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Old 02-15-2014, 12:49 PM   #21
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It annoys me that doctors will select the "subcontractors" that suit them, and then let the customer duke it out with the subcontractor. So you might end-up with an out of network anesthesiologist when the community is full of in-network ones. Then, since they have your insurance info from your main doctor, they get paid something less than their outragous rate and bill you the rest. I want them to have $0 from me or my insurance company to start with, then I'd give them a take it or leave it offer of whatever the in-network rate is.

The thing is that often community is not full of in-netword ones. That was the frustration I often had. For certain specialties (anesthesiology was one of them and there were others) the providers didn't join any network. The doctors couldn't refer to you to an in network provider as they didn't exist. I once called all the hospitals in the area and asked which anesthesiologists were in network. The answer was none. This is one reason that for certain specialities the insurance policy often provides for in network payment for out of network providers.
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Old 02-15-2014, 12:54 PM   #22
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With all the labs in our area my skepticism is along the lines that the lab the doctor chose is one in which he has a financial interest.
That might be true but.......

Can we really expect our doc to be an expert on our insurance and take responsibility to involve only other docs and labs that are in-network for our particular policy?

I've discussed this with our long time family doc. He has a whole bulletin board of notices posted trying to help patients understand insurance issues. I noticed one posting read something like "If you have Brand X insurance, they will not accept billing from our lab. Please provide us with a lab you want us to send your blood and urine samples to."

You really need to be proactive and understand your own insurance in detail including who is and isn't in network. I understand the frustration as I've fought this battle myself on several occasions. But now I know the labs, hospitals, clinics and docs in my area that are in network and I go out of my way to know who will be providing services.

It's a lot to ask your doc and his admin people to keep track of dozens of insurance policies and coordinate this all for you.
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Old 02-15-2014, 01:14 PM   #23
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That might be true but.......

Can we really expect our doc to be an expert on our insurance and take responsibility to involve only other docs and labs that are in-network for our particular policy?

I've discussed this with our long time family doc. He has a whole bulletin board of notices posted trying to help patients understand insurance issues. I noticed one posting read something like "If you have Brand X insurance, they will not accept billing from our lab. Please provide us with a lab you want us to send your blood and urine samples to."

You really need to be proactive and understand your own insurance in detail including who is and isn't in network. I understand the frustration as I've fought this battle myself on several occasions. But now I know the labs, hospitals, clinics and docs in my area that are in network and I go out of my way to know who will be providing services.

It's a lot to ask your doc and his admin people to keep track of dozens of insurance policies and coordinate this all for you.
I would have been quite happy to do the research myself if I had an inkling that he would use an out of network lab. I did check ahead of time that the surgeon, the out patient surgery center, and anesthetist were all in network. Over the past few years 3 different labs have been used for us, all of which have been in network but I guessed I should have asked, "if you find any polyps, which lab will you be using for the histolgy?" My not asking that question now leaves me a $1,500 bill to sort out. Very frustrating.
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Old 02-15-2014, 01:40 PM   #24
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I would have been quite happy to do the research myself if I had an inkling that he would use an out of network lab. I did check ahead of time that the surgeon, the out patient surgery center, and anesthetist were all in network. Over the past few years 3 different labs have been used for us, all of which have been in network but I guessed I should have asked, "if you find any polyps, which lab will you be using for the histolgy?" My not asking that question now leaves me a $1,500 bill to sort out. Very frustrating.
I agree it's frustrating and I've gone through similar.

It's hard to ask too many questions or probe in too much detail. When I needed an MRI done, I saw that our local hospital, which was in network, did MRI's, so I went there. It turned out that another company leased space in the hospital for their MRI equipment, paid the hospital to provide administrative support and technicians to run the equipment. So, I was in an in-network facility and everyone I dealt with had on the in-network hospital's logo. But the bill came from the company that owned the MRI equipment, an out-of-network situation.

I appealed and the insurance company wound up paying. But now I ask the question regarding who will be billing me.

My point is that I don't expect my doc to be responsible for knowing who is and isn't in network for my particular insurance. I try to do that. But it is a royal PITA for sure.
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Old 02-16-2014, 05:51 PM   #25
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I wanted a different blood test that insurance would not cover. Doctor wanted $225. I paid for the test at RequestATest.com and they send the order to a lab close to me. Got the blood drawn and the next day the report was emailed to me. Cost $69.00
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Old 02-17-2014, 11:59 AM   #26
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I wanted a different blood test that insurance would not cover. Doctor wanted $225. I paid for the test at RequestATest.com and they send the order to a lab close to me. Got the blood drawn and the next day the report was emailed to me. Cost $69.00
Way to go! I have found that by shopping around different labs, there is a huge range of prices for the same blood test, for the "patient price", i.e. cash. I've had good experiences paying cash for certain blood tests, once I found a good price. And there were no surprises, no "extra charges". Nice and transparent.
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