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Jenn | How to dispute medical charge I didn't authorize? |
I had a routine annual exam and pap in January, but when I got the bill, found out that they did an HPV test along with it. I did not authorize this test. As such, my insurance company covered the charges differently. Normally, a routine exam and pap would be totally covered with a $20 copay. I called and the office told me it was a mistake and would fixed. I then recieved a revised bill, the portion of the HPV test that insurance didn't cover was removed, but there were still charges on it. I called again today ro have them re-bill the insurance company for only the services I went in for, but I was given the runaround. The person was really rude to me, saying she didn't think they could re-bill because the ins co had already paid. I told her, duh, issue a credit to the ins co and then re-bill. The charge now is small, but I don't think I should pay because I didn't authorize the HPV test to begin with. Nor have I gotten any results to prove the test was actually done. Help
Additional Details
They didn't remove the co-pay, I already paid it at the office visit. Of course I wouldn't want cancer, but the point is that they did the test without my consent or knowledge, which is pretty shady. |
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Custo
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I work in insurance & health care, and have for 10+ years... I'm not a doctor, or a clinician. however, I have coded, paid, appealed, approved, denied, and disputed a lot of claims.
You've got a few options...
First off, you need to find out if the test was actually done, or not. If it was not performed, the doctor's office will need to submit a corrected claim to your insurance company. The claim will be adjusted, and all will be well.
If they refuse, call your insurance company. They will start a fraud investigation.
If the test was performed, then it needs to stay on the bill. The doctor's office needs to report all tests performed on their claim form. Even if they're not covered. They may need to charge $0.00. If the test was performed by mistake; it depends on the mistake. If they ordered the charge for you, by accident, they need to write off that charge. If it was for another patient, they need to apply the charge to that patient. If it was a mistake @ the lab, the doc's office will need to deal with that, and the orders they sent to the lab will need to be corrected.
I don't exactly know what you mean by "the portion of the HPV test that insurance didn't cover was removed, but there were still charges on it".... What charges are on your statement besides the visit and the pap, if they removed the HPV screen? Its pretty common for a doctor to request an HPV screen with your normal pap. Having the two test performed in conjunction with a pelvic exam is the most effective way to
diagnose & catch pre-cancerous cells. None of the three tests are perfect. But when performed together, you have a really good chance of finding abnormal cells, that can easily be missed if performing only one or two of the tests together.
The doctor's office may routinely order the HPV culture with all paps. If this is the case, then they're doing you a favor by writing it off.
I'd recommend you read the wikipedia entry on pap smear. It explains, in detail what a pap is, vs an HPV test. And, why the two should always be performed together with a pelvic exam.
Also, its possible the doc saw something during your pelvic exam, and thought it best to have the additional test performed. Maybe they didn't want to alarm you.... That all depends on your relationship with the doc... I hope this help. |
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Robert B
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Keep fighting it dont give up |
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EGOman
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Be careful ... You probably signed a consent form for the Dr. to treat you ... If he deemed the test necessary and did it while you were there then your consent to the test was given when you authorized him to treat you. I have run into many many problems with medical insurance. If its only a matter of principle about the remaining small charge you may want to just let it go. You may end up with the whole bill back if you don't be care full. Like I said we give permission to our care providers to treat us, they decide what tests and exams to administer b/c we give them permission too. Not that I think your wrong , just be careful , I've lost this battle before. |
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Catie
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If I am understanding you correctly, they removed the HPV test charge but left charges that are not legit. Are those charges connected to the HPV test? Or are the charges something additional they slapped on? The reason I ask is because if they have added charges since the adjustment of the HPV then there should be no problem with the office resubmitting the charges. You can fight this regardless of the situation. Ask to speak the persn in charge of insurance and if that doesn't work then complain directly to your doctor. EVERYONE answers to someone. Keep making some noise. You will get noticed. I had $700 in charges removed from my $10,000 hospital bill. It took some strategical moves on my part, but I was relentless. You can always threaten the insurance company with the Insurance Adjuster in your state. Be the same and you will see a result. Good luck.
One additional thought. A lot of folks consider a little charge okay and let it slide. Folks are so compliant. It is because of these very charges that makes me distrust insurance companies. It is aso these type of charges that are making ins companies richer & more greedy. Why pay for something you don't owe for crying out loud?! |
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Michele T
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If the test was done the insurance company will pay for their part, regardless of if you want them to or not. They would rather pay to have the preventative test done than pay for having to take care of you if you get sick from the HPV. Its kind of like a mammogram, they would rather pay for that then breast cancer care. The other problem with trying to get the Dr. and the insurance company to back out the charge is that by the time they do all that paperwork they have spent more than the original charge. I know insurance can be frustrating but is sounds like you have a good plan since they cover so much.
As for not having proof of the test being done that would make me really mad, they should get the results of your pap and HPV test to you as quickly as possible. I would call and demand your test results as soon as you can. |
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Common Sense
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What do you think a "PAP SMEAR" ( Papiloma ) test is all about ?
They take a "sample" from the cervex and test it for the
Human Papiloma Virus ( HPV ) which is the cause of
cervical cancer....The now have a vaccination which prevents
cervical cancer... |
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Yinzer from Sixburgh
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If they removed your co pay from the bill, why worry about it?
As for the results, ask for the path report.
As for not requesting the test, don't make a big deal out of it this time, just make sure at the next exam you tell them you do not want it and also want to know each test being performed.
HPV test are good to have, by the way. Would you rather die from cervical cancer? |
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The::Mega
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All I can say is good luck.. we are in a similar situation with a hospital billing regarding oxygen usage for my father.. he was on it 2 days then they took it off and he never used it again - he was billed for 6 days. BRICK WALL |
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shorty
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If what you have to pay is minimal then just pay it. Think of all the people that don't have insurance that have to pay out of pocket for each doctor visit. If it's not much just pay it. |
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rebel g
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Make sure you tell your insurance company what happened. They probably have more pull with the Dr than you do and they will not look kindly on being billed for something that may not have been done. That is fraud and they can really put the squeeze on the Dr to stop the charges. |
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