Crazy lab charges

[Dr. And Mom]

...and this is why pathology gets a bad name. SMH

For Her Head Cold, Insurer Coughed Up $25,865

A New York woman worried that her sore throat might be strep, so she went to the doctor to have it checked out. Then came the bill — with a price tag similar to a small SUV.

www.npr.org

---

Members don't see this ad.

 

[gbwillner]

Smells like improper billing, abuse/fraud, and a Stark Law violation all in one

 

[MetroPath]

...and this is why pathology gets a bad name. SMH

For Her Head Cold, Insurer Coughed Up $25,865

A New York woman worried that her sore throat might be strep, so she went to the doctor to have it checked out. Then came the bill — with a price tag similar to a small SUV.

www.npr.org

It’s really the internist and gastroenterologist who is in on this. Fraudulent orders and billing by clinicians.

 

[WEBB PINKERTON]

Gotta love shotgun testing.

Out of network entities are in the news a lot at the moment. Wouldn't be surprised if that surprise billing legislation goes through. Gas, path and ER will be hit hard.

 

[Torsed]

Was it client bill? Doc's milking that stuff, system is broken.

Biofire, there you go. Charge for each molecular test, classic. Houma, LA there is a lawyer that owns a lab that does exclusively BioFire for a majority of ENT etc in Louisiana. Nets over 2 million in profit a month. Pays his sales guys 250k a year. As in the article, if the Blues are paying, the moths will come to the light.

Yet some of us do traditional pathology where the pay is much less and actually take care of patients.

 

[LADoc00]

The original article is pure sensational reporting. I have no clue what else was done, what follow testing was ordered etc. but doesnt matter because the original poster put on her "just to conclusions" mom pants and posted this.

But the fact that "Dr. and Mom" comes on to the Path forum and says this is why "Path has a bad name" when this has likely ZERO to do with pathology and pathologists in general is all you need to know about the original poster.

 

[gbwillner]

The original article is pure sensational reporting. I have no clue what else was done, what follow testing was ordered etc. but doesnt matter because the original poster put on her "just to conclusions" mom pants and posted this.

But the fact that "Dr. and Mom" comes on to the Path forum and says this is why "Path has a bad name" when this has likely ZERO to do with pathology and pathologists in general is all you need to know about the original poster.

Ahhhh no, gotta disagree with you pretty strongly here. This is pretty outrageous. No, this has nothing to do with pathology, and everything to do will why Stark laws are important as there is always some A-hole who will try to defraud the system.

The patient states that they had a sore throat for 1 week, and went to the PCP. The test results as well as the detailed bill are actually posted on the article (For Her Head Cold, Insurer Coughed Up $25,865).

You'd think they'd start with a rapid strep test at the office and leave it at that since she was ambulatory and otherwise OK. Instead, they ordered a battery of unnecessary tests, including a 12-25 respiratory virus panel, billing almost $20k. WTF. the CLFS on that test is $463.09. That is 41x Medicare rates. Additionally, Medicare won't even pay for that test since there is ZERO utility for it outside of someone dying in the ICU with a pneumonia of unknown etiology. There were another $5K in DNA tests for bacterial pathogens, none indicated here, including 87486 (charged $986, CLFS price $39); 87581 (charged $1620, CLFS price $39); 87651 (charged $2850, CLFS price $39), and 87798 (charged $3672; CLFS price $39- almost 100x Medicare!). She also got blood chemistries including a lipid panel, which may be unrelated to her complaint but I suppose could be there for other reasons, as well as a respiratory culture. These went to Labcorp so he probably didn't directly profit from them.

PLEASE explain how this is OK. I look forward to a real explanation.

 

[gbwillner]

A little closer look at the story yields more info- it is not clear what the relationship is between the lab and the ordering physician. It is even possible there is no relationship.
What I believe the facts to be here:

• Patient with BCBS of Minnesota as the insurer walks into PCP's office in NYC with a complaint of a sore throat
• PCP orders a battery of unnecessary genetic tests; it's not even clear if she ordered relevant tests
• The PCP bills the insurer out of network. It is stated the reference lab used was out of network, but looking at the paperwork, it is not known who the lab is. Although there appears to be a client bill relationship, it is not clear if there is upcharging.
• The charges to the insurer are insane and average between 40-100x Medicare rates for the same services.
• The insurer pays most of the bill, the patient is on the hook for ~$2500.
• The PCP's office waives the amount due from the patient, satiated with their massive mammoth-like kill.

 

[LADoc00]

GBwilliner step back a sec and tell me cause and effect.

