On behalf of Wolf Popper LLP
Blood and other lab tests are often part of annual physicals or routine diagnostic testing for hospital patients around the country. Because the tests are common, we might expect our insurance to cover the costs. But, what you were expecting to be a nominal fee similar to a co-pay turns into a bill for hundreds of dollars from the lab.
That depends on how your insurance company views the necessity of the lab tests and how prices are negotiated between hospitals, labs and insurance companies. Some companies cover lab work as a preventative or diagnostic treatment, but certain plans can be exclusionary, leaving the patient to pay whatever the lab considers the full cost of services to be, which often are exorbitant prices.
Blood is thicker than water, prices are as clear as mud
An investigation by ABC News in 2013 revealed that each diagnostic lab can negotiate its own rates with insurance companies, resulting in a variety of price points across the industry, even among "in-network" providers. Less-than-transparent methods of how a hospital categorizes different tests may also be contributing to high costs. In other cases, providers may be restricted in how much they can actually talk about prices and contracts, helping to create an inefficient market.
How can consumers handle these cloak-and-dagger tactics by labs and insurance companies? With some healthcare plans currently in limbo due to Congress' attempt to repeal and replace the Affordable Care Act (Obama care), understanding the costs related to insurance is more important now than ever before.
People seeking health care diagnostic testing have a right to know how much they will pay for services, but with a variety of companies using the system to hide costs, how can prices be assured? Also, the price of a test, and whether it will be covered by insurance, is oftentimes not communicated to a patient until after the test is run. Sticker shock may cause blood to boil in your arteries, but there is a way to keep ice in your veins through the process.
Blood in your arteries, ice in your veins
When consumers are left without enough information to make the best decision for themselves, legal action can be taken to hold companies accountable for their misguidance. Consumer protection laws protect the rights of consumers and encourage corporate transparency.
Wolf Popper is representing consumers who believe they should not have to pay more than the rate negotiated by their insurance company for that service if their claim is not covered by their insurance company. Wolf Popper is representing plaintiffs in putative class actions against Quest and LabCorp to recoup alleged overpayments by consumers.
As a plaintiff in a consumer protection lawsuit, you have the opportunity to explain your situation to a judge and jury. Compensation is available through this process. Further, companies could be forced to be more transparent, resulting in a fairer marketplace for all.