Easing Medical Insurance Pains


I have this pet peeve. Well, actually it’s one of many pet peeves, but this one concerns medical insurance billing. How come I spend a third of my time at the doctor’s office filling out an insurance questionnaire and submitting my co-payment, only to get a bill from a lab or diagnostic center two weeks after my appointment?

What’s going on here? Isn’t the doctor’s office supposed to supply these other providers with my insurance information? Or am I not filling in the forms properly? And what’s the point of using a doctor or medical group that is a “participating member” of your insurance plan, if it isn’t using labs or diagnostic centers, which are also participating members?

This makes me crazy. So, one recent morning I spent 20 minutes on the phone following up on bills I received – one from my physician’s office, and two for lab procedures. My question for all three medical establishments was the same, “Why are you billing me?” The bill from my physician was “an oversight.”

They would bill the insurance company directly. Okay, good answer. Now what about the others? They told me they were “non-participating facilities,” and I would have to submit the claims myself to the insurance company, or pay them and wait for reimbursement.

The same question popped into my already confused brain again. How come I’m using a “participating” doctor, but being billed by “non-participating” labs?

I thought about this for a few minutes, then decided to find out if perhaps I was doing something wrong. I called my physician’s billing department and asked why my lab work was being sent to “non-participating” labs. The billing person didn’t know, (and I really shouldn’t have expected her to, but I had to start some place). She said it was the nurse who decided where the lab work went. I asked if the nurse knew who my insurance carrier was, and if she had a list of “in-network providers.” The billing lady didn’t know. She said to ask the nurse, but she wasn’t available.

Not being a very patient person, and anxious to get to the bottom of this dilemma, I dialed up a few friends who are nurses or who work in a doctor’s office to get some hands-on, user friendly information. My nurse friends told me this; it is the doctor’s nurse who is responsible for sending lab work out to be evaluated. Usually, he or she is familiar with the area labs that are covered by certain insurance companies. However, sometimes they don’t know who some of the smaller, or lesser known insurance companies allow, so they send their diagnostic work to the labs who are covered by the majority of insurance companies.

Another point these nurses made, is that sometimes they see more patients than the doctor does in one day, and it can be very overwhelming, not to mention time consuming, to check every patient’s chart for insurance information, then call the insurance company for participating labs. They told me that not all insurance companies supply a list of providers, since they change so frequently.

They recommend that before your next office visit, take the time to check with your insurance company to see who are “accepted providers.” Get the name, address and telephone number of the labs or diagnostic centers and ask your doctor’s nurse to note this in your chart so the information will be readily available the next time you have any diagnostic work done.

After talking to my nurse friends, I checked back with my doctor’s office and her nurse told me the same thing. This got me back on the phone with my insurance company getting the names of the labs and diagnostic centers they will accept in my area. I made copies of the names, addresses and phone numbers to give my primary care physician’s office, as well as my children’s pediatrician’s office, and a copy to keep with my own records at home.

So, take a few minutes now to get this information from your insurance company. A little time on the phone now will save a lot of aggravation and confusion later, not to mention make your nurse’s workload a little lighter.

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  • sherrie

    Me, too; Not recognizing the sender of today’s mail, I opened it to find a bill from a Lab I’d never heard of, & certainly not the only one that has been used for any tests I’ve had. This one does not participate in my plan,GHI.
    So, apparently the doctor;’s nurse or other person in charge of sending tests for eval, made a mistake worth $375. They know GHI is my insurer, and it’s the only one I’ve ever had. The liability shoul dnot be mine for this error. I pay all my bills on time.