facebook She could handle the biopsy and the results but not the “surprise” bill

BIG PHARMA POLITICS: Consumers pressure politicians to do something about rising drug prices. Read More

She could handle the biopsy and the results but not the “surprise” bill

medical dataVoices for Affordable Health has shared many “surprise” medical billing stories over the past few years, but none quite like Michelle Kuppersmith’s experience.

Kuppersmith, 32, told Kaiser Health News that she was shocked when a routine blood test revealed that her body made too many platelets, which help control bleeding. Her doctor suspected she had a rare blood disorder linked to blood clots, strokes and even leukemia.

The next step was a bone marrow biopsy, in which a large needle was used to remove a sample of the spongy tissue from her hip bone. Kuppersmith wasn’t eager to have the procedure, which is known to be painful. However, she eventually had the biopsy, performed by a provider within her insurance network and in a hospital that was also part of the network.

The test confirmed Kuppersmith had the blood disorder. Fortunately, it also showed that treatment, for now, would be a low-dose aspirin. She’d also have to return to her doctor every three or four months.

She was somewhat relieved until she got a bill telling her she was on the hook to pay $2,400 for a type of testing known as molecular profiling.

What?

Kuppersmith’s health plan covered a part of the claim, but not the charges submitted by an out-of-state laboratory. Though the physician and the hospital were within her insurance network, the lab that analyzed her tissue was not.

“The looming threat of a $2,400 bill has caused me, in many ways, more anxiety than the illness ever has,” Kuppersmith told Kaiser Health News.

She’d always checked whether a physician, clinic or hospital was within her insurance network. It never occurred to her that her biopsy would be sent to laboratory outside the network.

Kuppersmith lives in New York, one of 28 states with laws against surprise medical billing and requiring hospitals to inform patients in writing if their care could include out-of-network providers. Turns out the hospital had given Kuppersmith such a document previously, a year before she’d had the biopsy.

She decided to keep fighting the charge. In the end, her insurer agreed to cover half — $1,200. And the lab agreed not to bill Kuppersmith the other half.

“There are a lot of people who don’t have the time or wherewithal to do this kind of fighting,” she said.

The takeaway?

Be sure to ask your health care provider if there’s any chance an outside contractor – pathologist, anesthesiologist, laboratory or others – could become involved in your care. And make sure they are in your insurer’s network.

One more thing Kuppersmith learned: Be wary of signing blanket consent forms. Instead, tell your provider you want to know each time someone offering you care is outside your insurance network.

Have you received a “surprise” medical bill? How did you handle it? What lessons can you share with Voices for Affordable Health?