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Patients with High Deductible Plans are Hit with High Bills

— December 5, 2018

Patients with High Deductible Plans are Hit with High Bills

More so than ever before, patients are being hit with unexpected lab bills that can occur when tests are performed by out-of-network lab facilities.  Patient payments are a focus for lab companies as high-deductible health plans are increasing in popularity, and patients are struggling to understand the payment process, particularly when blood work is taken somewhere that’s familiar and sent out to be processed (i.e., the samples are taken at their primary physician’s office, then sent to a third-party lab).

Mark Guinan, executive vice president and CFO of lab company Quest Diagnostics said most of the company’s customers do not have contact with Quest until the bill comes in the mail. “A lot of times the reaction we might get is, ‘Who’s Quest? I never went to Quest,’” he said.

Some physicians try to ensure testing is covered by the patient’s insurance and sent to an in-network lab facility.  However, Martin Makary, MD, a professor of surgery Johns Hopkins Medicine, said, “There’s no formal training for some of this stuff,’’ and “by and large, patients do not have navigators.”

In April 2017, 59-year-old mechanic Glen Thibedeau scheduled a visit to his doctor because his blood pressure was high.  Basic blood work was ordered.  A couple weeks after this was performed at a Quest Diagnostics clinic, Thibedeau got a bill for more than $1,000.  Thankfully, Quest was a provider covered by his insurance. He ended up paying $130 of the $230 for which he was responsible but refuses to pay the last $100.

“I thought that was ridiculous,’’ he said. “Basic blood work for over $1,000?  I haven’t paid them $100, and I’m doing that out of spite.’’

Patients with High Deductible Plans are Hit with High Bills
Photo by Sharon McCutcheon on Unsplash

Another patient, Charles Bulson, took his issue all the way to Congress after he too was charged more than $1,000 for blood tests not covered by his insurance provider because they were coded incorrectly.  Bulson tried to resolve the issue with the lab, his insurer, Blue Cross Blue Shield, and his physician’s office first, but the bill was sent to collections.  So, Bulson contacted Senator Charles Schumer, D-New York, and hasn’t heard from the collections agency after the case made it to state regulators.

43-year-old, Allison Ritchie, found a lump under her jaw earlier this year and an ear, nose and throat (ENT) specialist said she needed to have a biopsy performed at a hospital to test for cancer.  Ritchie got everything preapproved by her insurance company, but her tissue samples were sent to an out-of-network lab. “I didn’t ask where they were sending tumor samples to,” said Ritchie. “It wasn’t a question that was at the forefront of my mind.”

This illustrates an important point.  Often, patients take all necessary precautions to ward against receiving high, unanticipated bills in the mail.  However, a kink somewhere in the logistics process, like Ritchie experienced, throws everything off anyway.

Bulson may have the right answer. “It’s this entire medical system that needs to be picked up, thrown down into a thousand pieces, and put back together again,” he said.


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