Being billed for services not medically necessary.

Two Peas is Closing
Click here to visit our final product sale. Click here to visit our FAQ page regarding the closing of Two Peas.

Posted 1/28/2013 by Scrapper_Girl in NSBR Board
 

*Delphinium Twinkle*
I'm just a pea:)

PeaNut 163,613
August 2004
Posts: 78,773
Layouts: 236
Loc: *Sunny Southern California*

Posted: 1/28/2013 1:08:29 PM
A comprehensive metabolic panel is a blood test that measures your sugar (glucose) level, electrolyte and fluid balance, kidney function, and liver function.




Bethie
proud Fiskateer #269
{My Blog}
*My Scraproom*
Uploaded with iPhone client

*Delphinium Twinkle*
I'm just a pea:)

PeaNut 163,613
August 2004
Posts: 78,773
Layouts: 236
Loc: *Sunny Southern California*

Posted: 1/28/2013 1:11:56 PM
I think the hemogram tests your platelet count


Bethie
proud Fiskateer #269
{My Blog}
*My Scraproom*
Uploaded with iPhone client

YoDutchess
BucketHead

PeaNut 333,436
August 2007
Posts: 745
Layouts: 0
Loc: PA

Posted: 1/28/2013 1:19:19 PM
Trigylcerides are on the Lipid Panel. It is separate from the Basic Metabolic panel which is the sodium, postassium, chloride, glucose, 3other things I forget at the moment but are important for balance of blood electrolytes. TSH part of assesting your thyroid function. What did your lab slip have on it originally?

busypea
boring + nerdy

PeaNut 52,817
October 2002
Posts: 27,974
Layouts: 145
Loc: Oregon

Posted: 1/28/2013 1:30:04 PM
Those are all normal, routine bloods tests that should be performed periodically to assess your overall health. Just because you feel well doesn't mean there isn't something bubbling under.

If you're old enough for mammograms, you're old enough that you need to pay attention to more things than just your cholesterol.

She should have talked to you about what she was ordering, but I suspect she was simply ordering a normal panel of blood tests for someone your age out of habit, not out of intent to defraud.

And please, talk to her about the results and about a more comprehensive periodic health evaluation.

irishscrappermom8
Ancient Ancestor of Pea

PeaNut 220,508
August 2005
Posts: 5,593
Layouts: 54
Loc: IL

Posted: 1/28/2013 1:35:20 PM
Well, it may have been coded as an annual physical and all those are standard/recommended tests that adults should have every year. The vit. D is really being pushed since almost all are quite deficient and the effects of a vitamin D deficiency may be subtle - it has been linked to bone density, increase risk of diabetes, ability to lose and keep weight off, etc.

A CBC/hemogram is standard as well. It will tell the doctor if you are anemic (many women are and it becomes more of an issue as you age).

A chem profile shows kidney and liver function mostly and your electrolytes.




Uploaded with iPhone client

*maureen*
Bad Wolf

PeaNut 191,892
February 2005
Posts: 6,033
Layouts: 0
Loc: Wheaton

Posted: 1/28/2013 1:38:22 PM
I have two questions for you: Why do you think it's fraud or medical abuse? What purpose would reporting it to the insurance company serve?

peanuttle
PeaAddict

PeaNut 136,677
March 2004
Posts: 1,244
Layouts: 0

Posted: 1/28/2013 1:41:03 PM
All the tests you listed are part of my annual blood work up that I have when I go for my physical. For my doctor, they are standard.

I think if you are paying out of pocket, you need to discuss with your doctor what is necessary and let him/her know that you are paying out of pocket.

wren*walk
PeaAddict

PeaNut 481,431
September 2010
Posts: 1,822
Layouts: 0

Posted: 1/28/2013 1:47:20 PM

I did not request, nor did the doctor discuss with me having the Vitamin D and TSH performed. I do not have any symptoms that would indicate ordering those tests.





You go for regular screening for cervical cancer, breast cancer, high cholesteol, do you have symptoms of any of those? Of course not. The tests that were ordered, including the TSH and Vit D are all part of normal, routine blood screening tests done of women of a certain age. You don't say how old you are, but I assume you are over 40?


So the Vit D test is not completely medically uncecessary, it is related to the TSH test and is now a part of normal routine screening for thyroid disease and ca deficiency. Which is more prevalent in women over the age of 40-50. And often manifests in that age group. The Vit D part IS expensive and at the current time has spotty coverage with insurers. They should have informed you at the time of testing that it may not be covered, at which time you could have refused the test. But that does not always happen.

