Pediatrician sent nasal swab to Hospital Lab without our knowledge or consent, invoking huge insurance co-pay and super high price
Our insurance sucks. We know this. It’s UHC based in Denver but we live in NY. It seems that in our area we get charged huge hospital prices which for most residents is counteracted by insurance designed to work with these high prices, but our plan gets totally creamed by this, as we learned by paying $400 for an x-ray and $1500 for an ultrasound.
But we know this. So, we take our baby with a 103 fever to the pediatrician, which is not affiliated with a hospital, and which definitely has a 40 dollar copay. Because they can’t explain his fever, they take a nasal swab to see what the virus is. Turns out they sent this to an external lab. Turns out our insurance doesn’t have a lab copay, it has 30% co-insurance, and only after the $5000 deductible is met. Turns out that this lab they sent it to was HOSPITAL, which invokes an additional $250 (or $500 – UHC’s own web site can’t even figure this out) copay.
We get a bill directly from the lab for $970.
We are being told we can’t ask to self-pay it at a self-pay price because insurance exists. How is this legal?
How is it legal for our pediatrician to send it to a hospital lab without our knowledge or consent? I mean to be clear, we knew they took the nasal swab and knew they were going to test our son for viruses. But we didn’t know it was going to a hospital. Is it reasonable for us to know this? Is it reasonable for us to stop everything and ask these types of questions when we have no sleep and our baby has a 103.5 fever?
What recourse do we have here? I could chalk it up to “we’ll know better next time” but we already know better and it doesn’t help. This system is impossible.
I have asked them to send me the CPT codes so I can research how much this should cost. The UHC estimator for virus testing says it should be 200 bucks. Or 90 bucks. Or 700 bucks. But haven’t found anything saying it should be a thousand. Also my freaking MRI cost less than this.
