Lab did test that we didn’t request

[MooseBucks]

DW recently got some bloodwork done..there were two tests that were optional that we didn’t give them the Drs orders for due to cost. There was a test the lab had a question on what exactly needed to be ordered and they called the Drs and I guess the nurse told them the two optional tests. Now we’re being billed $1900 for these lab tests. Not really sure how they can just call the drs and do the tests without my wife’s consent? She’s especially upset because the Drs warned her to call the insurance company to get the estimated cost first before doing them (which we did) and we weren’t going to.

[disneysteve]

A couple of comments on this:
1. The lab does not need your wife's consent. She isn't the one ordering the test. They only need the doctor's order and it sounds like they got that.
2. It sounds like there was a communication failure here between your wife and the doctor's office and/or within the doctor's office. She may have told the doctor that she didn't want the tests but his staff probably had no way to know that so when the lab called to verify what was ordered, they just read off the orders, not knowing that not all of the tests were actually being done.

What should you do? I would take it up with the doctor and/or the office manager. Explain that you specifically said you didn't want those tests due to the cost but they got done anyway. Hopefully they can intervene with the lab and get them to eat that charge. Good luck. Let us know how it turns out.

[MooseBucks]

Thanks for the response. Seems crazy that they can authorize work we declined when we made the choice not to get it.

[disneysteve]

Thanks for the response. Seems crazy that they can authorize work we declined when we made the choice not to get it.

As I said, it sounds like a communication failure. The person authorizing it probably didn’t know you didn’t want it. You may have told the doctor but his staff wouldn’t have known.

[Smallsteps]

A few years ago a doctor I used and his group moved to a fancier office with a very nice waiting room with nice artwork etc.
One of the first visits I had, he suggested as we were walking out a few tests that we had not taken before in dealing with my condition. I looked at him and smiled and said he had not asked before so I thought these tests were not really needed. I told him doctor you have a full waiting room willing to pay for your new art but not me.
On my next visit when I checked in the receptionist took my straight back to a room to wait because he said I do not play well with others, I guess some of those waiting last time heard me and thought twice about paying for the office upgrade with extra tests. Until he retired about a year after that due to his health, I was not allowed to wait in the waiting room.

[james.hendrickson]

Smallsteps, well...I'm not a doctor and I don't know what common etiquette is but isn't it somewhat impolite to ask you to wait in a back room?

[disneysteve]

On my next visit when I checked in the receptionist took my straight back to a room to wait because he said I do not play well with others,

They actually told you this? I would have walked right out the door and reported them to the state medical board and blasted them on social media. There's no way an office should treat a patient that way and get away with it.

[Smallsteps]

Yes this is exactly what happened,

I think when it comes to pricey tests it should really be the patients decision and not brushed off as a "communication failure" that seems like a lot of money for a couple of lab tests that were optional. moosebucks is right to ask what happened as that was a costly oops.

I just mentioned it because it became apparent this office were trying to increase revenue to pay for the new digs.
One of the staff said the whole waiting room was a buzz after my comment. As the doctor and I were not in the room but the corridor, I had no idea the conversation was heard by many who then questioned tests etc.
I found the whole thing amusing. There seemed no reason to get worked up about it. He was a bit abrupt, but top in his specialty ( which he also taught).
It was not really that bad just older magazines in the patient rooms vs the waiting room.

[disneysteve]

moosebucks is right to ask what happened as that was a costly oops.

Absolutely! I was just suggesting that what may have happened was a failure of communication. I can easily see that happening in the situation described.

[Smallsteps]

Absolutely! I was just suggesting that what may have happened was a failure of communication. I can easily see that happening in the situation described.

This is a problem then if it is so EASY to have these "mistakes" happen. Do you think doctor did not notate the request not have the additional tests? or did staff not read notes?
Most medical personal I know note any request/ discussion with patient to avoid this.

This is no offense to anyone, but healthcare is a purchase and the customer has the right to decide what level they can or will pay for.
If some tests are optional or there are lower cost treatment alternatives the Customer needs to decide.

What other service purchasing situations do people just let others decide and just send the bill? Then freak out about how they can pay for it.
People quit being savvy consumers when insurance pays for all or most.
Since most people have now higher co-pays/ and portions of bill they are responsible for they need more input and the CONFIDENCE their choice will be honored.

[disneysteve]

DW recently got some bloodwork done..there were two tests that were optional that we didn’t give them the Drs orders for due to cost. There was a test the lab had a question on what exactly needed to be ordered and they called the Drs and I guess the nurse told them the two optional tests.

Do you think doctor did not notate the request not have the additional tests? or did staff not read notes?

So with just the details given, let's look at what might have happened here.

1. Doctor orders tests A, B, C, D, and E. He writes a note in the chart indicating that he ordered them and gives the patient written orders for those tests.
2. Patient goes to the lab and only hands in the orders for tests A, B, and C.
3. The lab has a question, calls the office, and the staff looks in the chart and tells the lab that the tests ordered were A, B, C, D, and E. They had no way to know that the patient chose not to do D and E.

Note that Moosebucks didn't say that the doctor was informed of their decision not to do the tests. The doctor just advised them to call the insurance company first but he might not have known the outcome of that yet. So the chart may not have had any notation about this issue.

[disneysteve]

healthcare is a purchase and the customer has the right to decide what level they can or will pay for.
If some tests are optional or there are lower cost treatment alternatives the Customer needs to decide.

I agree 100% with this.

What other service purchasing situations do people just let others decide and just send the bill? Then freak out about how they can pay for it.
People quit being savvy consumers when insurance pays for all or most.
Since most people have now higher co-pays/ and portions of bill they are responsible for they need more input and the CONFIDENCE their choice will be honored.

And therein lies a big part of the reason why our healthcare system is so screwed up. As soon as you disconnect the customer (patient) from the cost, you introduce problems. Patients want everything done because they have no stake in the game. "My insurance covers it" so do it all. I can't tell you how many times I've heard that from patients over the years when I was trying to explain why I didn't feel a particular test was indicated. If the patient was paying for that MRI or blood test themselves, there's no way they'd be pushing so hard to have it done.

On the flip side, a more recent issue is the degree to which healthcare has become a retail operation rather than a service business. Walk In clinics and Urgent Cares and concierge and direct pay practices have accelerated this. More and more, people expect a menu with prices when they walk in the door as if they were walking into McDonald's. But a medical procedure isn't as black and white as a Big Mac and fries. While this might make things easier for the patient, it makes it financially harder for the provider since we don't always know our actual costs for providing the service until we're done.

Sorry to ramble. Being in the field, it's obviously something I'm surrounded by every day.

[MooseBucks]

Note that Moosebucks didn't say that the doctor was informed of their decision not to do the tests. The doctor just advised them to call the insurance company first but he might not have known the outcome of that yet. So the chart may not have had any notation about this issue.

They were made aware. The first set of orders was for a different lab. DW got new orders for the other lab company that did not include the extra tests.

[disneysteve]

They were made aware. The first set of orders was for a different lab. DW got new orders for the other lab company that did not include the extra tests.

Ah. So then the 2nd lab called the office with a question and got told all of the tests that were ordered including the ones you decided not to do? Again, sounds like a communication issue. The doctor may have made a note in the chart but the staff person answering the lab may only have looked at what was originally ordered.

It shouldn't have happened and the office should take care of it. I can just see how easily a mistake like that could happen.

[MooseBucks]

Finally got this all sorted out. The lab ended up admitting that they shouldn’t have done the test and waived the charges. Bill went from $1900 to $135 for the tests that were actually ordered.