Sorry this was all such a surprise to you but immediately jumping to the conclusion that there must be fraud involved is pretty sad. Perphaps you need to talk things over better with your MD. They are busy people and often overlook explaining the reasoning behind things like routine blood work.







crimsoncat05
PeaFixture

PeaNut 273,602
August 2006
Posts: 3,993
Layouts: 99
Loc: Phoenix, AZ area

Posted: 1/28/2013 1:49:49 PM
if they weren't covered by your insurance (and I'm surprised by that, actually, since most of them do sound like tests that should be performed periodically) then maybe it wasn't coded properly when it was submitted??




"Accepting anything without question is the antithesis of critical thinking and education. ~wren*walk, 8/20/12"


~*~kandie~*~
Can-American pea

PeaNut 68,157
February 2003
Posts: 10,187
Layouts: 14
Loc: New Hampshire

Posted: 1/28/2013 1:51:55 PM
all are recommended yearly lab tests.

did you not ask what they were drawing before the needle was put in your arm?


~*~Kathy~*~
Mom to Natalie and Ashley

]

*maureen*
Bad Wolf

PeaNut 191,892
February 2005
Posts: 6,033
Layouts: 0
Loc: Wheaton

Posted: 1/28/2013 1:52:02 PM


I have two questions for you: Why do you think it's fraud or medical abuse? What purpose would reporting it to the insurance company serve?



Over billing and ordering medically unnecessary tests by doctors is quite common.

I was billed for tests which were not discussed. I did not give permission for these tests.


I'm not going to touch that first answer. But your second answer about consenting to tests, you probably signed a general test consent so yes, you did consent. I would find it highly unusual to hear that there are doctors who would ask a patient to a consent for each individual test.

wren*walk
PeaAddict

PeaNut 481,431
September 2010
Posts: 1,822
Layouts: 0

Posted: 1/28/2013 1:59:27 PM

Thank you for your response. I did discuss wanting only the cholesterol test done. My doctor ordered additional tests without discussing them with me. Specifically the Vitamin D and TSH test.






Then the concern would be communication between you and your MD, which I addressed when I said they are very busy people. They don't spend much time explaining things like routine blood work. That is an issue you can address directly with your MD, or select another MD if this one doesn't suit your needs.

But the tests themselves are not unusual and are not medically unecessary for someone in your age group. No fraud here.









SDeven
Love Letters Pea

PeaNut 65,852
January 2003
Posts: 29,505
Layouts: 385
Loc: Nashville, TN!

Posted: 1/28/2013 3:41:08 PM
As someone who pays 100 percent of her medical costs out of pocket...it's been my experiene that doctors are in the habit of ordering certain things grouped together. If you want them to deviate from what they normally do, you really have to be specific and up front about it.

As the patient, I usually say something like "Please remember that I am paying cash personally for whatever you order and while I want whatever I need, please don't order anything that isn't absolutely necessary."

People with insurance rarely pay close attention to such things. A minor test here or there isn't usually noticed.

It's a fine line to walk.







IleneTell
StuckOnPeas

PeaNut 434,842
August 2009
Posts: 2,838
Layouts: 654

Posted: 1/28/2013 3:45:18 PM
I can really see where the OP is coming from...she was very clear about what she wanted, and she doesn't want to pay $600 for something she didn't ask for.

Also, the lab slip was only for the one test, not all of them. So why did all the tests get done? I don't blame her for being suspicious and not wanting to pay it.



SharlaG
Kingpin of something undisclosed, but important

PeaNut 88,246
May 2003
Posts: 36,986
Layouts: 0
Loc: Under a pile of dogs

Posted: 1/28/2013 3:48:00 PM
Yeah, you seem to think the doc received specific orders from you, and didn't listen. I could see a doctor being on 'autopilot' and not writing down to OMIT. Or the person in the office who communicates the test instructions assuming that you're like hundreds of insured patients who have a large panel of tests done on a blood specimen.

I hope the doctor credits those charges, if you really made it clear that you only wanted certain tests.







--If you see someone crying, ask if it's because of their haircut.




Maryland
Ancient Ancestor of Pea

PeaNut 87,597
May 2003
Posts: 11,075
Layouts: 0

Posted: 1/28/2013 3:49:16 PM
That's a lot of money! Sounds like if you were explained why you needed the tests, and agreed to it you would have been fine with the expense. But it sounds like you feel they ordered more tests without consulting you first. I would contact the billing dept and see what you could do. In the future, be sure to sit with them and go over every test they want to do and the cost first. You could contact your insurance company and see what is covered. Then you would feel better about it.

Sorry that you were caught off guard with that. Not everyone has the money for extra medical expenses. It's not as easy as people may think. Of course your health is important, so it is always better to be informed.


justalittletike
AncestralPea

PeaNut 434,313
August 2009
Posts: 4,506
Layouts: 26

Posted: 1/28/2013 4:00:12 PM
I would think your doctor would be almost negligent to have not ordered those 2 tests on you over 30 IMO. They are pretty once a year standard tests and for some much more often.


