Never hurts to pass this information on to others. I have a pip of a story but too long to go into now - all done with our Primary Care Doctor and a lab that did blood tests (we thought) - billing my husband’s Medicare Advantage plan for $40,000 and mine for $10,000. Not sure it qualifies as a scam but definitely poorly managed by the doctor and the lab.
It turned out to be genetic testing from swabs of our cheeks taken in the office on our Medicare wellness visits this year. Doctor had to admit after much quizzing that the gal coming into the exam room that day was not from his office but from the lab that did the tests and sent our MA plans the bills!!!
The $10,000 for my tests will stand which is still outrageous, but the $40,000 for my husband turned out to be double billing of $20,0000. The reason they gave was they billed it wrong the first time so tried to correct it by sending a second billing.
The insurance company is going to TRY to get refunded what they paid the lab which at their share was about $8,000 but billed twice was $16,000 and no one caught it. I caught it all on our EOB’s...Our charge was nil as we were there for the Medicare Wellness visits - except we did each have a $25 bill for NORMAL blood work from the normal lab..
The reasoning for the tests that day (we were told) was to test me to see how well my heart medication was metabolized in my system and for my husband’s bladder cancer. We have the reports from the lab and they tested for everything genetically under the sun that could possibly come up some day. My report was many pages long and my husband’s was only a few. Mine was billed for $10,000 and his (with double billing) was $40,000 and neither report touched on the reasons given for the tests.
It was all uncalled for and very disappointing to have your own PC doctor claiming ignorance. When I took my EOB in to his office because I wanted an explanation, he made a copy of it, found it interesting and said they (doctors/labs?) were told to STOP that kind of testing because of the expense. NO KIDDING? When I later contacted him about my husband’s EOB which came months later than my own EOB, he claimed he couldn’t understand any of it.
I don’t expect anyone to understand this hurried recap of what I found but let it be a warning to anyone on Medicare who goes to the PC for the wellness check. I had no reason to believe the gal who came into the examining room that day was NOT on the doctor’s staff. No reason to ask questions but remember - ASK QUESTIONS!
Sorry - I said too long to go into but since I was in the mood, I just plowed ahead...