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Doesn't necessarily have to be BAD news, right? Does your insurer cover Suboxone? Having trouble getting insurance to pay? Does your state medicaid program cover Suboxone? Have a beef with your insurer? Vent here!
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BCBS has stopped covering my labs...

Tue Apr 05, 2016 2:54 pm

I've been on Subs for about 5 years. My doctor requires me to take a drug test every month. For the first 4 years Blue Cross never game me a problem with paying for these labs. However at the end of last year they stopped paying for them. These labs are nearly 1500 a month. When I first noticed Blue Cross had stopped paying for the labs I asked the nurse at my doctors office about it and she said not to worry about it that "Millennium Labs" would not turn anything over to collections. She never told my why that was, only not to worry about it. Well I didn't worry about it for a few more months but then I kept getting letters from Millennium Labs saying they would take further action if these invoices weren't taken care of. I called BCBS to ask them why they were no longer paying for the labs and they said that they had requested my medical records from my doctor and until they saw those records they weren't gonna pay for the labs. So I contacted my Dr and informed them of what BCBS wanted. This was around January of this year. The nurse contacted me once she had submitted the records to BCBS. I waited a few more weeks and I kept getting harassing letters from Millennium Labs saying I needed to take care of these invoices. So I called BCBS back to see what was going on and the service rep told me they were "waiting for my medical records". I informed her that my doctor had told me she sent my medical records in several weeks ago. So the service rep put me back on hold and then came back on and said "i've found your records, I am forwarding them downstairs for review, but it'll be a few more weeks before a decision is made." At this point these bills total up over 10 grand. I have a feeling BCBS is gonna say "we ain't gonna pay for it". My question is this, do you think Millennium Labs will report it to the credit bureau's if I don't pay for these labs? I have nearly perfect credit and I want to buy a house in the near future. If this shows up on my credit report it'll ruin my credit. Furthermore, if BCBS isn't gonna pay for future lab tests I've got to hurry up and get off subs. Anyone have any experience with this? Thanks

Re: BCBS has stopped covering my labs...

Tue Apr 05, 2016 8:07 pm

Hey woodzson,

Altho w different circumstances and w a different carrier, I've had large lab charges accrue in dispute. My 2 cents is to:

Call the lab and get a 'stay' or 'hold' on your account till BCBS completes their review. Ask if your account is coded for collections. Mine was. Get on record that you dispute your responsibility for these charges. Ask the phone rep to note your comments in their digital file.

Call BCBS and ask if Millennium Labs is an in-network or out-of-network provider? Maybe their status changed in 2016? Did your deductible change in 2016?

Obtain your med records from your bup MD for a couple years back. Get copies of your urine tests to see what all they checked for. I obtain my medical records and am surprised at some of the inaccuracies in them: wrong diagnosis, meds, test results, that I later correct. I prefer to send the records in myself to the Insurance carrier and not to burden a busy MD's office to get them sent. I mail w signed tracking so I am assured they did arrive to the ins company.

IDK but I wonder if BCBS is reconsidering/questioning paying for this lab's charges bc late last year, this lab agreed to a $256 Million fine for encouraging excessive testing, including for things patients weren’t suspected of taking, including urine testing elderly folks for angle dust, PCP!! Idk, perhaps you are receiving unnecessary drug tests? Does your bup MD know about the fine? If BCBS denies paying this lab, then what lab is approved for you/your MD to use? Per link at bottom, in Oct 2015, " The United States alleged that Millennium caused physicians to order excessive numbers of urine drug tests, in part through the promotion of “custom profiles,” which, instead of being tailored to individual patients, were in effect standing orders that caused physicians to order large number of tests without an individualized assessment of each patient’s needs. This practice violated federal healthcare program rules limiting payment to services that are reasonable and medically necessary for the treatment and diagnosis of an individual patient’s illness or injury. The United States also alleged that Millennium’s provision of free point of care urine drug test cups to physicians—expressly conditioned on the physicians’ agreement to return the urine specimens to Millennium for hundreds of dollars’ worth of additional testing—violated the Stark Law and the Anti-Kickback Statute. The Stark Law and the Anti-Kickback Statute generally prohibit laboratories from giving physicians anything of value in exchange for referrals of tests."

https://www.justice.gov/opa/pr/millenni ... nd-genetic

With some work w BCBS and the lab, you should be able to get this cleared up and prevail. Stopping bup is NOT an option.

Re: BCBS has stopped covering my labs...

Wed Apr 06, 2016 4:08 pm

Thank you so much for the reply. were you able to get your charges dropped?

Re: BCBS has stopped covering my labs...

Wed Apr 06, 2016 10:12 pm

Yep, all worked out well. I avoided all charges because I communicated w all stakeholders. My argument to the carrier was: I followed my health ins. contract, my MD was in-network, he ordered lab tests specific to my condition, tests that are considered standard of care, standard operating practice and perhaps required by medical guidelines and state law, that I had no choice or control in these specific lab tests nor any choice/control in the lab that was chosen to perform the tests. Also, I reminded the ins carrier that I had received no correspondence from them that these tests were in any way an issue. If the lab tests lose coverage, then I should have been notified to make appropriate changes.

