Venipuncture as additional billing item on office visits

I never go out of network because the prices are just too outrageous. If I go to a lab recommended by the doc then I don't have to pay anything. I have Blue Care Network of Southeastern Michigan.

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ks1905

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Posted 9/18/2007 5:48 AM (GMT -6)

I'm in NY; I stay in Network for my blood work..... going out of Network can be a nightmare. I hate insurance companies!!!!!!!!!!!!!!!!!!!!! When I stay in network and just go for regular blood work I do not have to pay at all ($0 co-pay). Blue Cross & blue Shield.

--Keith

DX'd with Pan-Colitis June 2005

Current Status: Flaring since May

Current Meds: 6-mp & Colocort

Supplements: None

Irish_Mom

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Posts : 385

Posted 9/18/2007 9:18 AM (GMT -6)

Old Hat

This thread caught my eye since I'm a coder/biller for a doctor's office. It seems to be an insurance to insurance thing, but I have noticed that the majority of times this happens that the patient has a union-based insurance. We have a lot of patients with UFCW (United Food and Commercial Workers) that is handled by Blue Cross, and they don't pay for venipunctures.

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Old Hat

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Posted 9/18/2007 10:21 AM (GMT -6)

Thanks to all who replied so far-- I also try to stay in network, BUT my IBD subspecialist gastro does not participate in any insurance plans, typical of these doctors in my area, bills venipuncture as a separate charge, and wants me to have the bloods tested 3 times annually. I get out of one blood test annually because my in-network internist does it-- so that leaves me with 2 uncovered by insurance. The unions are probably right to oppose paying for it as an extra charge; now if only we patients affected could get the doctor to stop billing it that way! It annoys me especially because I read last yr in major newspaper that some doctors, hospitals, & labs are profiting handsomely from research use of the blood that we give for routine medical tests. If they are profiting, then they certainly should not be charging us for venipuncture, kinda like getting a gift & asking the giver to pay you for taking it, besides.

/ Old Hat (nearly 30 yrs with left-sided UC; currently on 3 X 3 Colazal daily for July flare in descending colon; should be back in remission soon)

ks1905

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Posted 9/18/2007 2:28 PM (GMT -6)

My GI doesn't care where I get my blood work done, just as long as I get it done. He is also 60 miles away from me so I am not going to get blood regular blood work done at his office. I would just tell your GI that you want to have your blood work done in Network.

--Keith

DX'd with Pan-Colitis June 2005

Current Status: Flaring since May

Current Meds: 6-mp & Colocort

Supplements: None

ledaebel

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Posts : 339

Posted 9/18/2007 8:02 PM (GMT -6)

My insurance pays for all my medical bills in the system. You have to be very careful when having labs drawn in an office because they might ship the specimens to a lab out of mnetwork. In the hosital where I work they have always charged extra for venipuncture. I worry about those people who do not have insurance or have minimal insurance.

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Old Hat

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Posted 9/19/2007 10:53 AM (GMT -6)

Keith-- I refused blood draw on most recent office visit to gastro. I was then charged the venipuncture amount in the billing slot beside "occult blood feces screen" which has always been left blank. (As if "occult blood" test was always considered part of basic office visit charge). I know it was not the biller's doing because she 1st read over the form my gastro had filled in, then she got up from her desk & went to doublecheck with gastro before totalling charge for that office visit. So the total charge equalled what it would have been IF I had consented to the blood draw. Let me just add that the additional charge brought the total over $300 for a 10 to 15-minute exam/consultation. This is not spare change for me! THANKS AGAIN, ALL for contributing your thoughts/experiences with the venipuncture billing issue. I feel bad about this-- like my gastro/patient relationship all comes down to the bottom line. I guess we should figure as much when the doctor declines to participate in any insurance plans. / Old Hat (nearly 30 yrs with left-sided UC; currently on 3 X 3 Colazal daily for July flare in descending colon; should be back in remission soon)

dakotagirl

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Posted 9/19/2007 6:14 PM (GMT -6)

Interesting that your doctor doesn't participate in ANY plans! Then decides to charge an arm AND a leg for an office visit! Sounds like highway robbery to me :(

However, having the right medical team is SO important!