Uploaded with iPhone client

*~*amanda*~*
...

PeaNut 393,905
October 2008
Posts: 7,415
Layouts: 0
Loc: Illinois

Posted: 1/28/2013 4:10:54 PM

It seems you're not hearing what you want to hear......




That.

I think that you reporting the doctor for fraud is fraud.

Do you have a medical background? If so I can see why are so adamant about the tests not being necessary. If you don't then you really have no idea, do you?

If one of the tests turned something up would you still be upset about it?

I don't think youre out of line for questioning the doctor about the billing by any means, but you're over reacting.



Compwalla
Pastafarian Pea

PeaNut 11,942
March 2001
Posts: 20,489
Layouts: 39
Loc: Midland, TX

Posted: 1/28/2013 4:14:25 PM
I'm really glad I have good insurance. I get most of those every 90 days, some only every six months.

I don't know if there is fraud but there is, at minimum, a serious communication problem with your doc.


Virginia

I distrust those people who know so well what God wants them to do because I notice it always coincides with their own desires. --Susan B. Anthony

Blog link - Dryer Lint
Aprons and More

justalittletike
AncestralPea

PeaNut 434,313
August 2009
Posts: 4,506
Layouts: 26

Posted: 1/28/2013 4:59:10 PM
Looks like you have already got your mind made up.


I however do not find it fraudulent but routine. Unless you said I do not want TSH or Vit D I would assume with your medical background you would assume it would be included in a yearly blood work up or at the very least you should be getting it.


Uploaded with iPhone client

crimsoncat05
PeaFixture

PeaNut 273,602
August 2006
Posts: 3,993
Layouts: 99
Loc: Phoenix, AZ area

Posted: 1/28/2013 5:01:55 PM
before 'fraud' is tossed around, I personally would first think that maybe the lab screwed up and did a usual panel of tests, or something like that, not seeing that you did NOT want some they usually do (I'm just guessing here, about the 'why it happened' part.

If you've already notified the office, and they said they would see about waiving the charges... if they do end up waiving the charges, then personally, I would let it go and assume it was a mix-up of some sort. (and I'd be glad to know the results of those tests, actually- I have thyroid issues and a pretty severe vit. D deficiency.)






"Accepting anything without question is the antithesis of critical thinking and education. ~wren*walk, 8/20/12"


SnowWhite.
in Fairy Tale Land

PeaNut 341,421
October 2007
Posts: 6,509
Layouts: 0
Loc: Philly 'burbs

Posted: 1/28/2013 5:06:23 PM

I however do not find it fraudulent but routine. Unless you said I do not want TSH or Vit D I would assume with your medical background you would assume it would be included in a yearly blood work up or at the very least you should be getting it.


That's crap. If she asked for a cholesterol test, she should get one. Period.

If I take my car to the mechanic and ask them to check the battery, they should check the battery. They should not check the transmission and the tires and the O2 sensors just because they're routine. And if checking the battery requires them to check the alternator, I should be warned about that, not just _assume_ that I know that and do it anyway, even though it wasn't what I asked for.

I'm completely with the OP. She wanted something specific, she asked for something specific. She's had no problem in years past making the exact same request and getting the right results, she should not have to pay for any of this, and I too would be questioning the doctor.

~dawn

wren*walk
PeaAddict

PeaNut 481,431
September 2010
Posts: 1,822
Layouts: 0

Posted: 1/28/2013 5:23:24 PM

She agreed and then proceeded to charge me for tests we did not discuss. Did I make that clear. Reading comprehension seems to be a problem for you.






And for you too.

Again, doctors are not that good at discussing such routine matters. Some are better than others. I would suggest finding a new doctor since this is such an important issue for you.

I find it hard to believe that you have any sort of a medical background since as many of us here have stated, these are ROUTINE tests for women in your age group. You not only did not seem to know that, but you seem to have little understanding of what any of the tests are, based on your own statements.

While I can find it understandable that it was something of a surprise to you to have received the additional tests if you were only expecting the lipids, I do not understand immmediately jumping to the conclusion that it must be fraud.

You really need to discuss this with your doctor since there is nothing unusual at all about the tests she ordered.




gavinsmom
Ancient Ancestor of Pea

PeaNut 9,019
January 2001
Posts: 5,673
Layouts: 22
Loc: michigan

Posted: 1/28/2013 5:29:07 PM

She should have talked to you about what she was ordering, but I suspect she was simply ordering a normal panel of blood tests for someone your age out of habit, not out of intent to defraud.


Maybe she wasn't explicitly clear that you ONLY wanted those test and NOT the others. They are usually grouped together as part of a routine exam.


