Why My Blood Work Cost So Much and What I Did About It

Folks, you know when you get your annual physical exam and your primary care doc orders some pretty average blood work—and then you get a huge bill for it that says your co-insurance is close to a month’s income? I hate when that happens.

Hate it because it is my responsibility to find out what’s wrong and how to fix it. And if I exhaust all avenues without success, it is my responsibility to pay that amount—even if it is an error committed by my prescribing doctor, or the lab service that performed the test—or even if my insurance carrier misled me about the cause of the denial in the first place.

“Medicare is tricky" for my MS blood work

Medicare is my sole insurance carrier and they told me it was a coding error. It was my job to call the doctor’s office and tell them to send new codes to the hospital lab. I did and they did. Medicare denied it again. This went on all summer: phone calls to Medicare, the hospital lab, and my doctor’s office coding people. (“Medicare is tricky,” they told me.) Three times the bill was resubmitted to Medicare—and three times it was kicked back to me to the tune of $754.

The fourth updated billing arrived in September with the same outstanding balance. And for the fourth time in three months, I called Medicare for an explanation—but this time, it was different. It wasn’t the coding after all, she said. It was the simple fact that my doctor did not include a diagnosis that explained why the tests were medically necessary. “I’m sorry you had to spend so much time and energy on this,” the Medicare rep intoned, “they should have gone into more detail.” Two seconds of silence passed, as though she was reading something to herself. Then she delivered the next bombshell.

A catch-22

“It looks like we did forgive the balance, but then we rebilled you because you signed a waiver of liability at the hospital before they drew your blood—and that makes you responsible for the payment.” I hit the roof.

“If I hadn’t signed it,” I said, my voice rising along with my rage, “the lab would have refused me service!”

“Yes,” she mournfully replied, “that is their right, unfortunately.”

I took two deep breaths and steadied my voice. “That puts the patient in a quandary.”

Filing an appeal

She agreed. “But there is something more you can do. At this late date, I recommend that you file an appeal with Medicare. I don’t see the deadline date for your appeal, but you should do it as soon as possible.

After sharing all the details she said must appear in my appeal, she added one more thing as an afterthought. “You also need to ask your doctor to write a letter indicating the reason why those tests were medically necessary.” Then I asked a question.

“So, should the doctor send her letter to Medicare under separate cover?”

Trying to meet deadlines

“Oh, no, she needs to give it to you to include in your appeal. Sorry, I forgot to mention that.” Rage gathered in my throat again. If I hadn’t asked the question, my appeal would have been denied. But there was more. “I don’t know the deadline for your appeal, it doesn’t say that in the system. I know it’s 120 days after the service date, but . . .” Her voice trailed off. “You should get it done as soon as possible. If you miss the deadline then we can’t help you. Sorry.” I researched the date that was 120 days after May 8, 2017. It was September 5th, three weeks before the day I wrote this article. Then I calculated 120 work days after May 8th, which is October 23rd, 23 days from today. But which one is it? Then I had a brainstorm.

Applying for hospital patient assistance program

My last phone call of the day was to the lab that issued the bill. Funny that I’d forgotten about my one last alternative: an ace up my sleeve. “I’m going to apply for your hospital patient assistance program,” I told the gal. “So please don’t put me in collection.”

I’m pretty sure that $754 will be written off to bad debt. The hospital lab thought they were off the hook making me sign that waiver and sticking me with the bill. But I’ll get the last laugh and make them eat it.

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