Lab Work Woes......

[Djmohr 6,965]

I had a crazy experience with the billing of my annual nutritional panel. I moved states so I have my PCP running all my labwork for me annually. She was provided with the list of testing required.

The good news, all my labs came back great with the exception of my BUN levels. They are slightly off and I have stage 3 kidney disease although it has been in remission. Anyway, nothing to really worry about at this time.

So yesterday I get my explanation of benefits in which all the labs were done. To my horror, CIGNA tells me that I am not covered for that bloodwork! And the bill for it is going to be near $3000.00! First my husband nearly came unglued which then stresses me out.

I of course said, there must be a mistake it was just routine lab work done at my general doctors. Now keep in mind my surgery was 2 years ago and we moved states and changed insurance as well twice now since then.

So I called Cigna and they inform me that the testing is coded as Bariatric Surgery Follow up. I immediately said, I had surgery two years ago, this was not a follow up, it is just a nutritional panel done by my PCP to ensure I have proper nutrition. She informs me anything tied to Bariatric surgery will in fact be denied. Of course my max out of pocket has been met this year because of my shoulder surgery and months of physical therapy.

I told her this was processed incorrectly and I would be contacting the doctors office. Of course to let them know they should not use the word Bariatric in their coding at all.

Has anyone else experienced this? And if so, were you able to get it resolved? I am worried, I don't have another 3K to give for blood work annualy. And of course not a single person warned me that when I would have my PCP do it, lab work would not be covered.

Thoughts?

[SuperDave 1,115]

I would definitely call your doctor and see if they can change the billing codes. If that isn't possible, sometimes you can get the doctor to charge a lower rate for things not covered by insurance. Everything that goes through your insurance is a set price, agreed on by the insurance company and the doctor. But it is possible to get a cash price from the doctor that is much lower. It certainly can't hurt to ask!

[Djmohr 6,965]

@@SuperDave

Thanks. So far that is what I have done and plan to do if they don't change the codes. Not that I would ever do this but if this happens to others I can see why some avoid getting their blood work done annualy. Who the heck can afford those costs?

Step 1 - doctors billing office is looking at it now and we will push hard to get those codes changes

Step2 - of step 1 fails, I will be calling the billing office to ask what they are going to do to write this off or at least down. Someone should have told me that these labs would not be covered at all.

It's another of those things you don't know until it happens. Ugh!

Did I say how badly I HATE calling both the insurance company and the doctors billing office? I was on the phone nearly all afternoon yesterday.

[James Marusek 5,244]

So far they have been covering the cost of my blood work. I am 3 years post-op RNY. But the scripts for this blood work come from my surgeon's office, not my PCP. My surgeon's office did state that when I get to my 5th year post-op, they would change the responsibility for generating the script for the blood work to my PCP.

[OKCPirate 5,323]

Try this link: https://ociaccess.oci.wi.gov/complaints/public/

You are dealing with a bureaucracy. They only thing they fear are regulators and lawyers.

[Djmohr 6,965]

@@OKCPirate

Thank YOU for the link. I seriously had no idea that this even existed, I just never ran into a ridiculous problem like this before.

I will definately use it if I have to. For now the doctors office is going to relook at their coding. If they leave it coded as Bariatric then I will have no choice.

It really is ridiculous what these insurance companies try to get away with.

Thanks again for taking the time to help me.