Title: What to Do When Radiology Lab Bills Differ from Insurance Estimates
I recently visited the NYU Langone radiology lab (located in the hospital) for an ultrasound. Before the procedure, I checked the CPT code on the BCBS website, which indicated an allowed amount of around $200 before any deductions. I felt comfortable with that estimate.
However, I received the bill and was shocked to find that the allowed amount is actually about $900.
When I reached out to my insurance, they explained that the lab billed the procedure under the lab’s name rather than the doctor’s. The estimate I viewed on the BCBS website was based on a doctor’s billing, and they don’t have an estimated amount for lab billing.
This being my first ultrasound, I’m unsure if this is standard procedure or what my next steps should be. Is it possible to ask NYU Langone to re-bill the procedure under a doctor? The ultrasound was performed by an intern/PA, so would that even qualify?
What advice do you have for me in this situation?
It sounds like you’re dealing with a frustrating situation regarding your ultrasound billing. Here are some steps you can take:
Verify the Charges: Review the bill you received carefully. Make sure you understand what it includes, and confirm that the procedure was billed correctly according to the services you received.
Contact NYU Langone Imaging Department: Reach out to the imaging department or billing department at NYU Langone. Explain your situation and ask if they can provide clarification on why the ultrasound was billed under the lab rather than a physician. You can inquire if they can reprocess the bill under a provider to potentially align with the amount you expected based on the CPT code you found.
Talk to Your Insurance Provider: Since you’ve already contacted BCBS, consider reaching out again after managing to clarify with the lab. Ask them about their policies regarding billing under labs versus providers. If you can provide them with any new information from NYU Langone, they may be able to adjust their initial assessment.
Documentation: Keep all documentation organized, including your bill, any communication with the lab and insurance company, and your insurance policy details. This can be helpful if there is a need for appeal later on.
Ask About a Payment Plan: If the bill is not adjusted and remains at the higher amount, inquire about payment plans or financial assistance options with the lab to make the bill more manageable.
Consider an Appeal: If you don’t get a satisfactory resolution, review the appeal process for your insurance provider. You might be able to contest the higher charge based on your initial understanding and the estimate provided.
Seek Help: If you continue to struggle, consider reaching out to a patient advocate at the hospital or a healthcare billing advocate who can assist you in navigating the issue.
Each case can be unique, but these steps can guide you through addressing the discrepancy and potentially resolving it. Good luck!