Radiology Lab Billed as “Lab,” Not Under a Doctor—What Should I Do?
I recently had an ultrasound at the NYU Langone radiology lab, which is located within the hospital. Before my visit, I checked the CPT code on the BCBS website and saw an allowed amount of around $200 before deductions, which I was fine with.
However, I’ve now received the bill, and the allowed amount has jumped to nearly $900. When I contacted my insurance, they explained that the lab billed it as a lab procedure rather than under a specific doctor. The estimation I found online is based on a doctor’s billing, so BCBS doesn’t have any information on the allowed amount for lab billing.
Since this was my first ultrasound, I’m unsure if this situation is typical and what steps I should take next. If I reach out to NYU Langone, can they change the billing to reflect a doctor? My procedure was performed by an intern or PA—does that even factor in?
I would appreciate any guidance on how to navigate this situation. Thank you!
It sounds like you’re experiencing a common issue with medical billing, especially when it involves different entities within a hospital. Here are some steps you can take to address the situation:
Contact the Billing Department: Reach out to the billing department at NYU Langone directly. Explain your situation and ask for clarification on the charges. You can inquire whether they can submit a claim under the correct CPT code associated with a physician if that would yield a more favorable billing scenario.
Request an Itemized Bill: Ask for an itemized bill that breaks down the costs. This might help you understand why the lab charged $900 instead of the expected amount. It could also help when discussing the bill with your insurance or if you contest it.
Verify Coverage and Network Status: Double-check your BCBS coverage details regarding lab tests and ultrasounds, specifically if there are different allowances for lab services versus those performed by a physician. Ensure that the NYU Langone facility is in your network, as out-of-network services can significantly increase costs.
Contact your Insurance Again: After gathering more information, contact BCBS again with the details. They might provide more guidance on how to proceed based on the breakdown of your bill and the coding used.
Ask about Financial Assistance: If you find the amount billed is beyond what you can afford, inquire about any financial assistance programs offered by NYU Langone. Many hospitals have payment plans or programs to help reduce bills for patients in need.
Consider Filing a Complaint: If you believe that the billing is inconsistent or unfair, consider filing a complaint with your state’s insurance department or looking into assistance from a medical billing advocate.
Consult a Patient Advocate: If you’re feeling overwhelmed, a patient advocate can provide guidance on navigating the billing process and might be able to help you negotiate a better outcome.
Document all your communications and keep copies of any bills or correspondence. This will be helpful if you need to escalate the issue. Good luck!