on what the lab does with the specimen it receives, not the diagnosis.
What the insurance company pays is based on the contract between the patient and the insurance company. OP had an elective procedure for which he negotiated a fee with the doctor. Elective procedures are often not covered by insurance at all. Apparently the insurance company paid for an office consultation but not the procedure itself.
If the lab is local, the doctor may be able to talk to the pathologist and see if the fee can be reduced. That might be more difficult with a large commercial lab but still possible.
There is nothing in the OP that suggests any kind of fraud.
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