I am in Texas. I recently went to a specialist to consult with him about a health concern of mine. After speaking about the symptoms with me, he wanted to get labs done and sent me down stairs to their lab. A few weeks later, I get a bill for $509 from a third party (Hospital next door) for the lab work. Aetna says these labs would be covered and I wouldn’t have to pay near as much if it was coded as an office visit but the third party has coded the lab work as “outpatient on-site” because the sample was sent to the hospital next door and tested at the hospital.
A few points. I was never aware this was going to a third party, I was never told there was another option, This was literally a consult and not for a procedure, and the original doctor’s office coded my visit as a normal office visit rather than an outpatient procedure.
I am at my wit’s end with this. I have talked to Aetna (they say I have to talk to the third party to straighten it out), I have talked to the third party (they tell me there is nothing they can do and I need to talk to my specialist), I then speak to my specialist, (they talk to the third party on my behalf and explain that this was an office visit but in the end they just say my only recourse is to talk to the third party). I feel like I am going around in circles. I am trying to be calm and not lose my temper but I am at my breaking point.
To her credit, the billing rep at my specialist is going to speak with one of the surgeons at the clinic who also works at the neighboring hospital (third party lab) to see if he can get anything done in terms of lowering the bill or straightening the situation out.
My question is do I have any recourse here? I have checked the surprise medical billing laws in Texas and it looks like this doesn’t apply as surprise billing. My argument is that I was never told the sample would be going to a third party and the blood was drawn on the premises of the clinic. I realize I will have to pay something but it feels ridiculous to be on the hook for third outpatient charges when I went in for an office visit consultation.
submitted by /u/Jared_Exotic
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I am in Texas. I recently went to a specialist to consult with him about a health concern of mine. After speaking about the symptoms with me, he wanted to get labs done and sent me down stairs to their lab. A few weeks later, I get a bill for $509 from a third party (Hospital next door) for the lab work. Aetna says these labs would be covered and I wouldn’t have to pay near as much if it was coded as an office visit but the third party has coded the lab work as “outpatient on-site” because the sample was sent to the hospital next door and tested at the hospital. A few points. I was never aware this was going to a third party, I was never told there was another option, This was literally a consult and not for a procedure, and the original doctor’s office coded my visit as a normal office visit rather than an outpatient procedure. I am at my wit’s end with this. I have talked to Aetna (they say I have to talk to the third party to straighten it out), I have talked to the third party (they tell me there is nothing they can do and I need to talk to my specialist), I then speak to my specialist, (they talk to the third party on my behalf and explain that this was an office visit but in the end they just say my only recourse is to talk to the third party). I feel like I am going around in circles. I am trying to be calm and not lose my temper but I am at my breaking point. To her credit, the billing rep at my specialist is going to speak with one of the surgeons at the clinic who also works at the neighboring hospital (third party lab) to see if he can get anything done in terms of lowering the bill or straightening the situation out. My question is do I have any recourse here? I have checked the surprise medical billing laws in Texas and it looks like this doesn’t apply as surprise billing. My argument is that I was never told the sample would be going to a third party and the blood was drawn on the premises of the clinic. I realize I will have to pay something but it feels ridiculous to be on the hook for third outpatient charges when I went in for an office visit consultation.
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