Help with surprise bill for blood test

[RARO1]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.

[golfing eagles]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.


This is one of the most ridiculous stories I've heard.

First of all, an HIV test is not "routine" at all

Second, they do not cost $500, in fact they're free if you donate blood

Third, unless Florida is different than NY or the law changed in the 5 years since I retired, you need a specific signed consent to draw blood for an HIV test, the sample is coded and only the physician can unlock the code.

Fourth, at least ethically if not legally the physician needs to disclose EVERYTHING he is doing for the patient.

I would suggest they find a new physician
I would not pay the bill, especially since the lab is charging them some sort of cash rate rather than the insurance rate
And if you really want to "screw" that medical office, you will see that at the bottom of every Medicare EOB the is an 800 number for reporting suspected fraud, the local TV stations love a story like this as well.

[villagetinker]

I would call Medicare immediately and complain, this is not right.

[MSchad]

I googled this:
Your doctor can't test you without your consent. HIV tests can only be done with the consent or at the request of the patient. Some states require written consent; for others, verbal consent is sufficient (visit Centers for Disease Control and Prevention (http://www.cdc.gov) for the requirements in your state).

[blueash]

This is one of the most ridiculous stories I've heard.

First of all, an HIV test is not "routine" at all

Second, they do not cost $500, in fact they're free if you donate blood

Third, unless Florida is different than NY or the law changed in the 5 years since I retired, you need a specific signed consent to draw blood for an HIV test, the sample is coded and only the physician can unlock the code.

Fourth, at least ethically if not legally the physician needs to disclose EVERYTHING he is doing for the patient.

I would suggest they find a new physician
I would not pay the bill, especially since the lab is charging them some sort of cash rate rather than the insurance rate
And if you really want to "screw" that medical office, you will see that at the bottom of every Medicare EOB the is an 800 number for reporting suspected fraud, the local TV stations love a story like this as well.

Specific signed informed consent for HIV testing has not been required within a health care setting even in NY for a half decade
The End of Written Informed Consent for HIV Testing: Not With a Bang but a Whimper (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508137/)
Informed consent is required if it is being done outside of a health care setting such as a community center.
The CDC recommends (https://www.cdc.gov/hiv/testing/index.html#:~:text=CDC%20recommends%20that%20every one%20between,at%20least%20once%20a%20year.) that everyone between ages 13 and 64 get tested once even if no risk factors are documented.
As the OP mentions that his parents are on Medicare this recommendation does not apply to them thus the suggestion that the test is routine seems unsupported.

I suppose, and I do not mean to suggest this applies to the particulars of this situation, that if the new doctor interviewed each person separately and one disclosed a behavior that increased the risk of HIV, the MD would be correct in ordering HIV testing on both parties and also be prohibited from disclosing the reason to the partner. The lab would also be prohibited by HIPAA from disclosing the diagnostic reason but the doctor should have used a code other than routine on the order slip.

In any case, if this medical office is routinely ordering HIV testing on Medicare age patients, they certainly have gotten feedback that the tests are not being covered and patients are getting huge bills. That alone should trigger a discussion as to whether the patient wants to have the testing done.

[Stu from NYC]

A Would find a new DR immediately if not sooner.
B I would think their is a state licensing board in Florida would complain to them.

[retiredguy123]

If the test is not covered by Medicare, then calling them or reporting it to them as fraud will be a waste of time. Also, complaining to the doctor that you did not consent to the test would also be a dead end because you probably did consent to it by signing forms in the doctor's office. I think the only way to be successful is to refuse to pay the bill. The lab may agree to negotiate a lower price, so they can avoid the collection agency fees, which are very high on a $500 bill.

[RARO1]

Specific signed informed consent for HIV testing has not been required within a health care setting even in NY for a half decade
The End of Written Informed Consent for HIV Testing: Not With a Bang but a Whimper (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508137/)
Informed consent is required if it is being done outside of a health care setting such as a community center.
The CDC recommends (https://www.cdc.gov/hiv/testing/index.html#:~:text=CDC%20recommends%20that%20every one%20between,at%20least%20once%20a%20year.) that everyone between ages 13 and 64 get tested once even if no risk factors are documented.
As the OP mentions that his parents are on Medicare this recommendation does not apply to them thus the suggestion that the test is routine seems unsupported.

