$1,500 urine toxicology screen

I am on Palliative Care and receive my routine, monthly narcotic medication through scripts written by a palliative care physician.

Given the increased federal scrutiny of physicians writing scripts for narcotics, it was decided that I would go to a pain management specialist for a consultation to review the narcotics that I am prescribed - a legitimacy, of sorts, that the narcotics that I am prescribed is reasonable given my underlying conditions.

The MD that I saw was board certified as an anesiologist and certified in pain management. He was an approved provider of my health plan, considered in-network.

The physician spent 90% of the visit on his laptop computer, scouring my on-line EPIC medical history and varied medical notes and imaging scans. He was a poor listener and a poor communicator. I felt that I got very little out of the consultation.

His recommendations amounted to an increase in my narcotic dosing, but with little substantive counseling.

At the end of the visit, the standard urinalysis and toxicology was requested. I expected as such and obliged.

Now, one week later, the billing for the visit with the pain management physician has arrived. I am shell-shocked.

• $1,535 for an "advanced toxicology urinalysis." One thousand, five hundred, and thirty-five dollars to analyze 4 oz of urine.

While I understand the need to monitor for abuse and deference of narcotics, I cannot understand the astronomical pricing of this particular urine test screening.

And here is the better part . . . . the MD sent the urine to a lab that he has a direct business partner relationship with. The laboratory is not a contracted provider with my insurance company. How can a physician practice send laboratory work to an out-of-network laboratory without notifying me, the patient? The pain management MD works in a building that houses physicians only associated with my health plan. It is an all-inclusive in-network clinic. How can lab work be sent to an out-of-network plan without my prior knowledge?

My insurance company has intervened on my behalf, citing his business relationship with the lab as a conflict of interest. I am responsible for $80 of the $1,500 charge.

What about people who have no medical insurance? What about people who do not have a health plan, as I do, who will protect the interests of its policy holders?

How can having a need to rely on a narcotic for a modicum of a life subject one to a $1,500 bill for random drug urine testing?

Has anyone heard of a $1,500 charge for a urine toxicology study?

• The pain management MD's billing for services: $945. This fee is covered by my insurance provider.

What about people who have no medical insurance?

Bottom Line: I received little tangible value from the pain management MD appointment despite a hefty price tag.

My situation is only one depiction of a health care system gone awry.

Buckle up. It is going to be a bumpy ride.
- Karen -

The cost of drug screens varies widely. The cost depends on the type of screen that is done. The more extensive, the more costly. The cost of a drug screen is for more than performing the actual test. The cost also covers the rent, utilities, salaries and benefits of employees, equipment, upkeep of the equipment, ect. It is the same with the cost for doctors visits. Although with doctors visits you have to add on things like the cost of the doctors education, training, continued education and training along with things like medical malpractice insurance.

In the State Of Louisiana, their Medicaid program will not pay for a Pain Management Doctor or for the management of chronic non cancer related pain. If someone has Medicaid Only and they need to see a pain management doctor, they must pay cash. If they don't have the money, they won't receive opiates for their chronic pain.
Pain management is not a life saving service. I understand you are not on Medicaid, but you asked what happens when/if someone doesn't have insurance that will pay for pain management services.

More and more insurance companies are refusing to pay for drug screens. When a patient has to pay for a service, doctors offices will give a much lower price than what is billed to insurance companies.

Karen, yes many years ago when I had private insurance I had this very same situation happen with a new PM dr. He was on my plan but the first UA was sent to an outside lab. I thought someone made a huge mistake. The charge was a little over $1,500 & if I remember right out of network only paid something 40% of their allowable fee. This amounted to very little too. My next visit to the dr I took my EOB in & showed it to him. He was not shocked at all & told me not to worry about it that it was taken care of. Back then he billed $4,500 for my refills of my pump, he was paid less than half of that.

Its nuts some of these fees charged. My current PM dr bills Medicare a little over $6,500 to fill my pump. Yes, you read that right. Medicare pays pennies on the dollar. Prior pump dr billed Medicare $856 to fill the pump & they paid it all!!

I am sorry that you had one more useless hassle to deal with. Good to see you post.

The worst PMD I've had,the only one I've fired,kept trying to run a $1,200 Drug Test through my Insurance.

Up to about a year after I'd seen him,it would show up on the Medicare Statement as "Declined".And it said that I could not be held responsible for it because they had given me no prior knowledge of the cost of the Lab Work.

Hope yours' works out.

Take care.

Rick

Karen,

I am so sorry for your mother's cruel words. I too pay $900/month with a $6700 deductible. I am in need of 2 surgeries & put it off until 2017 for financial reasons only.

My mother refers to me as a junkie and an addict too. She recently fell and was refused pain medication by her long time PCP. Guess who she asked for a pain pill? I told her I was out.

In your corner,
Karen

Karen,

Mommy dearest? Hmmmm. Too bad.

I am sorry too that hurtful words are tossed at you. I suspect something much deeper than offhand or biting insults must be behind the words. But you know that, I'm sure.

pmdancer, You too? You guys should start the 'worst mother's club'...

Seashell,

It is unfortunate that you'll probably never resolve your issues with mom. I bloviate, fume and rant to let off steam and to reduce the negative energy input around me. I try not to give anyone else the power to screw with my well-being. I hate to suggest this, but you have probably ingested your mother's stew of toxic crap for a long, long time, and it is certainly not helping your own health and well being .... and may be some part of your illness. We manifest outwardly what we can't detoxify internally, with all aspects of our essence, body, mind and soul...

Some people are a negative energy vortex that sucks the life out of those around them. George Gurdjieff, a Russian mystic and spiritual healer from early in the last century, called them psychic vampires.