Idk, in the past, looks like Millennium Labs (ML) did not go after the patient and that's maybe why your MD's nurse told you not to worry. But, bc of the recent huge fine, ML filed for bankruptcy protection. ML is also under legal fire from investors in a large debt deal last fall where its alleged ML did not disclose its pending fine to investors and their investment value since dropped. Idk, I only mention all this in case ML is maybe looking for money, Idk.

Imo, its BCBS that's on the hook for the lab tests. Imo, your MD is also a stakeholder bc s/he is the one ordering the lab tests at MLs and I think you need to talk w your MD's office again to express your concern.

Stay on it and I think you will be fine!! Come back and let us know as this could happen to others...

Re: BCBS has stopped covering my labs...

Thu Apr 07, 2016 8:50 pm

You're not liable no matter what. BCBS is a PPO plan, right? So your doctor and lab have to comply with their decisions. If I was BCBS I would question why your doctor wants a lab test every month. It's supposed to be random. If possible, find another Suboxone doctor on the PPO list. Mine only checks maybe once a year.

Let us know how it turns out.

r

Re: BCBS has stopped covering my labs...

Thu Apr 14, 2016 10:14 am

Thank you for your replies. I'm still waiting on BCBS to decide if they're gonna pay for the labs. Meanwhile I had my doctors appointment yesterday and I didn't see my doctor but I did talk to the nurse again. I expressed to her how I am very uneasy about the letters I'm getting from ML. She told me not to worry. She told me the only way ML would turn me over to collections is if BCBS had sent me checks to pay for ML and instead of endorsing those checks and forwarding them to ML I instead cashed them. Which I've never done. BCBS always, for some reason, would send me the check in my name and I would have to endorse and mail it to ML. I always did that. But these letters I'm getting from ML lately are very threatening. I've attached one so you can see.
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Re: BCBS has stopped covering my labs...

Thu Apr 14, 2016 7:37 pm

So what does the EOB say when you receive one from BCBS? Talking to a real person at the insurance company would be your best bet. Notate the name, time, and decision made during the phone call. They keep impeccable records but it's still good to have it written down anyway. I once was told that the hospital I was scheduled for a minor surgery was no longer part of their PPO network but that they still honor any charges for 30 days. Wow, I'm sure glad I kept the records for that one. I got billed for over $24,000 and my insurance EOB stated the hospital was not covered. When I called and reminded them of the date, person, and statement made from their own staff, they paid the bill. I thought for sure I was a goner.

Moral of the story. Talk to someone at BCBS asap! Let us know what they say about this lab work bill.

rule

Re: BCBS has stopped covering my labs...

Thu Apr 14, 2016 8:30 pm

My good lord, are insurance companies the worst or what???

My husband had external beam radiation therapy for an early case of prostate cancer last fall. By February of this year the urology center was billing us, first for $4000, and then for $8000. I thought, OK, we have to pay 15% of our in network care and United Healthcare is paying 85%. I was thinking, therefore, that we might be able to deduct our out of pocket medical expenses on our 2015 taxes from last year since we had already paid a few thousand dollars and now we were charged $8000 on top of that. So I called United Healthcare to ask what our total out of pocket was for last year. Lisa, the very nice customer service person I spoke to said, "The out of pocket maximum you paid for your family in 2015 is $6800. I said, how can that be when I have an $8000 bill from last year and we had already paid several thousand out of pocket in 2015?

Lisa looked at the bills from the urology center and said, "Oh my goodness, I think we have to reprocess all of the claims from the urology center. As of October 15th we started paying on your bills from the urology center as if they were out of network! And the urology center is in network with us! You shouldn't have an $8000 bill!" So apparently, once they reprocess the claims we shouldn't owe any of that $8000 bill. Awesome Sauce! Because that was really hanging over our heads and it would only very slowly be paid. But I asked how the error was made and Lisa said that it could very well be a glitch in United Healthcare's system and their fault! Yikes!

BTW, I just received my own lab bill for $145, which should be 15% of the total bill. So the lab test cost around $1000. Crazy expensive!

Amy

Re: BCBS has stopped covering my labs...

Thu Apr 14, 2016 11:19 pm

Hey W,

Did you call MLs? Are you coded for collections? Imo, if you haven't made that call, I really think it worth your while. I read the letter you provided and it looks like they have you coded for all or some level of responsibility.

As to your nurse telling you not worry, unless that nurse is willing to pay your ML bills, then I suggest the nurse might only be repeating information that was sales pitched to him/her by the aggressive ML sales rep which is only that, pitched sales info...

