Radiology Lab Billed as “Lab,” Not Doctor—What Are My Options?
I recently visited the NYU Langone radiology lab (located within the hospital) for an ultrasound. Prior to the appointment, I checked the CPT code on the BCBS website and found that the estimated allowed amount was around $200 before deductions, which I was fine with.
However, I just received the bill and the allowed amount is showing as approximately $900.
When I called my insurance, they explained that this discrepancy is because the lab billed as a lab rather than under a physician. The estimate I found on the BCBS website was based on a physician’s services, and they don’t have a set amount for lab billing.
Since this was my first ultrasound, I’m not sure if this is typical or what to do next. If I request that NYU Langone bill it under a doctor, will they accommodate that? The ultrasound was performed by an intern/PA; does that even apply here?
I would appreciate any guidance on how to handle this situation.
It sounds like you’re dealing with a frustrating situation. Here are some steps you can take to address the billing issue:
Contact NYU Langone’s Billing Department: Reach out to the billing department of the radiology lab and explain the situation. Ask if they can provide a breakdown of the charges and clarify why the service was billed differently than you expected.
Request a Claim Review: Ask if they can resubmit the claim under the physician who interpreted the ultrasound, if applicable. Sometimes labs are billed separately from physician services, and asking for clarification might help.
Check Your Insurance Policy: Review your health insurance policy to understand how they handle lab versus physician billing, especially for radiology services. This can provide you with more context about why there might be a discrepancy.
Appeal the Charge: If it turns out the lab bill is significantly higher than what you expected, consider submitting a formal appeal to your insurance company. Provide them with any supporting documents, such as the initial estimate.
Ask for Financial Assistance or a Payment Plan: If the bill is still higher than you can afford after appeal, inquire with NYU Langone about financial assistance programs or the possibility of setting up a payment plan.
Document Everything: Keep a record of all your communications with both the hospital and insurance company—including dates and names of representatives you’ve talked to—so you have a thorough account should you need to escalate the matter further.
Seek Assistance from a Patient Advocate: If you’re feeling overwhelmed, consider reaching out to a patient advocate. They can help navigate the complexities of medical billing and may be able to represent you in communications with the lab or insurance company.
Remember that it’s important to address this as soon as possible to avoid any impacts on your credit or additional charges. Good luck!