And so it begins ($$$$$)

Elley1486 · December 2014

This is going to be a long one folks...

On Saturday I received a check from my insurance provider for $2400...saying that there is a company called NEXGEN MDX that is an out of network provider and they are most likely going to bill me $2,283 for lab work done on my 1st prenatal visit. I was very confused because I already got a bill from a blood work place called LabCorp for $25.00 (my cop-pay) for my initial blood work at my 1st visit. I checked with the billing department for my OB and the only record they had was for my blood work that was sent to LabCorp and they said the only thing they could figure was for some reason, my blood needed to be sent to this NEXGEN company...but gave no other reasons for that but did say that I have a zero balance on my account. I have yet to see a bill from this NEXGEN company and the services were on 10/31/14.

I looked up NexGen and they are a specialized genetic testing company.

I called my health insurance provider to ask them what is going on and they said that my doctor had sent my blood work to this company for specialized testing and it was out of network which is why it cost so much. In addition to me needing to forward the $2400 check to this company, I would also be responsible for the remaining balance of $1100.

I totally freaked. The apt in question was my very first apt and I was 7 weeks. The doctor told us that we had some genetic testing available to us, but not until at least 11 weeks. We told her we did not want any done. She said that was fine and they would probably ask again at my 12 week apt to make sure we had not changed our minds. I never signed anything or was told I was getting my blood drawn for anything other than the "standard" testing.

We went to our 2nd apt on Friday when I was 12 weeks and they went over my lab results and asked about the genetic testing for down syndrome, etc...we declined. They asked about testing for sex. We declined that and also had them make note that we do not want to know the sex. No mention was made of any special genetic testing that was previously done other than my blood testing for type, iron, diabetes, etc (through LabCorp). Everything came back wonderful and I am low-risk at this point and do not have to go back until 18 weeks.

So, right now my health insurance is filing a grievance based on the fact that I never authorized any genetic testing and was never told any genetic testing I would want would be through an out of network provider costing me bookoo dollar.

I was just wondering if this or something like that has happened to anyone before? I mean it seems that my blood work got sent when it should not have and this was doctor error...but does that really happen? I am panicking at the thought of already having an $1100 lab bill that I did not want, nor can afford right now. That alone is more than my delivery stay should be! I have really good insurance and there were def other labs to send my blood work to that are in-network, even if I did request it. Not only that...but if I did receive the genetic testing...why didn't they give me results at my Friday apt? The nurse clearly had no information that I had it done because she asked if I was going to get it. I am so flippin mad, scared, confused and ready to cry. I really, really do not want to have to tell my husband we may need to pay $1100 for this.

Katerina&Baby · December 2014

Don't worry - you can absolutely fight this. You cannot be forced to pay for an elective service that you never requested or authorized (especially when you SPECIFICALLY declined it). Let your insurance and doctor's office duke it out - this is between them. Just make sure you document EVERYTHING. If your communications with insurance have been via phone, write them an email or letter "for their records" with EXACTLY what happened (include dates of appointments, what you were asked and how you responded all the way from the initial appointment to the present - so include the dates on which you spoke with the insurance company and, if you can recall, who you spoke with). If there is no option for email, send a certified letter and keep a copy for yourself.

Elley1486 · December 2014

The only communication with my doctor was with the billing office this morning and she said based on my chart and their records...my blood work was sent away and my insurance covered it, except for a $25 co-pay (which corroborates the $25 bill from a lab I got). She saw nothing else. I did not speak with the doctor directly...do you think I should call and try to get to her? The insurance told me to just sit tight, don't cash the check and I should know more within 15 days. He said that the claims department will contact NEXGEN for records proving that I ordered and accepted the charges for the testing (which I did not, so they should not have anything). Seems the insurance company is going to battle it out with NEXGEN and they may try to battle it out with my doctor on why she ordered the tests without my consent. I am just really worried that if I contact my dr, she could try to cover up the mistake somehow...I don't know. This is crazy.

Katerina&Baby · December 2014

Do as your insurance company asks and sit tight while they try and figure it out. You don't need to bother trying to keep the doctors office in the loop - they'll be filled in when NEXGEN is looking for records. My advice remains the same though - document everything while your mind is fresh - even if you never need the info, it's good to have a written record of what is happening, even if you only email it to yourself so you have a dated copy. Don't stress about it - honest. This kind of stuff happens and it's not your problem to deal with.

housewifebecomesher · December 2014

Not the same, but when I had DD they for some reason did not apply my insurance to her bill and we received an astronomical bill for her hospital stay. I can't ever decide if people are careless and make mistakes a lot or if they know people won't pay attention and hope they will just pay it.

Either way, that's really crappy for you and it sounds like your insurance is doing a good job getting it resolved. Leave it to the professionals, I say. As PP said I would document everything, including who you spoke to and the date and time at the office since they seem to be not so hot at paperwork.

Elley1486 · December 2014

Thanks guys...great advice, as always! We all have enough to stress about as it is. It just bugs me that I did my part in getting good insurance and paying out the ass for it, finding a good in-network provider, asking questions, taking notes, etc...and then this nonsense. I got enough on my plate, Jesus take the wheel!

brody624 · December 2014

Oh my goodness - I have no advice, however this is terrifying. I was going to have the testing done on Thursday, but now I'm terrified that something with get sent out of network (do I have control of that) and I will be charged insane amounts!

I hope this gets resolved for you!!

suzysurparis · December 2014

Dont freak out too much, back when I lived in the US, I remember having cancelled an appointment that was billed to my insurance and then when I actually did go to an appointment my insurance wouldnt cover it because I'd already used my annual visit. Needless to say I was pissed, but after explaining to the insurance company and the billing department of my Drs office, I had to sign a statement saying I never went, I was refunded everything. A lot of times the billing gets fucked up, it's not exactly easy. It's possible someone put in an incorrect code somewhere along the line, but your insurance will work it out. As PP recommended, write down everything in a document and follow the instructions of your insurance provider. Don't bother trying to speak directly with your Dr, they dont handle this stuff anyway.

wegrowsheep · December 2014

No advice, but kuddos to your insurance company for working with you. I'd be super pissed off!

jjbdvm · December 2014

Believe it or not, this kind of nonsense happens all the time. Be persistent- call insurance weekly, document EVERYTHING, including the names and exact times that you speak with people. Worse comes to worse, use the word "lawyer" and it will clear up by magic. I realize that last bit sounds crazy but I've got a chronic weird illness and insurance and doctors' offices will let you slip through the cracks if you don't stay on top of them.

I also recommend that anyone who reads this post become best friends with the front office and the financial manager of your doctor's office. If they know your name, they are more likely to help you out when crazy stuff like this happens. It costs little to bake cookies (ahem, when you aren't nauseous anymore) and get to know everyone's pet's names and will save you headaches and money in the long run. Plus, they like not being faceless employees just as much as you don't want to be a faceless patient

I sincerely hope this gets cleared up for you quickly. I completely understand what an awful headache it is when you get caught in the middle of these kind of mistakes and they expect you to pay the bill! FX for you!

Emilywooddesign · December 2014

Insurance companies are sneaky sneaky bastards! Hopefully you can get this sorted. I live in Canada where healthcare is free so I don't have to worry about this but I have experienced a bill for $5000,00 when I had to go to the hospital in Vegas ( they basically checked my heart and took a blood test) it took about 10 mins and my travel insurance tried to say I had a pre existing condition which is total bullshit! fought it and ended up not having no to pay, but I don't know how those motherfuckers sleep at night! Keep fighting!

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