Nicole

zombie*grrl
WHO PUT A DICK IN THIS BOX?

PeaNut 281,551
October 2006
Posts: 5,246
Layouts: 0

Posted: 1/28/2013 5:48:22 PM
As has been established, those are routine tests for someone in your age group. However, the doctor should have discussed with you what she wanted to have checked and why. This all would have been avoided had she simply done that.
If she has computer order entry in her office, she may have clicked on a routine panel for you and thus all labs were ordered instead of only specific ones.
I get all the tests you mentioned done yearly, except the vitamin D test. My doctor always tells me what he's ordering, but since they draw it in his office, I can see how something else could be added that I didn't know about unless I specifically asked. I wouldn't want to pay for tests we didn't discuss either (but I certainly don't think they're "unnecessary" at your age).

wren*walk
PeaAddict

PeaNut 481,431
September 2010
Posts: 1,822
Layouts: 0

Posted: 1/28/2013 5:49:32 PM

I know that I am not the only person who has insurance that is not great. When routine tests are not covered, sometimes you have to make a choice to go without.






I totally get that.

They should offer you the option to refuse the vit D if it is not covered. I didn't get it for years for the same reason. But my doctor still ordered it. They want that test so they put it on the requisition. I'm sorry they didn't communicate better with you about it and hope they waive the fee.








moodyblue
StuckOnPeas

PeaNut 346,032
November 2007
Posts: 2,012
Layouts: 0

Posted: 1/28/2013 5:51:55 PM
When I have blood work done, the doctor has a lab form and she or he checks off the tests to be performed. If the lab form only said Lipid Profile, that's all I would expect to have done. And if the doctor thought there should be other tests done, it's up to the doctor to explain that, especially if the patient clearly specifies only wanting the one profile done.

It seems likely to me that the lab people made an error, and "routinely" did what is often done - but the OP should not have to pay for them, no matter what anyone says about them being necessary or routine or standard. Lots of people "ration" their own care because of costs.

And am I the only one who doesn't consider that it might be possible for the doctor's office to make a huge part of their income by running their own lab - and they make more by running the full set of usual tests than when they do just the minimum? I think I've read in the past about doctors who have their own testing facilities often ordering more tests than doctors who don't. I'm not saying that they consciously committed fraud, but it's possible they made a mistake or added in the extra thinking it wouldn't be an issue.

I-95
It's all just nonsense anyway!

PeaNut 97,456
July 2003
Posts: 20,385
Layouts: 0
Loc: California, NY & Orlando

Posted: 1/28/2013 6:11:00 PM

gain, doctors are not that good at discussing such routine matters.


That's such a cop out. Really, if the OP said she told the doctor what she wanted, and then found herself billed for a whole bunch of other uncovered tests, then she should be outraged. Saying doctors are busy people, or they're not good at discussing patient care, no matter how 'routine' the tests are, is as good as saying it's OK to blow off your patient because, gosh, I'm a doctor and I'm so above all this petty stuff. BS.

It's easy to say things like that if... 1) you have great health insurance and don't care what your insurance company is billed for. 2) You work in the medical field and think a patient's needs and requests are less important than the busy doctor. 3) You're rich and don't care what you're billed for, necessary or not.

As someone who pays for every doctor visit, drug prescribed and test performed, out of my own pocket, you better believe I would be pea livid at a doctor who didn't listen, plus an unbudgeted $600 expense for tests I didn't ask for, and were not specifically discussed. It doesn't have to be a long drawn out, time wasting discussion, just a simple 'I'm going to order the XYZ tests, I think we should take a look at your blah blah levels'. That way I can ask how much they cost, and make an informed decision as to whether I can afford them, if they're critical to my health etc.....but that's MY decision to make, not the doctor's.

People tend to forget that doctors are basically in a service industry. You go see them about a specific thing, you hire them DX and treat you, then you pay them for their services. I wouldn't pay for something I hadn't ordered in a restaurant either, unless the waiter had suggested additional menu items, and I had agreed to go ahead and get those items.

The word 'fraud' may have been a trifle strong, but it's by no means unheard of for a doctor to add extra lab tests, especially if the practice owns the lab. Whether the motivation is to CYA, or padding the bill, it isn't right to do it on the assumption it's OK with the patient, or because the doctor is too 'busy' to explain such trivialities.

mishkismom
Ancient Ancestor of Pea

PeaNut 163,728
August 2004
Posts: 5,024
Layouts: 41
Loc: Connecticut

Posted: 1/28/2013 6:14:04 PM

Well, the test was not discussed, it was mot on any form and I have been billed for it. That is fraudulent.

