Ask Your Health Provider This One Question When You Have An Appointment
One would think that I, being a health care finance consultant by profession, would know better. However, my learning a lesson becomes a teaching experience for you the next time you visit either your physician or the hospital for a procedure.
I needed to have some lab work done after having an appointment at my endocrinologist. I called my insurance company and was told that if I had it done at my primary doctor’s office that it would be covered in full except for a $40 copay. That sounded great to me, because I know lab work can be expensive sometimes, though I wasn’t having anything out of the ordinary performed.
I called my doctor’s office and made an appointment. I knew that I’d have to actually have an office visit of some kind because, unless I’d gone to an independent lab, physicians and clinics have to charge for some kind of procedure before they can perform any other services on you.
I went to the appointment, had the doctor give me the quick once over, and after that went to get my lab work done. They drew the blood there in the office, and after I gave them a urine sample I figured my monetary issues were complete, and went home feeling pretty good and pretty smart because of the phone calls I’d made.
That is… until I got a bill from the lab that actually performed the service. When I had called my doctor’s office, all I asked is if they processed lab work. I never asked them if they ran the tests on the lab work, because in health care, the term “process” is only an upfront term meaning they collect what’s needed. I forgot that part; I needed to ask them if they actually did the lab work.
Luckily, the bill isn’t all that high. The insurance company paid portions of the bill because I’d gone to the physician and had another physician who was in their network request it. Still, I should have asked that question beforehand so I wouldn’t have gotten caught off guard.
The unknown truth about health care is that sometimes you’re going to get a second bill you’re not expecting. If the physicians who read your x-rays aren’t employees of the hospital, you’re going to get a bill from their physician’s group. If you have to have some kind of surgery or procedure at the hospital or ambulatory center, you’re probably going to get a secondary bill from the surgeon, and a third bill from the anesthesiologist.
In a way, you can view health care services as ala carte. Even if you go to a clinic, there are some services that will end up producing a bill for the physician. Unless you’re covered by Medicaid, you’re going to be responsible for that second bill as well as the first one.
To make sure you’re not caught off guard, you as a patient or payer of services needs to remember to ask your provider if there’s a possibility that you could be getting a medical bill from someone else for services your provider starts. Lab work is a prime example; if your physician doesn’t process lab work in the office and gives you a script, you’ll take it with you to an outside lab and you’ll get a bill from them. If that’s the case, you might need to expect that they’re working with someone else.
Once you have that information, you should check with your insurance company to see if that secondary provider is a participating provider in their network. If not, you’re allowed to go to someone else who is in their network; you’re never obligated to go to someone your doctor recommends, although most of the time it’s probably the smartest move to take.
Health care can be confusing, and if I forgot to ask the proper question, and I’m in the industry, there’s no doubt in my mind that it’s something the majority of people probably will never think about.
Now you know.