I suppose, and I do not mean to suggest this applies to the particulars of this situation, that if the new doctor interviewed each person separately and one disclosed a behavior that increased the risk of HIV, the MD would be correct in ordering HIV testing on both parties and also be prohibited from disclosing the reason to the partner. The lab would also be prohibited by HIPAA from disclosing the diagnostic reason but the doctor should have used a code other than routine on the order slip.

In any case, if this medical office is routinely ordering HIV testing on Medicare age patients, they certainly have gotten feedback that the tests are not being covered and patients are getting huge bills. That alone should trigger a discussion as to whether the patient wants to have the testing done.

If they did disclose a risk behavior to the DR then as per Medicare’s policy they should have covered it, they will cover 1 test a year for people 16-65, and for people over 65 if they are at an increase risk for hiv.

[Bogie Shooter]

This firm advertises on TV constantly, a call to them may clear things up for you.
Morgan & Morgan For the People

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[blueash]

Additional information. Florida has a rule regarding HIV testing in a health care setting. The link is HERE (file:///C:/Users/pjchi/Desktop/Model%20Protocol%20for%20Health%20Care%20Settings_ 6.30.17%20%7Bno%20link%7D.pdf) . However, the language is not entirely clear as to what is required within a health care setting. The person must be informed a test is being done. An attorney might be able to interpret. The language does not require any pre-test counseling.
The person doing the test, which might be either the doctor or the lab or both is required to notify that the test is "planned". Does that mean simply saying "we are drawing blood for screening tests" is enough? Or is there a requirement to specify that HIV testing is being done? See below. The rule has specific requirements for the person ordering the tests as to how results are to be handled which suggests they are differentiating ordering the test from performing the test. But, if the refusal to be tested must be recorded in the medical record that strongly suggests the burden to inform rests on the entity with the medical record, the doctor.

Model Protocol for HIV Counseling and Testing in Health Care Settings

...In Florida, HIV testing is established and governed by section 381.004, Florida Statutes, Florida Administrative Code Rule 64D-2.004, Internal Operating Procedures, and Model Protocols, all of which are in line with the HIV testing guidelines issued by the Centers for Disease Control and Prevention.

Section 2. HIV Testing in Other Health Care Settings
1. Pre-test counseling is not required
2. Notification
No person shall perform an HIV test without first notifying the person to be tested that the test is planned and that he or she has the right to refuse. Limited exceptions can be found in section 381.004(2)(h), Florida Statutes, and in Florida Administrative Code Rule 64D-2.004(1).
Notification may be oral or in writing. Refusal to test shall be documented in the medical record. Special provisions for hospitals are listed in section 381.004(2)(g), Florida Statutes.
3. Notification of Test Results
The person ordering the test, or that person's designee, shall ensure that all reasonable efforts are made to notify the test subject of his or her test result.

A call to the Florida Health Department which is in charge of this part of the law might be useful.
They may refer you back to the general statute FL 381.004 section (2a) (http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0381/Sections/0381.004.html) which says this:

2) HUMAN IMMUNODEFICIENCY VIRUS TESTING; INFORMED CONSENT; RESULTS; COUNSELING; CONFIDENTIALITY.—
(a) Before performing an HIV test:
1. In a health care setting, the person to be tested shall be notified orally or in writing that the test is planned and that he or she has the right to decline the test. If the person to be tested declines the test, such decision shall be documented in the medical record. A person who has signed a general consent form for medical care is not required to sign or otherwise provide a separate consent for an HIV test during the period in which the general consent form is in effect. [my bolding]

I would strenuously argue that this paragraph not requiring a separate consent does not relieve the requirement for notification. Those are not the same. But I am not a lawyer. I might just send a copy of this law to the medical office and ask if there is documentation that your parents were informed of their right to decline the test or even informed the test was to be done as the statute seems to require.

[gatorbill1]

Why did they go to Ocala - Premiere has a large office here in TV

[Villageswimmer]

Is there more than one Premier Medical Associates? The reason I ask is that I recalled having read something negative wrt an organization by this name. I googled “Premier Medical Associates Medicare fraud.” I was unable to post the link but it was a DOJ document ordering them to pay $750,000 for fraudulent claims.