I wonder, if you questioned the charge, would they remove it?

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ks1905

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Posted 9/19/2007 7:54 PM (GMT -6)

I do not know how they can charge you for something that they didn't perform; is that legal?

I guess that I got a really good deal today when I was at my GI's office for a 30 minute visit, he only charged me $215. He doesn't take insurance either.

--Keith

DX'd with Pan-Colitis June 2005

Current Status: Flaring since May

Current Meds: 6-mp & Colocort

Supplements: None

Pitz

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Posts : 84

Posted 9/19/2007 9:23 PM (GMT -6)

I'm currently being monitored for 3 different meds by 3 different doctors (6-MP, Coumadin and Hydrea). I was having some done at my hematologist's office and the rest at my PCP's office. I wouldn't be charged for the CBC at either office. However, when having my INR tested for the proper Coumadin dose, my PCP's office was charging for an office visit (which resulted in a copay for me) when I wouldn't even see the doctor, just have my blood drawn. They told me it was because the doctor had to check the results, determine what Coumadin dose I should be on, and then someone would call me with that dose. Hello!!! The doctor has to look at the results of EVERY lab test! There are times when I have to have this done every week depending on the results. They never charged me a copay for CBCs, though. My hematologist's office never charges me for any lab work unless I actually see the doctor.

The next time I saw my PCP, I talked to him about it and he agreed that it didn't make sense for me since I needed it so often and they agreed that I would only be charged once per month, no matter how many times I needed my INR checked. He said it didn't make sense for me to be charged each time since I needed it so often. However, I've since decided to get all my labs done at the hematologist's office, which my PCP agreed to. Things just got too confusing trying to remember what to have tested, and where and how often. It's making things so much easier (and cheaper for me, too!). They just fax all results to both my GI and my PCP.

Ulcerative Pancolitis (dx'd 6/2002)

Pentasa (4gm/day)

6-MP (100mg/day)

Prednisone (currently 10mg/day & tapering by 2.5 every 7-10 days)

various meds for other conditions

ks1905

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Posted 9/19/2007 9:31 PM (GMT -6)

Pitz--

Old Hat didn't have any blood drawn and was still charged for it. You had blood drawn and they charged for the doctor to look at the results, I can (sort of) understand the charge. Old Hat's Charge is baffling.

--Keith

DX'd with Pan-Colitis June 2005

Current Status: Flaring since May

Current Meds: 6-mp & Colocort

Supplements: None

Post Edited (ks1905) : 9/19/2007 9:31:08 PM (GMT-6)

Pitz

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Joined : Jul 2007

Posts : 84

Posted 9/20/2007 7:49 AM (GMT -6)

But my problem is that if they were going to charge for one, they should charge for them all. The INR is the only lab work I ever had a copay for. I mean, the doctor has to look at results of every lab test, anyway, so their reasoning didn't make sense to me. All my lab draws require a call back from someone to adjust my medication. I never see the doctor when I have lab work - I'm only there a max of five minutes.

Ulcerative Pancolitis (dx'd 6/2002)

Pentasa (4gm/day)

6-MP (100mg/day)

Prednisone (currently 10mg/day & tapering by 2.5 every 7-10 days)

various meds for other conditions

Old Hat

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Posts : 5212

Posted 9/20/2007 9:34 AM (GMT -6)

I get your point, Pitz-- & am glad to read that your PCP "saw the light". Unfortunately, DakotaGirl, a $300 office visit fee for senior specialist in my area is not unusual-- I guess we patients have to compensate for 401K retirement plans! (Ha!) So, yes, Keith-- you did get a "bargain". It could be that my gastro is burning out after a couple decades treating IBD & wants to take the patient bucks + switch to full-time teaching/research. That gives opportunities to consult on the most complicated IBD cases, which are likely more interesting to veteran specialists than patients like me who respond to existing meds. / Old Hat (nearly 30 yrs with left-sided UC; currently on 6 Colazal daily for July flare in descending colon; should be back in remission soon)

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