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Blood work at doctor's office? Ask if covered by insurer

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Posted at 5:00 AM, Mar 14, 2022

The last thing you need after a hospital stay is a fight with your health insurer over a medical bill. Some of those are called "surprise" bills for out-of-network charges.

It can happen even if you plan your surgery, making sure the hospital or facility is considered in-network by your insurer and that you're fully covered.

"So you would think everyone that touches you in the facility would be part of the network as well," says Patricia Kelmar.

Kelmar is with the Arizona Public Interest Research Group (PIRG) and says that isn't always the case.

"Oftentimes anesthesiologists, radiologists, even sometimes lab work and imaging work was out of network," she says — and patients end up with a big medical bill.

The same thing could happen if you're taken to a hospital emergency room.

"In emergency care, the average was around $450. But we were seeing tens of thousands of dollars for some treatments," Kelmar says.

In these out-of-network cases, a new federal law that took effect Jan. 1 means you now only have to pay what you would for in-network insurance coverage.

But while the law covers air ambulance transport, it does not include ground ambulance service.

That could still mean big bills and something PIRG would like to see changed.

And Kelmar says PIRG is seeing another concerning issue.

"More cases of out-of-network labs being co-located in physicians' offices," she says.

Kelmar says if you're at your doctor for a checkup and they offer to do your blood work or run an image scan in the office, ask questions first.

"Double check with your provider and with the actual lab or imaging service to make sure that's an in-network service for you," she says.

If not, it may be worth finding a lab that is in-network.

PIRG has another warning.

They say in non-emergency situations when you are scheduling treatment in advance, some out-of-network doctors may ask you to sign the Surprise Billing Protection Form. That allows the doctor to charge out-of-network rates.

PIRG advises you not to sign the form until you have read the waiver, received your estimate of charges, and have decided you will pay the out-of-network charges listed in the form (amounts are not applied to your deductible).

Since the billing law is new, PIRG says it's especially important to open medical bills immediately.

"If you see a charge that seems particularly high, you should be asking your provider why they are sending that bill and ask the insurance company as well," Kelmar says.

If you do see an issue, this government site allows you to file a complaint, upload your bill and get a resolution.

You can also call 1-800-985-3059.