Extremely high medical bill

I had a follow up appt with my DD GI last week and co incidentally my DD had flu/sinus type symptoms. The GI ordered a simple test to test for flu and other viruses. I have high deductible plan and the childrens hospital and GI is in network of my insurance. After the claim has been processed, just for this silly viral test my payment is supposed to be 1700$. This does not include doctor's bill. That is a separate 270$. I can not understand how a silly viral test to check for flu is so ridiculously high. This is highway robbery.

I want to fight out this bill. How can I get a comparable cost at other hospitals and labs. The test details from my claim is as follows.


"01/16/2015 Lab Testing For Infection

Service Description: Tests, analysis and cultures (attempts to multiply) of samples. The purpose is to identify a specific organism that caused an infection. These commonly are bacteria, viruses, fungi or parasites.

Claim Codes: UG* Your network physician or health care provider has agreed to the plan discount. The discount shown is your savings for using a network physician or health care provider. You have not met your deductible and owe the amount shown."

Post Edited (kamakya) : 1/22/2015 9:29:58 AM (GMT-7)

this does sound more like what they filed. having a claim processed in a week would be a world speed record.

It sounds like they were testing for more than just the flu. Lab testing is outrageous and this just proves it. Have you received an actual bill at this point? Once you do I would be calling about it. My son has had lots of costly bills and has had to call about them and have them resubmitted through the insurance and also has had to have companies write off some of the charges. He is over 18 and I am not responsible for his bills and he is unemployed.

if they did multiple tests, like several bacteria cultures, screening for parasites, and the virus test, each could have been 3 or 4 hundred.

you need to see what exactly was the suite of tests that got ordered.

This particular test was that they put some stuff in her nose for 10 seconds and said they will check for flu and viruses.

Get the details on the test. It may not be just viral test.

Plus, never ever perform any test in any hospital. If LabCorp or Quest does it, they should ALWAYS be used. I learned the lesson VERY hard way. When I went to ER for kidney stone, they ran some tests, billed me for about $2500 (total bill, $10,000). Same tests were repeated after 6 months, the bill $57.
It is VERY hard to argue with these people, as they NEVER know anything. When I asked them why the difference, ask your insurance company. When you ask insurance company, ask the hospital. They just make you run from Pillar to post.

Argue, if you can and get it lowered. Don't waste too much energy and time on it. You are on the losing end of the stick. If possible, do not use the hospital lab again.

BTW, I told the doctor who was treating me for kidney stone (He is head of the dept, urology, at that hospital) that the hospital runs a legal robbery scheme and hence I would not run any test in the hospital.

How high is your deductible? It's good that this bill came in January because if you have to pay a large amount better in the early part of the year so you can hit your deductible early. If you need a colonoscopy this is the year to get it, in other words.

I agree with others who say "negotiate" and also ask what tests were done and get comps for them at Quest so you can negotiate intelligently.

Sometimes call the billing dept and they will write off most if it is that unreasonable! Sorry, how stressful is that!!

The test that has been done is "RESPIRATORY VIRAL PANEL PCR" Opt code 87633. It is shocking to see such a huge bill. I'm trying to find more information.

Called my insurance and asked if the price is correct and they are saying that is the negotiated price with the hospital. I asked them cost of the same test with Labcorp and they are saying that they can not share that information but did mention it was significantly lower.

That's crazy! I'd talk to your doctor's billing department about it. Sometimes doctor's offices charge a lot for services because they think insurance will pay it. Then it comes back that insurance only covered 50% and they can adjust it for the patient who pays the rest. Also, if you do end up having to pay it, you can make a payment plan with hospitals. Medical bills are the leading cause of debt in the US because most people don't know that you can set up special plans with doctors. People see the amount due as $100 or whatever and say "well I can't pay that" so they don't and then they get slammed with late fees every month. You can call the doctor and say "I can't afford this, but I can give you $25 a month" and they'll usually understand and work with you.

I hope you don't have to pay that much though!

I called Lab Quest for pricing. The cost of this test for someone with insurance and no discount is 585$. If I had got this test done through lab corp through my insurance it would have been much lower than 585$. The hospital for a simple test is charging 3 times that of labcorp (even without any discount).

I do not understand how insurance companies are allowing this. Are they hand in glove with hospitals?

I was curious cause we did something similar in school last year and the lab supplies were dirt cheap... $15 roughly for each of us. Was not the same test but they work in the same way.

For your defence if needed - the raw materials for your test as stated from the excerpt below probably cost them $45-$55 plus labour which is also minimal.

So they're asking you pay $1,700 for something that cost maybe $200 on the high side "including" labour.

PS - I just decided I'm moving to the US to start a biology lab of some sort! Live the high life...


The $45-$55 comes from the following: link.springer.com/article/10.1186%2F1743-422X-10-184#page-1

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Cost analysis
At CDHA (Halifax, NS, Canada), the average number of specimens submitted yearly for adenovirus testing is 312 (range 208 to 466 for years 2009 to 2012) and the turnaround time for virus culture can be up to 14 days. A cost analysis was performed that assumed a more practical approach of bi-weekly molecular testing (3–5 specimens with positive, negative and reagent controls). Excluding labor, the average cost of a commercial PCR following nucleic acid extraction would range from $45 to $55 (CAD) per specimen. In comparison, the in-house real-time PCR following a nucleic acid extraction would reduce the cost approximately ~2-fold ($21.44 to $25.97). Replacement of the nucleic acid extraction with the homogenization-base protocol further reduces the cost ~2-fold ($8.84 to $10.97), which is comparable to the average cost of virus culture ($9.47 to 11.64). The time require for bi-weekly processing for either molecular methods is ~5 h/week, which is far lower than the time required for weekly maintenance and processing of specimens using cell culture and DFA staining.