Limited health plan leaves him with $900 bill

I have a very limited health plan.  It covers only hospital stays and one routine visit per year.  I wanted to have my routine visit completely covered by the plan.

I printed out what was covered and not covered from material that was sent to me from the plan.  I gave that information to the billing clerks at my doctor’s office and told them please make sure that any procedures/blood work would be covered entirely within my policy. I did everything possible on my end to make sure that I would not have to pay for this visit.

After all of this, I got a bill for a $900 blood test!  My question is why is it my job to inform these health care providers on what is covered and what is not? Why is it that I have to go above and beyond to make sure that my doctor’s office is billing these things correctly? And why is it that after giving them the information I am still being charged for something that I did not request?

Exasperated and Exhausted

Dear Exasperated and Exhausted,

Yes, I’m tired just hearing about your story!  You certainly went to great effort to inform the doctor’s office about your plan and what you wanted from the visit.  Yet, they still missed the mark.

The office staff apparently did not verify what services would be covered.  The doctor went through his or her usual routine of preventive visits, and ordered the tests he thought appropriate.  Thus, though you did not request the blood test, your doctor did and it showed up on your bill.

In answer to your question, it is not your job to inform the office staff what is covered.  You should not have to inform them about your plan.  You should also not have to ensure correct billing.  It is their job to communicate with you, and respond to your requests.  In this case, they did not do their job effectively.

Since you were very clear with them about what you wanted to happen, I would hold them partly responsible for the mistake.  I would approach them and ask why your requests were not heeded.  And, now that the mistake has resulted in a very large bill, what could they do to remedy the situation?

Under the ACA, health plans cannot limit benefits for “essential health services”.  From the very few details you have mentioned, your plan will not meet these standards.  You can continue to have the plan but you would be considered uninsured by the ACA and thus have to pay the penalty/tax.  So, you might want to consider your options for January 2014.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.