Gyno ran STD tests insurance won’t cover
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Anonymous
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Annual exam/PAP. Doctor asks if I want STD testing. I say sure, why not. I’ve had this done as an add-on to annual exams before and never been changed a dime, as insurance covers the tests as preventative. Stupidly, I did not ask which specific tests; and she did not itemize.
Imagine my surprise when I receive results for a panel testing everything including trich and HSV 1/2. Unsurprisingly, I am being billed by insurance for those specific tests because they are not considered “preventative” STD screening. The normal stuff (HIV, chlamydia, etc.) is of course covered. Trich and HSV 1/2 have never been part of a standard STD panel in all of my years of going to the gyno. In fact, it is specifically recommended by the CDC NOT to run these tests without symptoms, so I am not surprised my insurance isn’t covering them. Am I just screwed? I’ve called and talked to the practice billing department and office manager, who said that is the standard panel since I consented to STD testing, and they are not responsible for what insurance does or does not cover. She even said that no one else seems to have a problem with this (highly doubt it, as I have a very standard BCBS PPO). My insurance company says they will not cover these tests because they are not considered preventative care under the ACA. I will not go to this practice any more over this, obviously, but do I have any other recourse here? It’s not the money, it’s the principle of the practice wasting my (and insurance) resources on medically unnecessary testing. It was a money grab, pure and simple. |
Anonymous
| How much is the bill? |
Anonymous
A little over $100. Again, it’s not the money. It’s an unfair business practice. I’m guessing most insurance plans wouldn’t cover these tests either. |
Anonymous
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I’m curious how much money the office actually gets for this though? Doesn’t most of the money they get come from billing for the visit? And the cost of the tests ultimately is paid to the lab?
This is still a bummer for sure and it shouldn’t be this complicated. But you know that saying don’t attribute to malice what can be explained by stupidity? I think it’s just our dumb system that is overly complex. I would never make all these calls and pay all this attention to a $100 bill. I’d have just paid it. A lot of people are like me I think. Insurance and medical bills make no sense to me and I’ve given up on trying to understand. It’s easier to just pay and not think about it. |
Anonymous
| You failed to ask questions. You also signed a paper about consent, right to refuse treatment and obligation to pay. Next time ask more questions. It’s your fault not theirs. |
Anonymous
| OP: DId you pass? If yes, fantastic! |
Anonymous
Oh stop it. Our system is stupidly complicated and it’s absurd to expect OP to be able to navigate it better than the people who literally designed and benefit from the systemic dysfunction. |
Anonymous
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https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm
I think you misread the CDC guidelines. You should definitely have a test if you have symptoms. But there is a recommendation for screening in other circumstances. And the majority of people with trich do not have symptoms. Nowhere does it say “don’t test unless the pt is symptomatic.” I also think HSV is part of a standard panel, but I’d have to check. |
Anonymous
| Isn't there a no surprises billing act? How did they not itemize? |
Anonymous
Oh stop it. It’s really not that hard to say “I consent only to what is covered by my insurance company I’m not paying out of pocket for it.” |
Anonymous
I’m sure I will just end up paying it, but this is why medical practices (and insurances) get away with this sort of thing. $100 here and there, sure, not a big deal to people like you and me. But to some people, a $100 unexpected expense for something that is presumably covered in full by insurance is a lot. The practice did the trich swab in-office so they certainly made money off it according to my EOB. As well their in-office LabCorp made money on the other tests, and while the in-office lab testing is certainly a convenience and they can’t receive “kickbacks” per se, it is definitely all a transactional relationship. I only inquired about this because it is outside of the standard care protocol the CDC recommends and nothing I’ve experienced at other providers in the DC area. |
Anonymous
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ONLY IN THE US IS THE SYSTEM SO COMPLEX THAT PATIENTS ARE BILKED OUT OF MONEY BY THE HEALTHCARE INDUSTRY WHEN THEY DON’T ACT AS THEIR OWN LAWYERS.
No patient should be expected to navigate such a system. Don’t you dare blame OP or others for not remembering to ask all the right questions every single time. Sorry this happened, OP. Healthcare and guns are the two biggest industries crying out for regulation in this country. Every other first world country does significantly better in these two categories. |
Anonymous
It is itemized on the bills, but the doctor did not tell me specifically what tests were included as part of the breezy, 10 second “do you want to be tested for STDs” conversation. It was 100% my fault for not asking what specific tests were going to be performed as part pf the panel. Good learning experience for the future: don’t assume anything wrt doctors and insurance. |
Anonymous
I have never seen anyone succeed in negotiating any of the terms on the boilerplate forms you fill out at doctors appointments. I’m an attorney and don’t even bother reading them. If you try to negotiate I expect they’ll tell you to pound sand. |
Anonymous
Good luck with this, as the practice will tell you they are not liable for knowing what your insurance plan will and will not ultimately cover. And the insurance will jump not to cover anything they don’t have to. |