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Old 03-07-2008, 04:34 PM   #21
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After my MIL passed away, she kept getting bills from the local test lab for a procedure that Medicare would not cover. My wife tried explaining this to them but they kept calling. She finally told them to get lost because her mother had passed away and she wasn't going to pay them since she was not obliged to. They were a pain.

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Old 03-07-2008, 08:18 PM   #22
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there are several flaws with your comparison, Midpack.

- the doctor orders the test, and the patient has no idea (sometimes not until many months after the fact) that the ins. has rejected the lab's claim.

- Whereas Ford is going to give Avis a good deal because a.) they want to sell cars and b.) Avis wants to buy them.. is Quest in the position of "wanting to sell homocysteine tests?" Sort of.. BUT Aetna (the supposed buyer of the tests) does not actually WANT to buy those tests.. it would rather buy NO tests at all, if it could get away with it.

- you're right that there's a different sense of 'entitlement'.. but no one is asking for the test to be free.. it's just that you can't compare a market where you can blithely pick and choose a new car.. to one that has the shadow of life and death over it.

- Anyone can walk in to WalMart and get the same benefit of lower prices. But anyone cannot just access the cheapest or best health insurance, whether by state regs or because it's linked to their jobs... some people can't get health insurance at all, regardless of ability to pay. You can't use free market reasoning for a non-free market.

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Old 03-08-2008, 05:16 AM   #23
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Originally Posted by MikeD View Post
I had a giant fight with Discover card that lasted over two years and ended up in court over $335.00. I told Discover not to pay a charge within my 60 days. They paid it anyway and told me it was now between the fraud biller and me.
That's odd. Clear violation of the Fair Credit and Reporting Act. You were dealing with idiots on the phone and when it got to court the co.'s attorney knew it.

Best to send such letters of protest over fraud charges certified mail/return receipt requested. Then there's no plausible denial.
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Old 03-08-2008, 06:18 AM   #24
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Originally Posted by ladelfina View Post
there are several flaws with your comparison, Midpack.
We'll just have to agree to disagree, respectfully. I get involved in health care disputes at work all the time, and this case isn't surprising at all, although I understand why it's frustrating to the originator.
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Old 03-08-2008, 08:29 AM   #25
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If Aetna did not cover the test, then they would not have "ordinarily" paid $102 or anything else. So even though Aetna works for the client, they have a clear delineation of what they will pay and won't.
It sucks, but if the bill is for $193, then 193 is what is owed. Whether they profit $93 or $192, it's their profit to be made. You can't buy something and then say you won't pay at the agreed upon cost. At least I can't anyway. I would absolutely hate it, but would pay the full amount (after exhausting all avenues and making sure that I was in fact the one that was originally to have paid).
All a good reason why healthcare should be made into something easier for everyone to understand. You should've been made aware of the costs to you before the treatment anyway. It seems like healthcare is like car repair - if you don't ask upfront every time, you are bound to get hammered.
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Old 03-08-2008, 08:16 PM   #26
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So even though Aetna works for the client, they have a clear delineation of what they will pay and won't.
... You can't buy something and then say you won't pay at the agreed upon cost.
Hmm.. but strangely the OP is being asked to pay beyond the agreed-upon cost in that one normally expects insurance to cover tests that your insurance-connected doc orders. I doubt that this denied test is actually listed anywhere in his insurance docs as being uncovered. So how is he to know beforehand, since he wasn't informed of the cost at the time of "purchase"??. Submitting to the doc's instructions to get the test is not true informed acceptance of any random bill that may come out of that. It's only "clear" to Aetna at the time beancounter Y has to tally up their monthly numbers. most likely; it's not clear to anyone else, nor is it written in stone.

If there's no way of knowing it won't be covered and it's too late to change your "order".. Quest could name any amount at all and you'd say the patient was liable. What if they said the test was $1950, after the fact?
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Old 03-09-2008, 05:16 PM   #27
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I'm trying to decide whether to file an appeal with Aetna. Before the blood test, I haven't looked at this policy bulletin. OK, you're right. I hadn't looked at any of the policy bulletins. Am I expected to?

Seems an Aetna approved Dr. or an Aetna approved clinic should have known this.

I'm still willing to pay $102.

From AETNA website dated 9/17/2007:

Aetna considers homocysteine testing experimental and investigational for assessing CHD or stroke risk. Homocysteine testing may be medically necessary for the following indications: 1) evaluating persons with homocystinuria (cystathionine beta synthase deficiency); 2) evaluating persons with coagulation disorders (e.g., unexplained thrombotic disorders such as deep venous thrombosis or pulmonary embolism); 3) for evaluating women with recurrent pregnancy loss (see CPB 348 - Recurrent Pregnancy Loss); and 4) for evaluating persons with borderline vitamin B12 deficiency (see CPB 536 - Vitamin B-12 Therapy ). Homocysteine testing is considered experimental and investigational for all other indications.
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Old 03-09-2008, 09:07 PM   #28
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aha! the smoking gun! That seems pretty explicit..

I would try to consult with the doctor who ordered the test and find out more. Is there reason for it being considered experimental? Maybe he/she can make a case that it's not and go to bat for you... Best of luck!!

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