Way too much billed for an H.Pylori Test

[emmalynx]

Hi! I'm an immigrant and haven't been living in the US for long. I recently submitted a stool sample to a lab for an H.Pylori test (which thankfully turned out to be negative). I looked up the cost beforehand for these tests and it said that they're between 11 and 195 dollars nationwide. I have a relatively good insurance through my employer. I now got a bill for that in the mail, saying that they billed my health insurance 998 dollar (wtf?!), of which they covered 630, which leaves me with a bill of 368. This seems absurd to me, is there anything I can do about this?

 

[sanctified112]

@emmalynx If the provider is in network, the billed amount is irrelevant. What matters is the contract rate that the provider has with your insurance company.

 

[phamchaubang04041994]

@sanctified112 This is correct, the billed amount is irrelevant. The contract rate is what matters.

 

[emmalynx]

@sanctified112 Thanks for your reply! I think I don't fully understand what you mean. What is a contract rate? I understand why the bill was split between what my insurance paid and what I have to pay, I just don't understand why they billed an amount that is five times the maximum national average for a particular service. How on earth am I supposed to decide whether or not to do a certain procedure if I can't reliably estimate the cost for it upfront.

 

[foreverthankful]

@emmalynx Look on your EOB- Explanation of Benefits- from your insurance. You'll see a "network discount" or "allowable amount" listed--- this will reflect any automatic network discount you're getting. Sometimes it shows the actual allowable amount, sometimes it just shows the amount they subtracted from the billed amount to get to the allowable amount.

As an example, my PCP charges $600 for an office visit- they bill insurance that amount. However, because they are in-network with my insurance, the allowable amount (the amount both the doctor and insurance agreed to) is $175. If I have a plan where I have to pay that full contracted rate before I meet the deductible (like an HDHP) then I would owe just that $175--- but because I have a PPO, I just pay the $20 copay.

 

[curtisptrsn]

@emmalynx The contracted rate is the price agreed upon between your provider and your insurance company. It doesn't have to match what the provider bills, or what other providers charge, or what other insurance companies agree to.

Where did you get the $11-$195 figure from? Googling for those numbers, it seems like you might have gotten it from MDSave, which stated that that's the average for purchasing it on MDSave -- which may not be where you got your test.

Reliably estimating costs upfront is (frustratingly) very difficult. Your best bet is to do it through your insurance company, though that could take more time than you're willing to spend.

 

[wooboy]

@emmalynx Welcome to health insurance in the US.

 

[krippy]

@emmalynx It isn’t easy and it isn’t fun, but you can get an estimate for most things if you call your insurance company and ask them. I have an account with my insurance company’s online app and I can get costs for most services there, though lab diagnostics and such I do still have to call.

 

[yeswin]

@emmalynx

I looked up the cost beforehand for these tests

Where?

Did you call your health insurance people and ask them or did you look it up independently?

No one else but your own health insurance company knows your policy, your network, or your deductible status.

You ALWAYS need to check directly with your health insurance company via the number on the back of your card before you schedule any testing or procedures.

 

[t8erbug]

@emmalynx Sounds like the allowed amount was applied to your deductible. No there is nothing you can do about it.

 

[alenajoy]

@emmalynx The 998 is irrelevant. They could’ve charged 7 billion and your bill would still be $368

 

[celticghirl]

@emmalynx Did you select an out of network lab?

 

[chanty]

@emmalynx Everyone else’s comments is right on but on the other hand welcome to American where life is not affordable and health care is the biggest scam !