This week, I had an experience with a client that I feel compelled to share. It’s an issue I’ve touched on before, but since it happened again with a different client, I believe it’s worth discussing to help others avoid the “just because” charge.
The Scenario
A client reached out to me because her insurance didn’t cover her Pap smear. I asked her to send me the explanation of benefits (EOB) and the bill she received. Upon reviewing them, I discovered a couple of key issues.
Firstly, the client didn’t fully understand her insurance plan.
- She didn’t have an Affordable Care Act (ACA) plan, which means her wellness benefits were limited.
- Although her gynecologist visit was covered, the lab tests were not.
This can also happen with ACA plans, by the way.
- Unnecessary Tests
- When I examined the bill, I noticed that besides the Pap smear, several additional tests for sexually transmitted diseases (STDs) had been conducted. When I asked the client if she had any concerns about STDs, she said no. She told me that her doctor ordered the tests because “insurance would pay for it,” the “just because” charge.
This is a huge red flag.
- If you visit your doctor for routine tests and they suggest additional screenings with the assurance that insurance will cover them, be cautious.
- Unless you have a specific reason to undergo these screenings, it’s better to decline. Doctors often don’t know the specifics of what insurance will cover. Even if their office confirms coverage with your insurance company, there’s no guarantee of payment. Insurance companies typically state that coverage is not guaranteed until the claim is reviewed.
- The Impact on Your Bill
In this client’s case, the additional unnecessary tests resulted in a $750 bill.
Each test cost an additional $150, which significantly increased her overall expenses.
My advice to clients is simple:
if your doctor recommends a test with the rationale that “insurance will cover it,” stop and ask questions.
- Here are some important questions to consider:
– What are the screenings for?
– Is there a specific concern that warrants these tests?
– Did your office confirm with my insurance company that this is a covered procedure?
If the doctor’s office hasn’t confirmed coverage or you’re unsure about the necessity of the test, you can always say, “Let me think about it and I’ll decide next time.”
This gives you time to research and verify if the test is needed and covered by your insurance.
Did you know there is a bigger one here too?
- Unnecessary tests drive up insurance premiums for everyone.
- The more claims insurance companies process, the higher the premiums become.
- When unnecessary tests are conducted simply because “insurance will cover it,” it contributes to the rising cost of healthcare.
- If your doctor gets annoyed when you ask questions, that’s a red flag.
- You should be able to have open conversations with your healthcare provider about your needs and risk factors.
- A good doctor will respect your concerns and discuss the best course of action with you.
Remember, healthcare is not one-size-fits-all.
Guidelines for screenings can vary based on age, health history, and individual risk factors. It’s important to do your research and discuss it with your doctor to make informed decisions about your health.
Always be proactive in understanding your insurance coverage and questioning the necessity of recommended tests. Don’t fall into the “just because” trap.
If you need help understanding how this all works, please feel free to connect with me here.