Scopes w/Hospital and Dr. In-Network, Hosp. Lab Out-of-Network

[mom2277]

I have an 8 year-old child who is undiagnosed. Eosinophilic esophagitis seems likely, and she is having scopes next week at Vanderbilt. We had them scheduled for last month, but had to reschedule due to inclement weather.

I learned via a $900 bill before the last scope that Vanderbilt Hospital's laboratory is out-of-network. Both the doctor and hospital, however, are in-network.

Case management ended up deciding that Vanderbilt Hospital made the mistake in processing her labs when they knew she had Cover Kids, and determined I had no obligation to pay the bill. Our nearby children's hospital, similarly, is not in-network for many labs for kids on Cover Kids, but has a system where those labs are flagged to be sent to the in-network lab. Otherwise, they would have a sideline business of suing all the parents of kids on Medicaid and Cover Kids because those children's labs weren't in-network.

My daughter's case management nurse told me that I don't have to worry about the labs being out-of-network at her upcoming scope. She said the doctor, the hospital's financial advisors, and everyone had it "beaten into them" on what they need to do.

At the same time, I'm very worried we'll end up with a $50,000 bill that I cannot possibly pay because the labs are done by Vanderbilt Hospital. (We saw the supposed best GI closer to us, and I left with zero confidence to the point I probably would forego the scope rather than let him do it.)

I asked the doctor's office to let us do the pre-op labs here the day before. So far, I've received no response.

Any suggestions on how to ensure that we don't get saddled with astronomical debt from uninsured labs?

Thank you!

 

[Trysha]

If your daughter's case management nurse told you there won't be bills get it in writing from her or the hospital management and billing centre.
Once you have in writing their billing practice for you then it is a legal document
which is binding on the hospital.
Make sure the signature is that of an authorised management person connected in a supervisory capacity at the billing centre.

No one should have to endure all this,------- quite appalling practises.
Hugs and best wishes
Trysha

 

[my little penguin]

Per op labs typically need to be done very close to the actual procedure and the docs need to have access to those results immediately not days later so i am not sure you would be able to do them at an outside lab.
I would talk to the billing dept who would have a better idea of the ins and ours based on your insurance vs the nurses.

One more thing you can get a paper review of the records as well as the slides at Bch , chop or cchmc ( Cincy ) without getting a second or third scope done or opinion .
This way the top docs who deal with EoE in the country can review the file and slides .
We have done this more than once .

 

[Patricia56]

I agree - get it in writing from anyone and everyone. The case management nurse should have the power to waive the bills just like last time but if they're substantially more than last time who knows if her authority will extend that far. My son's standing labs cost about $2000 each time they're run. There's always the chance she'll get hospitalized and then you might be in a real jam if things aren't handled correctly.

 

[crohnsinct]

I was a health care administrator and legally they can not bill you for labs that they sent to a lab not covered by your insurance. You had no control over where the labs were being sent. It is their responsibility. I have written off hundreds of such bills. Doesn't mean that they won't try to bill you and that your time and energy won't be taken up complaining and resolving the issue.

In addition to getting it in writing from them that it will be done correctly or you will not be billed, I would also write a letter to them informing them that their lab is not covered and listing the ones that are covered.

 

[mom2277]

I'm very touched by the number of extremely helpful suggestions and insights into the laboratory issues. I don't think I've ever posted a question without being touched by the generous offering of shared knowledge and support. Thank you so, so much!

I heard from Vanderbilt, and the doctor doesn't plan to do any pre-op labs. (Her labs were normal during the office visit, save a somewhat elevated CRP with normal SED.)

As long as we don't get snow in the South (LOL), we should be good to go next Wed. for the scopes!

 

[Farmwife]

I'm glad things are a go. I hope the snow stays away.