Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

Emergency Med Labs


Nasty Weather:
For the last 3 years when I would go for more quarterly blood tests they always got billed as Emergency Med Labs and I did not have to pay, my last visit in Jan they billed as diagnostic labs and they now want $496 for a service that never cost me before, I have been arguing with the Hospital but not getting anywhere, has anybody else had this experience?

This does not make sense to me as quartley labs are neither "emergency" or "diagionstic" do you have the five digit procedure codes that they billed them with. Since they are labs they should start with an 8.

Nasty Weather:
That way they get covered 100% any other way you pay

Review your previous statements for the diagnostic codes used to submit them to your insurance. Be ready to tell the billing office for the lab/hospital "this lab has been billed under XXXX code, now it's been submitted under YYYY code."

If you can't get cooperation over the phone, put in writing your disagreement. State specifically that these are the exact same tests that have been conducted, the dates of service (the days the labs were performed, and the doctor who requested them.

Then demand they correct their error. Send this statement by registered mail.

Contact your insurer. Tell them the lab/hospital/etc. is miscoding your labs and submitting them under incorrect codes. Tell them the labs are the same ones that have been done the last three years, etc.

Your insurer should tell the billing party you cannot be held financially responsible because of their billing error. Have your insurer send you written documentation that you are not responsible for payment in this case. This is usually all it takes for the billing party to resubmit the request for payment with the correct codes. (I've had to go this route with BC-BS over some hospital bills in the past.)

If neither of these work, contact the insurance oversight department of your state. Be ready to show you've exhausted all options and the lack of cooperation you've encountered. Usually getting your state's insurance commission involved is enough to get everyone's attention and get this resolved once and for all.

Personally, I'd be careful about calling out how they were coded as "Emergency" in the past, if they were not, in fact, Emergency labs.  You could be looking at an even bigger bill if the insurance company decides that the old ones were coded incorrectly, instead of this one.  I would start with the ordering doctor, before jumping to the insurance company.

If they are Emergency, fine, but I don't see how a quarterly draw would be an emergency.  They ARE diagnostic, in that they are giving insight into how your treatment is working or if you need to start treatment (whichever applies).  Coding something incorrectly in order to avoid a patient charge could constitute Insurance Fraud (by the clinician, of course, not the patient).

Just my 2 cents.



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