Are you 1,000% positive it wasn't on the form? It isn't routine to have a copy of the lab slip so I don't see how you can say that. I also know from my own labs that everything but the Vit. D is part of a yearly blood work.
I will say I hope they can give you a break though. That is a lot of money for something you asked them not to do. Next time you know to specifically ask them not to do this.


Jan *********************************************

pjaye
The only happy ending will be mine

PeaNut 111,502
October 2003
Posts: 6,847
Layouts: 59
Loc: Vic, Australia

Posted: 1/28/2013 6:15:33 PM
Unless you have a medical degree, you don't know what is "medically necessary".
A doctors office isn't somewhere you go and decide what you'll have or not have like a MacDonalds drive through, although this seems to be what you think.
It's not your role as a patient to "order" the tests you want from your doctor.
If the doctor thinks it is needed based on your examination then that is what should be ordered.
Obviously if they know there is a cost to you, then they should tell you why they have ordered those tests...and as a patient you have the right to refuse any tests (usually not a smart thing to do, but everyone has the right to refuse any medical treatment).
But I think yours is one of the most bizarre posts I have ever read about medical treatment - like ordering off a menu and know that your thyroid is perfectly OK because your weight is stable.
Also as you state you are well (by that I assume no major medical illnesses) then you are already over servicing yourself by ordering an annual PAP and mammogram - these are both recommended 2nd yearly (I just googled screening PAP tests seem to be 3rd yearly in the USA).

wren*walk
PeaAddict

PeaNut 481,431
September 2010
Posts: 1,822
Layouts: 0

Posted: 1/28/2013 6:15:46 PM

That's such a cop out. Really, if the OP said she told the doctor what she wanted, and then found herself billed for a whole bunch of other uncovered tests, then she should be outraged. Saying doctors are busy people, or they're not good at discussing patient care, no matter how 'routine' the tests are, is as good as saying it's OK to blow off your patient because, gosh, I'm a doctor and I'm so above all this petty stuff. BS.






Oy, you need to chill out.

You must have missed the part where I said, twice or three times actually, that this was a communication issue and to seek a new doc.

Whether you like to think of it as a cop out or bs or whatever, it is a fact. Stop the presses...some doctors are just better at things like this than others.

You don't like your doctor or the way they do things, find another. Afer all, like you say, it is a service industry and there is no better way of sending the message than to walk out the door and find another service provider.






basketdiva
StuckOnPeas

PeaNut 187,030
January 2005
Posts: 2,098
Layouts: 0
Loc: Eastern Shores of Mobile Bay

Posted: 1/28/2013 6:25:36 PM
IF, as you say that only one test was listed on the lab slip, then it is the lab you should be upset with for doing unauthorized work-not the doctor.
It is also possible that it was just a billing error on the part of the lab, plain and simple. Lab might be used to doing all those tests on a normal basis and hit the wrong charge codes.

Just curious-how many vials of blood did they draw? I have those tests and they draw 2or3 vials ( can't remember the exact number). Also-did you get results for all those test or just a bill.

blondiek237
PeaFixture

PeaNut 70,239
February 2003
Posts: 3,343
Layouts: 8
Loc: Massachusetts

Posted: 1/28/2013 6:44:25 PM
OP. I'm with you, I would NOT pay for tests that I did not want. I don't care if they are routine, you only asked for the tests you wanted done. We are going to see this more and more. As companies switch to high deductible plans to lower costs. I keep seeing here that insurance is sol expensive because we, the patients, don't see the cost and just go along as it doesn't cost us out of pocket. Well here we have someone that is managing their care and she is being told to suck it up. No way no how would I just suck it up and pay it.

simplekelly
Loving Life

PeaNut 142,378
April 2004
Posts: 16,519
Layouts: 6
Loc: Why do you want to know?

Posted: 1/28/2013 6:50:08 PM

The word 'fraud' may have been a trifle strong, but it's by no means unheard of for a doctor to add extra lab tests, especially if the practice owns the lab. Whether the motivation is to CYA, or padding the bill, it isn't right to do it on the assumption it's OK with the patient, or because the doctor is too 'busy' to explain such trivialities.
considering the OP said last year this wasn't a problem, and this happened ONCE, "fraud reporting" is ridiculous! Should the OP sew the dr too? And to automatically assume this is a "padding" issue is also ridiculous. Of course she shouldn't pay. And the drs office sounds like they are fixing it. But for routine bloodwork panel for a woman her age to be done is not fraud. It's an "oops. Crap there goes that auto pilot again". If the tests weren't routine, then MAYBE there would be cause for concern.

But to go straight to ."should I report to my insurance company for fraud" is crazy with no prior issues (according to current information the OP has provided....you never know when they start adding info, lol)



best,


**Live your dreams, not your fears**

I-95
It's all just nonsense anyway!

