I had my first primary care doctor visit in awhile last April, a routine new patient wellness visit, which is supposed to be 100% covered under my ACA plan. After a bizarre issue with the initial billing in December, I've now received a partially-uncovered $500 bill for the visit despite everything being in-network. Is this at all normal, and if so what's the best strategy for getting this number way the heck down? I thought I was being a Responsible Adult scheduling this doctor's appointment -- no outstanding health issues, just wanted a routine check-up, did my research, found a good in-network doctor. All indications were that I shouldn't expect any bills from what was just a blood draw, urinalysis, and a 20-minute poke-and-chat with the doctor:
- The ACA mandates insurance plans cover one free annual wellness visit, including preventive tests and screenings
- My plan (BCBS via the ACA individual market) requires an initial visit with a primary care physician anyway to be eligible for any other benefits
- According to the statement of benefits, my plan is supposed to cover in-network preventive care, screening, and blood work at "no charge/no deductible"
- The doctor's office is in-network
- The lab used (the local hospital) is also in-network
- The visit was a standard new-patient wellness appointment with no pre-existing complaints and that turned up no extraneous issues
For some inexplicable reason, the initial bill for this was sent -- eight months after the fact -- to a parent living out-of-state, who has had zero involvement with either this doctor or my insurance plan. After a few calls to the doctor's office and the hospital, they apologetically straightened out the billing info and that was apparently that.
But now I've got an email notification from BCBS that while the office visit itself has finally been covered, there are six different charges from the local hospital for various tests -- all but one uncovered -- for a grand total of around $500:
- comprehensive metabolic panel (~$170)
- lipid panel (the only one covered, negotiated from $90 down to $10)
- urinalysis ($50+)
- free thyroxine (~$80)
- TSH (~$100)
- CBC/automated/WBC (~$100)
All tests were coded for "LAB - WELLNESS", which, again, both the ACA and my plan claim to cover.
My questions:
- Are these tests expected for a wellness visit, and if not is it normal for a doctor's office to tack them on unasked?
- Is there a reason these wouldn't be counted as preventive/screening/blood work by my insurance?
- Who should I contact about this? Doctor's office? Hospital? Insurance? All of the above?
- Any good strategies for bringing this number down if it's not some kind of mistake? Could the 90% discount the insurer secured for themselves on that lipid panel be a good guide?
- Would the initial botched billing and very protracted notification process give me any leverage in negotiating down? I've seen references to timely filing limits -- might the entire thing be wiped if they took too long to bill for it (not to mention billed the wrong person)?
- Speaking of protracted, how worried should I be about this being sent to collections, impacting my credit score, etc.? The original visit was last April.
Any advice or experiences with the godawful American insurance system would be much appreciated!
- The ACA mandates insurance plans cover one free annual wellness visit, including preventive tests and screenings
- My plan (BCBS via the ACA individual market) requires an initial visit with a primary care physician anyway to be eligible for any other benefits
- According to the statement of benefits, my plan is supposed to cover in-network preventive care, screening, and blood work at "no charge/no deductible"
- The doctor's office is in-network
- The lab used (the local hospital) is also in-network
- The visit was a standard new-patient wellness appointment with no pre-existing complaints and that turned up no extraneous issues
For some inexplicable reason, the initial bill for this was sent -- eight months after the fact -- to a parent living out-of-state, who has had zero involvement with either this doctor or my insurance plan. After a few calls to the doctor's office and the hospital, they apologetically straightened out the billing info and that was apparently that.
But now I've got an email notification from BCBS that while the office visit itself has finally been covered, there are six different charges from the local hospital for various tests -- all but one uncovered -- for a grand total of around $500:
- comprehensive metabolic panel (~$170)
- lipid panel (the only one covered, negotiated from $90 down to $10)
- urinalysis ($50+)
- free thyroxine (~$80)
- TSH (~$100)
- CBC/automated/WBC (~$100)
All tests were coded for "LAB - WELLNESS", which, again, both the ACA and my plan claim to cover.
My questions:
- Are these tests expected for a wellness visit, and if not is it normal for a doctor's office to tack them on unasked?
- Is there a reason these wouldn't be counted as preventive/screening/blood work by my insurance?
- Who should I contact about this? Doctor's office? Hospital? Insurance? All of the above?
- Any good strategies for bringing this number down if it's not some kind of mistake? Could the 90% discount the insurer secured for themselves on that lipid panel be a good guide?
- Would the initial botched billing and very protracted notification process give me any leverage in negotiating down? I've seen references to timely filing limits -- might the entire thing be wiped if they took too long to bill for it (not to mention billed the wrong person)?
- Speaking of protracted, how worried should I be about this being sent to collections, impacting my credit score, etc.? The original visit was last April.
Any advice or experiences with the godawful American insurance system would be much appreciated!