Got the bill, big suprise.

[RRoss34]

Went in for some bloodwork and when the results came back the doc said everything was fine but that I wasn't vaccinated for hep b.  He asks if I want to get vaccinated.  I say ok.  3 shots over a few months.  Got the first two shots and now a few months later, a bill for $224 dollars.  

Obviously this isn't covered by my health insurance (Blue Cross Classic HMO) but I thought the cost of the visit would cover it since nothing was mentioned about the cost.  Also, I got a flu shot earlier and it said clearly that it was $25 and the office asked that I pay then and there (same with my copay).  But I not a word was mentioned about the price of these shots and the fact that they weren't covered in  my plan.

Of course my last shot is scheduled in August which will be another 112 bucks.  So if I decide not to proceed, then the $224 is for nothing.

I feel like like a victim of bait and switch.  I don't blame my HMO, but do you think they'll pay for it?  Or is my issue solely with the doctor's office?  Any thoughts?  Thanks.

[InsureBob]

If you look at the policy, it will tell you if it covered under the doctor copay or not.  That is why it is encumbent upon the insured (you) to ask to see the contract, and find out if the lab/blood is done in-house (meaning the dr. has the means to do it as part of the dr. copay), or if lab/x-ray are billed separately.

No bait and switch, just a consumer not looking closely at a contract their are involved with.

The question you need to ask every dr. is "do you have an in-house lab, or is blood and x-ray done by someone else.  I need to know, so that I won't be unpleasantly surprised when I get my bill."

Did you get the bill, or was in an EOB (Explanation of Benefits)?  You don't have to pay the EOB, and you can still fight it.  The EOB is sent before the bill, though it looks like one, so that you can dispute any incorrect charges, and correct them, before payment is remitted.

[PlateletGal]

Very interesting.

[boogaloo]

No, the employer actually has say in what is covered under the policy.  They can choose to cover maternity, cancer treatment, etc..  

[PlateletGal]

"It's actually the employer who determines what is covered or not."

The employer only covers the plan they select... that's it, correct ?

[boogaloo]

It's actually the employer who determines what is covered or not.  They are the one who sets up the initial plan.  

However, that being said, I would call your insurance company and make sure they actually saw the claim.  I work for a BlueCross Plan in Tennesse.  I am not aware of any of our plans that don't cover hep B immunization, including the HMO product.  The flu shot also should have been covered.  It could be different depending on what State you live in.

Did you get an estimation of benefits (eob) from BlueCross showing what they covered or did not?  I can tell you (although I probably shouldn't), some BlueCross plans are horrible.  There are specific states I would not work for BlueCross in.  Hopefully you are not in one of those.

[PlateletGal]

It sounds crazy, but it is up to us to find out from our insurance companies what is covered and what isn't. And the worst part is, the insurance companies have rules in place where they can change their mind about paying a claim in an instant !