PeaNut 97,456
July 2003
Posts: 20,385
Layouts: 0
Loc: California, NY & Orlando

Posted: 1/28/2013 7:04:26 PM

Oy, you need to chill out.


OK, I've chilled now

Sorry, I wasn't actually specifically picking on you, even though I used your words to open my rant. I was just a bit put out by the number of posters who were saying, basically, how dare the OP question anything the doctor ordered, and who did she think she was to do so (not counting the whole fraud thing, that's a different issue) But she had said that she has requested the same things before and it has not been a problem. That her doctor knows her financial/insurance issues, so I think she should be outraged.

I think the fraud part was a little over the top, but who knows, the doctor might have gone through an expensive divorce recently and is padding the bills with a few extras...anything is possible..but yes, she should talk to the clinic first, and if not satisfied with the results, change doctors.

dawndoll
Jeepers PEApers

PeaNut 10,973
February 2001
Posts: 2,210
Layouts: 1

Posted: 1/28/2013 7:37:12 PM

IF, as you say that only one test was listed on the lab slip, then it is the lab you should be upset with for doing unauthorized work-not the doctor.


This. The lab should have done only the tests ordered. However, there could very well have been a mix-up with patient slips, etc. Should not be a problem to call them and have them remove the charges.
And if this is the case, that the disputed tests were not on the lab orders, I cannot imagine why in the world you would even be the slightest bit angry at your doctor, let alone accusing him of fraud, etc.
If he didn't write it on there, he is innocent.




Edgy Coolness
PeaFixture

PeaNut 365,853
March 2008
Posts: 3,514
Layouts: 0
Loc: Dallas, Texas

Posted: 1/28/2013 7:45:58 PM


Scrapper_Girl
StuckOnPeas

PeaNut 41,512
June 2002
Posts: 2,925
Layouts: 18

Posted: 1/28/2013 1:03:48 PM
I am very healthy and rarely get sick. So, each year, I go to the doctor request a pap smear, cholesterol screening and an order for a mammogram.

This year I did the same, and recently received a bill which included the following services:

Comprehensive Metabolic Panel
Lipid Panel
Vitamin D, 25 HydrozY
Assay Thyroid Stim Hormone
Auto Hemogram/Plate/Diff

I believe the Lipid Panel is the Cholesterol screening.

I did not request, nor did the doctor discuss with me having the Vitamin D and TSH performed. I do not have any symptoms that would indicate ordering those tests.

My question is, are the Hemogram or Metabolic profile related in any way to the Cholesterol screening?

I have already phoned the doctor's office regarding the 2 tests which were not discussed. Her very quick response was I will talk to the doctor about waiving those charges. This leads me to believe they knew they were ordering or charging for unnecessary tests.

My second question is, is this medical fraud/abuse? Would you notify the Insurance Company?

Thanks.



1. If I am reading your post correctly, you seldom if ever go to the doctor and do not see a Gynecologist to have your yearly Well Woman Exam, which even at the GP should be covered 100% and includes all of the gynecological testing, so this is not only your yearly Well Woman Exam, it is also your Annual Health Exam.

1.1. Your Insurance Company should have sent you a detail Explanation of Benefits with every single item billed by both your doctor and the reference laboratories. It will detail the amount paid and give you the reason why the order was not paid. Even if you have traditional Medicare the underwriting Insurance company should send you a EOB detailing the 20% you owe.

2. You gave the doctor your list of tests YOU wanted to be done and probably ignored any commentary that you needed including the two test you are complaining about the TSH and Vita-D which are recommended tests for women of a certain age.

3. Also, you obviously don't know what your total Insurance Benefits are including the Annual Health Exam Benefits and Well Woman Benefits are or if they can be combined in one visit and if I remember correctly, they can't be and we often had to do 2 patient appointments in order to do both since these women chose only to see one doctor per year.

4.You also did not look at your blood work order when you allowed them to draw multiple tubes of blood (a fasting lipid panel would be 1 speckled top tube, not 2 and a purple.) And if it still holds true, all reference laboratories make a copy of the patient's ID and Insurance card, sign a ABN or waiver that they are responsible for any monies owed if their Insurance Company refuses to pay and most send you an automated bill of what you owe if the ICD9/ICD9CM codes aren't marked plus I do believe they now require patients who use a draw stations instead of the doctors office to pay a copay where they ask if you are fasting and go through the tests ordered on the form.

Bottom line, you have to be your own healthcare advocate especially as the PPACA goes into affect and as you age into Medicare as well. As for your question is it Insurance fraud, if you received an EOB and it was something they billed for but did not do, yes but doing testing that is recommended is not.

And just so you know for future reference, you have the right to contest the Insurance company not paying for valid tests your doctor ordered and I would ask the doctor's office to recode it and resend it.









