Why Did I Get a Separate Lab Bill? Understanding Unexpected Charges Bill

You went to the doctor, paid your copay… and then a separate lab bill showed up. Why does this happen?

In this episode of Take Care, Melody Mulaik explains why lab work is often billed separately from your doctor’s visit, how insurance companies classify lab services, and why those charges may apply to your deductible instead of your copay.

You’ll learn the difference between preventive and diagnostic lab tests, what questions to ask before getting bloodwork done, and how to check your insurance so you only pay what you truly owe.

This episode helps you make sense of unexpected lab bills and avoid paying more than you need to.

In this episode, Melody discusses:

• 00:00 – Why lab bills often arrive separately from your doctor visit
• 00:41 – Doctor visits vs lab services: why they’re considered different
• 01:37 – How lab companies and outside processing work
• 02:08 – How insurance plans “bucket” lab services
• 03:01 – Copays, deductibles, and how labs are billed
• 03:41 – Preventive labs vs diagnostic labs explained
• 04:28 – When labs during an annual visit become diagnostic
• 05:03 – Asking if your lab is in-network
• 05:53 – Finding out where your labs are sent
• 06:14 – Mixed preventive and diagnostic labs in one visit
• 06:49 – Asking for cost estimates before bloodwork
• 07:29 – Why you should always verify lab bills with your insurance
• 08:00 – Final reminders on validating what you actually owe

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Transcript

Melody 0:12

Hello everybody and welcome back to Take Care, the podcast where we make healthcare feel less confusing and a whole lot more manageable. Today, we're tackling one of the most common questions I hear. And that is, why did I get a bill for lab charges separately? Or sometimes phrased another way is why do I have to pay separately for lab charges, right? I went to the doctor's office and yes, they did some lab work, but I just assumed that was part of my physician visit. Now, why am I getting a separate bill from a totally different entity? So that's a very common scenario that happens, and it's confusing because usually we're not told in advance that that's going to happen. So, how does this ever happen, right? There's several different ways. One thing to think about is technically that doctor's visit and those lab services are two different services. Even if you're getting blood drawn while you're in the doctor's office, that does not make it necessarily the same service. So sometimes that blood draw occurs in your physician's office. Sometimes they send you to a separate lab. There's a lot of different reasons that happens. Sometimes it has to do with just staffing of your doctor's office and the services they're choosing to do. If they're part of a larger organization, a lot of times the labs will get processed within that organization. But sometimes they are contracting with other entities that are out there. And again, I'm always going to remain agnostic as terms of who the different lab companies that it might get sent to. But there's two or three out there that probably most of you have heard of that may be processing your lab. So again, we look at, we have our doctor's visit. Typically we're going to be paying that copay for that visit. And then separate and distinct, we'll actually have the labs that we have to pay for. And those aren't necessarily part of that copayment that's going to come into play. So again, the first thing to think about is what is occurring in your physician office visit, but also separately, what about your insurance. And what your insurance coverages may be driving what you're getting billed for as well. So typically what happens is the insurance company, and even when you look at your coverage or your benefit. If you even go to your insurance company's website, which you know I'm a big advocate of you doing, you'll see it groups different coverage together. It will group and it'll say, you know, hospital visits, and an ED visit, and a physician office visit. But then it will separately call out diagnostic tests such as radiology services and cts and MRS, and things like that. But you may see they also have a separate line item for your lab services as well. And when we're talking lab, we're talking things that are occurring, in the outpatient basis, right? So we're associated with office visits. We're not talking about things associated as part of a hospital stay. So, they're going to put those things into the different buckets. It's important that you look at how they bucket those labs and those x-rays for that. So, when we look at our lab piece of it, again, we might have that copay, which we typically do for our physician visit. But then our labs themselves might actually apply towards our deductible. And then we'll be looking at co-payments or co-insurance after our deductible gets met for those particular services. So again, you're thinking, I've already paid for the appointment, why am I paying again? Because again, that insurance company classifies those labs separate and distinct from your office visit. The other thing that comes into play is that lab work that you're getting done, is it considered part of a preventive service or is it considered to be a diagnostic service? Right. So as an example, as a woman, you get a pap smear that's considered to be a preventive service. And typically, and I'm not going to say always, but typically you won't receive a separate bill for that pap smear. Even though it was sent out, there was an evaluation done. It's considered part of that preventative service. And it's all covered under that co-payment that you made when you went in to see your physician. Separately, if we've got a diagnostic service being done, think about all the lab work that you go get done if you're getting your prescriptions filled. Separate that from maybe the lab work associated with an annual physical. An annual physical would be preventive and the insurance company might classify all of that lab work in that preventative visit and under your copay. But anything that's diagnostic, they will separate out and they will apply towards your deductible. So, I know it's a little bit confusing, but how they distinguish between preventative services and diagnostic for you within your insurance plan becomes really important. The other thing when we look at are our labs is again, do they send you to a separate location that makes it a little bit clearer that you're going to a separate lab location. And that lab location may even be in your doctor's office building or it may be in a totally different building versus having those labs drawn within your doctor's office. So how does that impact us? What are the questions that you want to ask so that you understand what you might be responsible for? When you go to your doctor's visit, and it may be something you ask the front desk staff, it may be something that you ask the nurse or even potentially the doctor. Is this lab in network for my insurance? Right? There is potential where they might tell you to go to another lab and you want to confirm before you go to an outside lab that your insurance really is going to be taken. Now, generally the labs will validate that because they want to make, getting paid is easy as possible. So, if something is not covered or they don't have a relationship with your insurance company, they will generally tell you pretty quickly. But you do want to ask that. Ask if labs are being drawn in your doctor's office, ask them where they're going to send those labs. So, it may be they say, oh, we send them to the main hospital to be processed. Or they might say, we send them to X, Y, Z lab company. That way when you get that bill, you're already expecting it because they told you which outside lab they were using to process your blood work. Again, ask if those labs are considered to be preventative or diagnostic. Many times, you know, because you've gone to an annual physical or you've gone to your annual exam at your OB GYN, but let's say you're at an annual exam, but you bring up a particular problem that you've been having and your physician orders additional lab work to evaluate that. That's where it kind of crosses into diagnostics. So you might actually find some of your lab work is considered to be preventive and some of it's diagnostic. And so that may even affect what you owe, even if you had all that blood drawn at the same time. So again, that's where it can seem to be a little confusing. Ask for a cost estimate if you're getting blood work drawn and they're doing six different tests. It's appropriate to say, well, what's an estimate of, what are my fees going to be? And you may find that they don't give you an answer, but they may give you a phone number that you can call. Now, I know that gets a little challenging if you really want to know that information in advance, but you have the right as a patient. Before you get that blood drawn to say, I'd like to have an estimate of what this is going to cost. If they hand you a phone number, then you have the right to step away and call that number and find out that information so that you can make an educated decision regarding your healthcare and your next steps from a financial standpoint. And like with everything else that I always advocate before you pay those lab bills, always log into your insurance company's website. Look up, see what they claim that you owe. Make sure things were billed correctly so that you're only paying what you actually owe. In the process, so always validate what you're paying before you just get this bill. You're surprised by it and you think, well, they sent it to me. It must be accurate. I have to pay it, not necessarily validate it against your insurance. So we know healthcare billing can be very complex and this one particular area can be very confusing. Make sure that you walk through the process, validate what you owe, and only pay for what you know and have confirm that you owe. So, if this episode helped you, make sure to share it with someone else who's expressed frustration about the challenges of the healthcare system. And if you need more quick practical explanation, make sure that you've subscribed to take care. Until next time, take care.