My doctor sent me on a wild goose chase to have a pulmonary function test at the hospital. The test came back normal, but the bill came back unpaid.

According to my insurance company it does not matter what the procedure was (this was a test), it is treated the same as if it was surgery or anything else in that it goes against my deductible. So, I get to pay $544 for a test that I didn't ask for in the first place.

According to my doctor, the hospital was the only place to get the test, so it is not like I had much choice. Also, if ANYONE along the line told me the cost I would not have agreed to the test in the first place, because of my belief that it would have dubious diagnistic value.

No wonder the medical industry has such a bad reputation. When I get my brakes done, I am told the cost BEFORE I agree to the work. What is preventing this common courtesy in the medical industry. I have a science/engineering degree, I could have just as easily have read the results off a printout and checked normal value in a reference just as easily as an MD, and I would not have charged almost $540 for 10-15 minutes of work.

If you have an HMO, likely the doctor's office or med group should be paying that for refering you. It sounds to me like a case of the insurance has paid the Dr for a test and the office hasn't compensated the hospital. Generally if your Dr refers you for a test, the Dr's office gets compensated by the insurance for the whole deal even if you needed say a CAT scan the Dr couldn't give you and the Dr had you gho to the hospital for the CAT. In that case it is teh Dr who needs to pay for the CAT since they already got the money from your insurance which is hte reason your insurance wont pay for it. If your insurance insists it is a surgery, request an audit from the hospital saying it was lab. That should shut them up and have them pay the bill. If they require a pre certification for a lab, you have a bad insurance company.

Great post Icephalt....Unfortunately many people don't know enough about how the system works to know when to ask or what to ask.
My deductible is paid for the year, and I just recently landed in the ER and the Emerg surgery. WHen I checked out I went to the business office to tell them that they will accept my insurance company's 80% as payment in full. In other words I told them they would agree to accept assignment. Many times that is all it takes, because they know you are aware of the system and wont argue. Sometimes they will, but stick to your guns......
e-deal- icephalt is right, argue with them. A Pulmonary Function test is just THAT a test. Considered a lab test..... Don't forget that you will prolly receive a bill from the pulmonologist too.

You should check your benefit booklet, I work in the insurance industry and I can tell you that there are quite a few plans that are set up so anything done outside of a Dr.'s office are subject to the deductible, including lab work done at an outpatient facility.

I know how you feel. We got stuck with a $250 deductible a few years back--because I hadn't done my homework on the subject.

Since that time, however, I have become better versed in the subject of medical insurance coverage. I found out this year (my spouse's job is coming to an end soon, so we'll be w/out coverage again) that he AND I both had our $500 yearly deductibles ANd $2,000 out-of-pocket maximums to meet.

I met mine, but, since he hadn't had anything 'big' done until April of this year, he had to incur his. I have to call the anesthesiologist's office tomorrow to talk about setting up a payment plan. I will also do the same for the surgeon and the hospital.

It really pays to do your homework. Most people don't know how the system work. When switching insurance companies, it's a good idea to call member services/customer service in the beginning and throw a few key questions around: like, what is the deductible, is the coverage 80/20 if you stay in network, etc.

Also, it does not hurt to call the customer service and ask them if a certain doctor is in network, even if you don't see their name listed online. My general surgeon is not listed on Cigna's website but IS in our particular healthcare plan (thank goodness...)

All of this information goes a long way when you get new insurance coverage. I also have a great tip for anyone out there getting ready to go through a lot of stuff:

I made a 'phone log' when I call up the insurance company, doctor, or hospital. I write down the basis of the conversation, person's name, contact phone/fax #, reference #'s to the said coversation, etc. That way, if someone tries to pull a fast one on you, you have actual documentation. Even though our insurance coverage will be ending next month, I'm still going to type the handwritten 'notes' to file away to use as reference material in the future.

Hope this helps!

Hoosier