Rhondito
MississiPEA

PeaNut 40,147
June 2002
Posts: 24,330
Layouts: 2
Loc: Flowood, Mississippi

Posted: 1/28/2013 8:06:04 PM

The point is not whether or not I should have these tests. The point is, I chose not to and was then billed for the services.


It's hard to argue with that statement.

Maybe you *should* be getting the other tests, but as you said earlier - sometimes you have to make choices based on what you can afford. You may not like those choices, but you do what you have to do.

My guess is that somewhere along the chain, someone assumed the order was for routine blood testing and did what was normal. I doubt it was done on purpose to milk you for more money (especially since you stated you've not had this problem before), but was just a mistake. We all make them.
You are right to talk with the doctor's office about it and I agree they should waive those charges. It will be a reminder to the staff to pay closer attention to exactly what is ordered.

Oh, and PS,
If you've been with this doctor and/or clinic for a while and this is the first time you've had an issue, give them the benefit of the doubt. As I said before, I doubt it was done on purpose. A little kindness goes a long way.


Rhonda



OSUBuckeyeFan
When does football season start?

PeaNut 182,623
December 2004
Posts: 7,038
Layouts: 0
Loc: USA

Posted: 1/28/2013 8:15:03 PM
Im an RN and frequently draw blood from my patients...If you had all that labwork done, you had about 4or 5 vials of blood drawn. A Comprehensive Metabolic panel goes in a green top and they can run the lipid panel off this as well..TSH goes in a marble top, the heme panel In a purple top and the Vit D in another colored tube(not sure which right now as I'm not at work to look it up).

So I'm not sure how any of that didn't tip you off that they were drawing more tests than what you asked for.




scrappin jen
PeaAddict

PeaNut 111,615
October 2003
Posts: 1,644
Layouts: 0

Posted: 1/28/2013 8:16:19 PM
As a thyroid cancer survivor I am glad for you that they did the TSH test for you. It is a cancer rising 10-15% annually compared to the other cancers which are declining. It carries no syptoms, I had no lumps on my neck, and am glad I found mine when I did. Thyroids can be tricky so a test every few years is a good thing. I doubt that fraud applies to your situation. It seems those were medically necessary test for someone your age. I guess ordering ala carte as you tried to do got mixed up in their system, which could be an honest mistake. I wouldn't call anyone out on it, it seems you have talked to the doctor about the payment of them which they seemed to be willing to work with you on -even talk of theme eating the cost.

Please take good care of yourself- to avoid tests for several years as you posted is a bit concerning. I understand wanting to be in control of your costs but your health is priceless. New research suggests yearly paps are no longer necessary unless you have a significant history. I don't know your situation, but I have seen first hand your health can turn on a dime and best to be well monitored.

ETA***"And just so you know for future reference, you have the right to contest the Insurance company not paying for valid tests your doctor ordered and I would ask the doctor's office to recode it and resend it."

This above made me think-I would be more upset about my crappy insurance and less upset at the doctor trying to care for my health too. I can't imagine not paying for those tests you listed if you haven't had one in recent years.

Cade387
PeaNut

PeaNut 566,163
September 2012
Posts: 445
Layouts: 1

Posted: 1/28/2013 8:27:25 PM
Based on this statement:
-----------------------
Basketdiva, I think it was one vial, but no more than two. No results were given, just a bill. I had to hound them for the results of my lipid panel. They said absolutely nothing about any other test results when I finally received a call back. I didn't know about the other tests until I received the bill.
-----------------------

I would find a new doctor. My dr. Sends to a blood draw station that bills separate and is not a part of their office. I get s personal call from my doctor herself the next day after I have blood work done. I don't get EOB or any bills for weeks after the tests. If you are getting billed before discussing results then your doctor is dropping the ball.

Also, I had normal blood work for years and no changes in weight or anything and became severely deficient in vitamin D in one year's time. It can change without realizing it.

You also didn't mention if your healthcare is tied to an employer plan. My DH's employer requires a physical and I wouldn't have the option to "opt out" of those tests as the plan requires them or our rates double.

vanmama
StuckOnPeas

PeaNut 3,281
March 2000
Posts: 2,435
Layouts: 0
Loc: central Illinois

Posted: 1/28/2013 9:48:01 PM
I work in the billing office for a medical group. We went on a new system last year and have found that, when charges are put into the system, sometimes the system itself grabs certain things and charges for them, even when the actual test was not performed at that office but at a separate lab. Our old system did not do this so it has been an eye opener. We spend a lot of time deleting charges before they are billed. And they insist this system is so much better than our old one...

That might be what happened...it's easy for us to go back through the notes and fix the issue.