You said "BCBS always, for some reason, would send me the check in my name and I would have to endorse and mail it to ML." I'm not familiar w involving the patient in a contractual payment to a lab provider. Ime, the ins carrier directly paid the lab provider. Why does BCBS handle payment this way? Do you know? Why do they not pay ML directly? Maybe this is why you are receiving the letters, bc ML is holding you responsible for the entire payment rather than just your portion...

I moved while on bup treatment and in fulfilling the new bup MDs requirements, I had to be screened by 'staff' to see if bup was appropriate and I had to first meet w one of his people. She was just 19, her 2nd day and trying to decide if she wanted to be in health care. She was unfamiliar w bup and not sure what to do w me... I'll save the details but I complained to my ins carrier. After investigation, they denied the $750 claim. 1yr later, I applied for a mortgage to buy a home. Surprise surprise, this bup MD jerk, sent me to collections who filed a nonpayment collection report on my credit rating. It dropped my score 40 points. I got the loan, but at a higher interest rate and only bc I could document and prove that my carrier denied them payment for lack of proper service.

As Rule and Amy, as well as I am saying, research and document... and document your concerns to your carrier, MLs and your MD.

Re: BCBS has stopped covering my labs...

Sun Apr 17, 2016 12:42 am

I think the doctor is getting some kickbacks from the lab. How many Suboxone doctors want a urine test every month? It's supposed to be random, not monthly. Find another doctor if possible.

Re: BCBS has stopped covering my labs...

Sun Apr 17, 2016 10:20 am

Oh gosh rule get this, I take a drug screen before each sub meeting and have to take a drug screen before each dr appt once a month. So that's 2 a month for me after 4 yrs of being there. The poor ppl that's still new have to attend a meeting every week which includes a screen every time plus dr appt once a month with a screen. So those ppl take a screen sometimes 5 in one month! There's many times I take 2 screens the same week lol. Let's just say that nobody gets away with using at my clinic :) Up until recently I kinda thought that was the norm. I don't mind it though, honestly I'm proud to be passing them.

Re: BCBS has stopped covering my labs...

Sun Apr 17, 2016 11:59 am

You're right, Rule. It's supposed to be random! I get tested about once every 6 months at a random time. And they also count any scheduled pill I'm on. Jen, twice a month certainly seems to be overkill.

I know that sub doctors are walking a fine line. In order for them to be here for us, they have to show the DEA that they are in compliance. However, I think some of them do have financial or sadistic motivations for what they do.

My sub doctor's office just informed me that they can no longer do phone appointments. Instead they have to do video appointments. I only have to visit the office once a quarter, but now I have to download an application that allows allows me to video chat with my provider.

That doesn't bother me one bit, because they could have taken away the remote appointments altogether. My doctor's office always goes out of their way to make things as easy on us patients as possible. I wish every doctor was like mine.

Amy

Re: BCBS has stopped covering my labs...

Mon Apr 18, 2016 1:54 pm

Amy, that's great you can do video appointments. I can sure see why going in monthly can be a problem with where you live. The news yesterday said you were all snowed in and the airport was cancelling some flights. That's what you get for living in such a beautiful state. I'm not a resident of your fine state but I've been paying taxes to it for over 30 years so you'd think I do have some kind of stake in it. They should at least grant me a resident fishing license for being a taxpayer for so long. I'll have to check into that one.

Hope all is well with you and yours,

rule

Re: BCBS has stopped covering my labs...

Mon Apr 18, 2016 3:10 pm

:) We were not actually snowed in, although I've had such a bad cold I haven't felt like going anywhere anyway!. We are warm enough here that the snow on the streets has melted quite efficiently! We always need the moisture too.

Amy

Re: BCBS has stopped covering my labs...

Tue May 03, 2016 3:34 pm

Thanks for the feedback. I had BCBS contact ML to explain my claims were "under review". ML promised not to send any more letters until this is resolved. I'll keep you posted. But I have a feeling BCBS is gonna deny the claims and I'm gonna have to go to war with ML. Let me ask you this.. my step dad is a Representative in the North Carolina House of Representatives, is there any way I could use his influence to help me resolve this with either BCBS or ML? I'm sure he'll do whatever I need him to do.

Re: BCBS has stopped covering my labs...

Tue May 03, 2016 7:36 pm

Well, if he can help just you, that would be limited, but save you a lot of hassle, which would be great!

If I had a dad in the state legislature, I would probably be lobbying for him to get on a committee to improve the lives of addicts, particularly those on buprenorphine. He has you as an example of an addict who has turned his life around on this medication. Maybe he can think of lawmaking ways to help all of us, or at least those in North Carolina.

Just a thought! :)

Amy

Re: BCBS has stopped covering my labs...

Thu May 05, 2016 7:24 pm

I wouldn't get anyone else involved if you don't have to. The EOB from BCBS normally states at the bottom that the patient is not responsible for these charges. That is why I asked if you had any EOB's. That's your ticket out of paying that bill.

If a provider sends your lab work to a company who isn't part of the PPO they themselves should denied the test knowing full well that BCBS wouldn't pay them.

Houston, we have a problem.
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