An unrepentant serial abuser does not consider their actions as abuse. They feel justified, I suppose, in their self-serving and destructive attitude towards others as they lack a solid connection with their feeling center. I suspect the heart chakra is non operational, down for the count, dead by the side of the road in your N-A-Z-I mother.

You seem to be subjected to a full blast of the negative cesspool that swirls around mom. Like you said, no empathy, no compassion. It wouldn't surprise me if internalizing the crap from mom has really impacted your health.

But you can be the judge of how much effect this seeming emotional black hole in the middle of your life has on you. I suspect your are well aware of it, though.

One nice thing is that once you make peace within yourself about the creature of darkness that is your mother in this life, you should be able disinfect and cauterize the wounds she has inflicted, and cast the the demon of negative energy back into the universe. (be gone, devil, I cast thee out!!!)

If something doesn't serve you anymore, get rid of it.

Ok, I've started preaching again. I shall step off the soap box.

I hope you know I am not presuming to offer this as a diagnosis on your physical illnesses and any possible health solutions, just an observation on your mother /daughter relationship from what you have related in your post.

IMO, there are some past life connections and karma at work here too (there always are in these situations as I understand the way things work) but many people don't believe in those notions, and they aren't necessary to accept as tangible or real to remove the influence of a festering human being from your spiritual body, past life connections or not.

If I have made an unwelcome observation, I apologize. This is only my opinion. Even recognizing the possibility of the 'infection that is your mother' may be helping to push you towards an early grave doesn't mean that healing will magically follow. However, taking the power she holds over you back, can't hurt.

I will offer this thought though too, (nasty mom not withstanding)..... that 'spontaneous healing' is very real and has happened to the most unlikely of people. Some very ill patients have beat the death sentence pronounced on them by their doctors and somehow they have believed themselves back to health. It's a mystery, for sure.

However, miracles do happen sometimes.

Post Edited (jazzer) : 11/20/2016 6:22:05 PM (GMT-7)

Karen, I do not blame you a bit for being upset over the dr appt.. However, since this was a required consult, I view this visit as an independent medical exam & nothing more. My experiences with an IME, although totally different from your situation, the drs did nothing during the consult. Scanned thru records at best, offered no opinion or recommendations. The patient walked out knowing no more than when they walked in the place. The dr got paid a hefty fee by the insurance company for the visit. The only good thing that came from your appt is he agreed with the others recommendations for your pain meds.

It's a shame about your relationship with your mother, but there is not one single thing you can do to ever change that. This is something that has to come from her. I very much like what the psychologist said about going to the well. You know sometimes when there are hurtful people in our lives we have to put some distance between them for our own self preservation. Been there & done that and as bad as I hated doing it, once I made the decision to limit the contact I was amazed at how much better I felt emotionally. I also had to accept that person may never change & it was out of my control. I hope you can do something to get some of this off of your back too. Yes, it very much is affecting you over all & in every aspect of your life. There is a lot of truth to what jazzer is saying.

You are a fighter or you wouldn't have made it this far. I know at times you feel like you are on a sinking ship. Rid yourself of some of this extra burden that you don't need, you may be surprised.

Come here & get things off your chest, we are good listeners. Take care.

Karen, I do hope that your mother does not have a key to your condo. If she does, then when its possible consider calling various locksmith's to see what they would charge to change your locks. There are lots of ways to avoid her such as not answering the phone or the door.

Hold your ground on putting some restraints on her, do not let her bulldoze you over. Worst case scenario, tell her to take her tough love crap & shove it. Sounds rough, but your well being is much, much more important than hers.

Come here any time to talk about things, sometimes clearing the air helps. We are here for you. Take care.

I am certain that cumulated toxic stress played a key role in my development of Addison's disease (adrenal insufficiency).

My mother, of course, is blind to considering the causal relationship.

I have expressed to my mother that I need to take a vacation from interacting with her - for a few weeks, at least. To allow for decompression. She is not in agreement. Arguing that her deep love for me is not being appreciated.

I told her that her love for me is always an expression of Tough Love. Tough Love is the only means of expression that she knows. I have had enough Tough Love for a lifetime.

I have expressed to her that I need a mother who is gentle in presence and caring. Non-judgmental as to my appearance (my skin, my hair, my clothing). And who will take evan a fraction of the time that she spends playing duplicate bridge with her friends to understand the medical complexities that affect me.

I will be spending Thanksgiving by myself and my little dog. And that is fine with me. I am by nature a quiet person and will actually enjoy not having to be "on script."

If you were to know me, you would see a tiny wisp of a person who is impeccable in dress and appearance, with a nice dosing of social grace and decorum. Why my mother has chosen to find issue with me throughout my life I cannot cognitively comprehend. I have been her closest consultant, her closest ally, her constant cheerleader. I assumed the role as caregiver at a young age and deferred my own opportunities in deference to my very real and immediate brother's needs.

I am 56 years of age with life-threatening fragile health. The life that I wanted for myself will never come to be. This is the deep loss that I am coming to terms with. This deep loss is colliding with a body that I can no longer will to do what I need it to do.

Behind each of our faces, is a very personal life story. We do not always share who we are outside of our pain experience. Here I have offered a small glimpse into my own if less than settled life. I think I feel better for the ability to express myself - if not to others, then to myself. Thank You to the members of this forum for your outreaching of care. It truly makes a difference and fills a deep void.

I hope for everyone a Thankful Thanksgiving,
- Karen -

Karen, what can I say? You, my friend, have been a wealth of information and compassion. Oh, that we could all have the mom of our dreams...mine, sadly, is long dead. But, through you, I am a better mother to my daughter. Because of you, I am more mindful of what she is going through, what Cushing's Disease is doing to her. I cannot thank you enough, for your support, your wisdom, your guidance and your encouragement. You, my friend, are on my gratitude list, today and every day.