Laura in IL

dawndoll
Jeepers PEApers

PeaNut 10,973
February 2001
Posts: 2,210
Layouts: 1

Posted: 1/28/2013 9:56:19 PM
Vanmama,
Do you use Meditech by any chance?




SDeven
Love Letters Pea

PeaNut 65,852
January 2003
Posts: 29,505
Layouts: 385
Loc: Nashville, TN!

Posted: 1/28/2013 10:00:50 PM

Unless you have a medical degree, you don't know what is "medically necessary".

As a patient, I am absolutely entitled to a reasonable explanation of what my doctor believes is "medically necessary", especially whn I am paying the bill directly and when I specifically ask for that information.

It's been my experience that there are many paths to treat most everything. Some expensive, some not, however, if you prefer to at least start with the less expensive path, you better be prepared to stand on a milk crate and shout it out several times per visit, because doctors are the least cost-consious people on the planet.

My doctor does not have carte blanche to treat and prescribe without explanation. He's being paid to provide me with an explanation and advice, not oversight. I make the decisions, according to my needs and what I can afford, with his input.






pjaye
The only happy ending will be mine

PeaNut 111,502
October 2003
Posts: 6,847
Layouts: 59
Loc: Vic, Australia

Posted: 1/29/2013 12:56:27 AM

Unless you have a medical degree, you don't know what is "medically necessary".
--------------------------------------------------------------------------------


As a patient, I am absolutely entitled to a reasonable explanation of what my doctor believes is "medically necessary", especially whn I am paying the bill directly and when I specifically ask for that information.
and if you read the rest of my comments you will see where I clearly say that you should be told what is being ordered and that you also have a right to refuse those tests.

That wasn't my point.

My point was that the OP thinks she knows what tests are "medically necessary" and unless she is a doctor, then she doesn't. She seems to think that visiting a doctor is the same as ordering take out food - you look at the menu and decide what you will have.
I just commented that I think this is an extremely bizarre attitude to have. We'd have some very interesting outcomes in medicine if patients dictated what tests and treatments "they'll have" based on how they feel.

doesitmatter?
Ancient Ancestor of Pea

PeaNut 509,811
May 2011
Posts: 6,639
Layouts: 27

Posted: 1/29/2013 11:27:37 AM

I work in the billing office for a medical group. We went on a new system last year and have found that, when charges are put into the system, sometimes the system itself grabs certain things and charges for them, even when the actual test was not performed at that office but at a separate lab. Our old system did not do this so it has been an eye opener. We spend a lot of time deleting charges before they are billed. And they insist this system is so much better than our old one...

That might be what happened...it's easy for us to go back through the notes and fix the issue.



That's crazy!!!!


Child of God, follower of Jesus, and so thankful for His presence in my life <><

nlbremer
PeaAddict

PeaNut 243,520
January 2006
Posts: 1,037
Layouts: 43
Loc: Summerville, SC

Posted: 1/29/2013 11:54:15 AM
Something similar happened to me after my last physical. I got a bill for several hundred dollars for various tests. I called the doctor's office, and they were able to submit notes to the ins. co. and they ended up covering it. Some of the tests my Dr. did aren't necessarily standard, but I have a thyroid disorder, so he usually orders a couple of extra tests around that, and then he did do a couple of other tests, too, but I thought he would only do them if he felt it was necessary. Thankfully, having the notes submitted ended in my favor. Perhaps your doctor's office could do the same if they don't waive the charges?

vanmama
StuckOnPeas

PeaNut 3,281
March 2000
Posts: 2,435
Layouts: 0
Loc: central Illinois

Posted: 1/29/2013 7:26:51 PM
dawndoll, no, we use IDX. It does a lot of things our old system (MISYS) didn't do, but Misys was so much easier for us to use.


Laura in IL

scrapApea
StuckOnPeas

PeaNut 23,080
October 2001
Posts: 2,272
Layouts: 0
Loc: where seasons change

Posted: 1/29/2013 7:53:51 PM

all are recommended yearly lab tests.

did you not ask what they were drawing before the needle was put in your arm?
Ha- have you ever actually ask anyone who is "putting" it in your arm? They're clueless. They're just assembly workers. My last exam the nurse asked ME if I was having a pap. I said don't you know? Don't you have to have the room ready etc? Guess not. To me that's kind of scary that nobody knows what they're to be doing.

rncantsleep
PeaNut

PeaNut 219,350
August 2005
Posts: 42
Layouts: 0
Loc: Phoenix

Posted: 1/30/2013 9:06:00 AM
Not sure if this clarifies for the OP, but on most lab slips I can circle ONE item that orders the multiple 'routine' or annual labs...so when I choose that option, it would order everything on your list except for the vitamin D.

Show/Hide Icons . Show/Hide Signatures
Hide
{{ title }}
{{ icon }}
{{ body }}
{{ footer }}