Dear Nurse Katz,
The other day when I got my annual physical, my physician sent me to the lab for "routine lab tests." About a month later, I received a separate bill from the lab for calcium, creatine, glucose, potassium and sodium tests for $500. Is this correct and if so, why was I not told that this would not be covered by my insurance?
Rob, what it sounds like you are describing is called unbundling. All of your lab tests should have been included in a single comprehensive metabolic panel that costs approximately half of each individual test. Unfortunately, this seems to be happening more often as clinicians outsource their billing and reimbursement gets more complicated.
What you can do is call the lab and your physician's billing department and request a copy of your itemized bills. After examining the bills, verify the charges by asking questions such as, "what is included in the routine lab tests?" If you find that their definition of "routine lab tests" includes calcium, creatine, glucose, potassium and sodium tests (which by most definitions it should), be sure to point it out to them and give them a chance correct the charge. If this was done intentionally, it could be considered fraud and there are serious ramifications for this.
On the other hand, by bringing this to your physician's attention, he/she may call up the lab to help you resolve the situation or give you some direction on who to contact etc. Hopefully this is a misunderstanding, but if not, your physician may decide to use a different lab all together to avoid future "inappropriate billing," which may result in many unhappy customers. If your physician's office is too busy, and they leave it up to you to resolve, be sure to get everything in writing and document the steps you have taken with all parties before you report it to the Office of Inspector General (OIG). Many people I have worked with have been very successful at resolving these types of disputes, especially when items were correctly documented and pointed out to the correct people in an appropriate manner.
Either way, it is NOT the physician's responsibility to know what labs your health insurance covers; however, a good way to avoid a "surprise bill" is to ask ahead of time if your lab work is being sent out and where. If the lab is not listed under your health insurance, you can request that your doctor send your labs to one that is or if he/she can write a prescription to get your lab work done at a covered facility. You may also want to reread the forms you signed to be sure you specify where you want your lab work sent to.
Unfortunately, this is one of the most common "billing surprises" I have come across, so Rob, know you are not the only one going through this. At least now you can help your friends and relatives by being a better health care advocate and educating them about the "unbundling billing surprise."
Other "billing surprises" like the unbundled bundle are revealed in the book, Healthcare Made Easy to help keep you on top of your medical bills and avoid medical debt.