Tell me how ANYTHING you just said results in the conclusion "...and this is why pathology gets a bad name. SMH"

It doesnt. Pathology and commercial labs' fee schedule are completely unrelated entities.

Philadelphia abortion clinic horror: Column

We've forgotten what belongs on Page One.

www.usatoday.com

"Infant beheadings. Severedbaby feet in jars. A child screaming after it was delivered alive during an abortion procedure. Haven't heard about these sickening accusations?

It's not your fault. Since the murder trial of Pennsylvania abortion doctor Kermit Gosnell began March 18, there has been precious little coverage of the case that should be on every news show and front page. The revolting revelations of Gosnell's former staff, who have been testifying to what they witnessed and did during late-term abortions, should shock anyone with a heart."

AND THIS WHY OB GYNS GET A BAD NAME. See what I did there? Can I be more obvious? Hey we got a angry lady with a large lab bill AND INFANT BEHEADINGS. Wanna play of game of which "specialty can get the worst name" with me? hahaha.

Stop pandering to the OP who is making a bizarre connection between 2 totally unrelated things: pathology and some random lady's lab bill.

 

[WEBB PINKERTON]

Speaking of abortions.

Did anyone else notice the Pathology Blawg guy's lab was in the news last year due to an investigation into planned parenthood?

Missouri investigating St. Louis Planned Parenthood for 'multiple' failed abortions

ST. LOUIS – The state said Friday it is investigating the local Planned Parenthood office for “multiple” failed abortions, revealing for the first time why it is holding up the

www.stltoday.com

 

[LADoc00]

You know you suck as a doctor when...you cant tell if you failed at a surgical abortion.

Yes..yes maybe just maybe it worked this time!

 

[gbwillner]

GBwilliner step back a sec and tell me cause and effect.

Tell me how ANYTHING you just said results in the conclusion "...and this is why pathology gets a bad name. SMH"

It doesnt. Pathology and commercial labs' fee schedule are completely unrelated entities.

Philadelphia abortion clinic horror: Column

We've forgotten what belongs on Page One.

www.usatoday.com

"Infant beheadings. Severedbaby feet in jars. A child screaming after it was delivered alive during an abortion procedure. Haven't heard about these sickening accusations?

It's not your fault. Since the murder trial of Pennsylvania abortion doctor Kermit Gosnell began March 18, there has been precious little coverage of the case that should be on every news show and front page. The revolting revelations of Gosnell's former staff, who have been testifying to what they witnessed and did during late-term abortions, should shock anyone with a heart."

AND THIS WHY OB GYNS GET A BAD NAME. See what I did there? Can I be more obvious? Hey we got a angry lady with a large lab bill AND INFANT BEHEADINGS. Wanna play of game of which "specialty can get the worst name" with me? hahaha.

Stop pandering to the OP who is making a bizarre connection between 2 totally unrelated things: pathology and some random lady's lab bill.

Maybe because I dismissed the OP's initial comment as hyperbole and because I never considered "pathology" to be at fault what happened here, I was not so hot and bothered about her comment. However, my disagreement was with your statement: "The original article is pure sensational reporting. "

The reporting here by NPR is as far from "sensational" as you can get. They never blame pathology and appropriately explain possible causes for "surprise" billing here. If you listen to the audio story, they followed up with BCBS who admitted dropping the ball and put a stop payment on that check.

The issue here is likely Stark law violations or fraud/abuse 2/2 a financial relationship between the lab and the PCP.

 

[Dr. And Mom]

Maybe because I dismissed the OP's initial comment as hyperbole and because I never considered "pathology" to be at fault what happened here, I was not so hot and bothered about her comment. However, my disagreement was with your statement: "The original article is pure sensational reporting. "

The reporting here by NPR is as far from "sensational" as you can get. They never blame pathology and appropriately explain possible causes for "surprise" billing here. If you listen to the audio story, they followed up with BCBS who admitted dropping the ball and put a stop payment on that check.

The issue here is likely Stark law violations or fraud/abuse 2/2 a financial relationship between the lab and the PCP.

Yes, thank you, I was not trying to dunk on all pathologists or our specialty per say, just as I don’t think every radiologist is responsible for $30 K PET scans done inappropriately (or every OB is responsible for the misdeeds of one butcher). The small lab I work at still has us as gate keepers of sorts, trying to prevent out of control charges that threaten healthcare, especially when tests are ordered inappropriately and there is no medical need. Larger labs probably have different priorities.

 

[yaah]

I tend to wonder if some of it might be related to not knowing which test to order. Modern EMRs have extensive lists of test options that come up when you put in a test you want. Put in "lipid panel" and you might get 10 options one of which uses NMR and mass spec and costs tens of thousands of dollars.