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PostPosted: Mon Nov 23, 2015 12:28 pm 
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This was originally posted as a reply from an old thread posted back in 2012, but figured it might recieve more attention if I started a new thread. I am new to this forum, hopefully I am not violating any rules, though if I am I do apologize in advance.

I received a claim apparently submitted to Cigna for $1,760.00 with the services being provided by a company "PHYS CHOICE LAB SVC". I have only been seeing this doctor going on 4 months, however have only had 3 appointments total with 3 DT's max. I don't see how this charge could be that costly, nor was I ever informed the drug testing would have to be paid for, it was assumed it would be included in the appointment fee I pay out of pocket each visit (175$) . I did a little research and actually found a thread put out by the government about possible fraud with this kind of circumstance to benefit the prescribing physician, which it says is clearly illegal.
Here is the link to that article posted by the gov:http://oig.hhs.gov/fraud/docs/alertsandbulletins/2014/OIG_SFA_Laboratory_Payments_06252014.pdf


I'll keep up with updates as I am going to contact Cigna , as well as my physician to find out what is going on.




*Update*

After contacting Cigna, the physician/doctors office has apparently tried to bill Cigna on three seperate times for each drug test, each time amounting to the $1,760.00 . I find it hard to believe one urine sample could cost that much. Will now be contacting the doctors office to see why they are trying to bill Cigna like that, and why they continue after it was denied three times.

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PostPosted: Mon Nov 23, 2015 5:27 pm 
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Wesley,

2 things. 1) I deleted your other duplicate thread because you don't need two of the same subject. This one stayed because it had more views. The other was in the legal section so if you want me to move this there, just say so.

2) Your problem is not unique. The doctor used a 3rd party to have the testing done. What you need to do is call them and kindly ask if they are putting in for a preferred provider status with Cigna. Same thing happened to me but with Blue Cross/BS. The lab said they would accept whatever my insurance company will pay as payment in full.

It may be some fraud is happening but it's doubtful. And yes, it costs a fortune to have blood or urine tested. Cigna and the lab need to come to an agreement about how much Cigna will pay. They negotiate that stuff everyday with labs.

Hopefully, you can get this straightened out and not be held liable for any expenses. You shouldn't be. They would have to come up with a release form signed by you stating you'll pay in full whatever the insurance company doesn't pay. In other words, no. (I'm guessing here) You should be in the clear for this bill. It's up to your doctor's office to send it to a lab which is covered as a provider with Cigna.

I hope I didn't' make matters worse. It's just my 2ยข worth.

rule

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PostPosted: Mon Nov 23, 2015 9:46 pm 
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First of all, I am on your side. I see this type of garbage all the time, and I've written about it on my blog. But it is important that you know what you are dealing with. Don't take my comments as a sign that I'm not sympathetic to your situation.

The link you posted is not relevant for a couple reasons. First, the rules related to kickbacks apply to medicaid and medicare services. The 'STARK' laws were passed a number of years ago, and prevent doctors from engaging in enterprises --- including labs, pharmacies, and imaging facilities among others-- that receive referrals from their own practices. STARK laws prevent doctors, for example, from ordering meds that are dispensed by a pharmacy that they have ownership in. But by my understanding the law only applies to patients covered by medicaid or medicare.

But beyond that, the law would only be an issue if your doc had ownership in the lab that billed you, OR if the lab paid 'kickbacks' to the doc who ordered the labs. You didn't provide evidence to that effect, so I assume you don't have that evidence.

A number of labs aggressively market themselves to addiction practices. I contracted with one of them a few years ago. They promised that they would only accept what insurance paid, and NEVER bill patients for additional costs. After a few weeks, patients started complaining to me that their entire 'psych' benefit for their insurance coverage was exhausted from paying for two lab results. The company was charging insurers $600-$800 per urine test!! I fired them as soon as I heard about it. Their answer to me was 'what's the difference? Insurance is paying for it!' I then found out that they were also billing patients, and even sending patients to collection.

There are many docs out there who are scared that they will get into trouble if they don't treat every patient like a criminal, and test, test, and test again. These docs brag about their testing, and about all the ways they 'catch' patients who aren't completely honest with them. Of course if they want to catch everyone, they will have many 'false positives' where patients with unusual lab results, caused by variations in metabolism, will be kicked out for no reason. But they don't care about those patients, or about that risk.

I got off track... the attitude of state regulators favors the docs who treat patients like criminals. Nobody is looking out for the interest of 'drug addict' patients.

Your doctor SHOULD have informed you that you would incur additional costs from the drug tests that were sent off. But I do not believe that there are any laws that REQUIRE you to be notified about those costs.

I could write all night about how things 'should' be or 'could' be. But the only way to provide such an answer would be to ignore half of the debate about healthcare. I think that the STARK laws are a good start to regulating all testing, but that wouldn't help your situation unless your doc was getting kickbacks. I think that all doctors should be required to list the cost of their services, along with any costs routinely associated with those services. Unfortunately the ACA did nothing to increase transparency in healthcare costs.

But back to your case--- the lab's argument will be that they provided a service, and billed you a reasonable charge for those services. The doc will say that they ordered testing, and that the costs of the testing are your responsibility. The insurer will say that the lab is charging more than they will pay for the services, and they have no relationship with the lab to limit those charges.

Your best bet might be to negotiate with the lab. Their only leverage is to threaten to put your account into collection and hurt your credit rating. They gain nothing from that--- so you may be able to pay a third or half of the bill, and walk away. Of course if your credit history is already bad, you can simply ignore them-- which is probably what happens to most of their charges. But I don't see any way to make your insurance responsible, unless they have a contract with the lab (which would be very unusual). Likewise I don't see any case against the doc, other than destroying his/her online reputation on review sites. Your doc probably has no control over your lab charges at this point.

Let us know what happens. After all this typing, I wish I had better advice for you...


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PostPosted: Fri Nov 27, 2015 6:25 pm 
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Wesley, I'm copying and pasting my response (though slightly edited) to your comment in the Legal section:

Wesley - You mentioned you pay $175 out of pocket... How did the lab know to bill Cigna? I'm going to guess that either some of your visit is covered and the $175 is your responsibility or more likely, the doctor accepts insurance/Cigna and took your insurance information but doesn't accept insurance for their Suboxone program. Either way, what happened to me might be relevant.

This happened to me when I was in an Intensive Outpatient Program. Each morning, a list would go around the all of the counsellors who circle their patients that they had wanted to be tested that day. My counsellor always circled her patients each day. Which was no big deal to me and I even mastered peeing in a cup without covering my hands (lady problems!).

A month or so after I had graduated from the program, I received bills from 2 different labs that were not approved by Cigna so were not covered. I was furious because it was over $4,000 since I was essentially tested each day throughout the program. How could my counsellors decision to test me so often be my responsibility??

I called Cigna and the labs and explained the situation. Cigna explained to me that because the program had been covered by them, they are only to use their approved labs and that I'm no liable to pay.

Labs do this all of the time knowing that there are those who will pay, no questions asked. I would call Cigna and explain the situation. Ask them why your doctor, would pass along your insurance info and test to a lab that does not accept Cigna. Cigna should then call the lab and at that point, they should back off. And if they do, be sure to request a letter stating your $0 balance in the event they every try to come at you again.


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