[blueash]

If they did disclose a risk behavior to the DR then as per Medicare’s policy they should have covered it, they will cover 1 test a year for people 16-65, and for people over 65 if they are at an increase risk for hiv.

Absolutely yes. But it gets a bit tricky. When a MD orders a lab test there are two separate codes. One specifies the lab test being ordered. The other specifies the reason for the test. There are different codes for the reason. One code is used if there is no medical reason for the test, it is just being done as a screening test. If the MD used that code then Medicare should decline to pay per their regulation.
There are several other codes for ordering the test including one for test being done due to increased risk. If one of the parents had told of an at risk behavior that is the code that should have been used and Medicare would have paid. Maybe the MD used a wrong code or he didn't want the at risk code in the record in case the spouse looked at the order form. It gets very tricky. The MD's office staff would have to tell the spouse that the test was routine as it cannot tell the spouse that the other spouse has been involved with at risk behaviors.

If this unlikely scenario is the true one then there are three options. Pay the bill and stay silent, admit to your spouse that the test was done due to a risk event and have the MD re-code the original order, or the at risk spouse can ask the MD to re-code and hope the other spouse never figures out why the bill suddenly got paid.

[Bonnevie]

file a complaint with the Florida Attorney General's ofc. Florida Attorney General - Citizen Services Contact Form (http://myfloridalegal.com/contact.nsf/contact?Open&Section=Citizen_Services) seems to me this is taking advantage of a senior citizen and they have a dept. that handles tha

of note is that Premier Medical just had to pay a fine: THE VILLAGES — Premier Medical Associates, a private medical practice in The Villages, agreed to a $750,000 settlement this week to resolve civil claims that it falsely billed federal programs for services “that were not medically necessary and reasonable.”

sounds like they found a way to get the patients to pay for the services that weren't medically necessary and reasonable. I would definitely complain to the Florida Attorney General as this seems to be exploiting a senior.

you should have been told they wouldn't be paid for....I recently had tests ordered at Quest and they always tell me before they do it if something may not be covered.

you might just call Premier and tell them you are going to file a complaint unless they cancel that charge.

[RARO1]

Why did they go to Ocala - Premiere has a large office here in TV

I’m not sure, I know their AARP insurance isn’t accepted by a lot of providers in the villages, hens they have to go up to Ocala

[Jayhawk]

Is there more than one Premier Medical Associates? The reason I ask is that I recalled having read something negative wrt an organization by this name. I googled “Premier Medical Associates Medicare fraud.” I was unable to post the link but it was a DOJ document ordering them to pay $750,000 for fraudulent claims.

Premier Medical Associates Agree To Pay $750,000 To Resolve Claims Of False Billing | USAO-MDFL | Department of Justice (https://www.justice.gov/usao-mdfl/pr/premier-medical-associates-agree-pay-750000-resolve-claims-false-billing)

[retiredguy123]

Additional information. Florida has a rule regarding HIV testing in a health care setting. The link is HERE (file:///C:/Users/pjchi/Desktop/Model%20Protocol%20for%20Health%20Care%20Settings_ 6.30.17%20%7Bno%20link%7D.pdf) . However, the language is not entirely clear as to what is required within a health care setting. The person must be informed a test is being done. An attorney might be able to interpret. The language does not require any pre-test counseling.
The person doing the test, which might be either the doctor or the lab or both is required to notify that the test is "planned". Does that mean simply saying "we are drawing blood for screening tests" is enough? Or is there a requirement to specify that HIV testing is being done? See below. The rule has specific requirements for the person ordering the tests as to how results are to be handled which suggests they are differentiating ordering the test from performing the test. But, if the refusal to be tested must be recorded in the medical record that strongly suggests the burden to inform rests on the entity with the medical record, the doctor.

Model Protocol for HIV Counseling and Testing in Health Care Settings

...In Florida, HIV testing is established and governed by section 381.004, Florida Statutes, Florida Administrative Code Rule 64D-2.004, Internal Operating Procedures, and Model Protocols, all of which are in line with the HIV testing guidelines issued by the Centers for Disease Control and Prevention.

Section 2. HIV Testing in Other Health Care Settings
1. Pre-test counseling is not required
2. Notification
No person shall perform an HIV test without first notifying the person to be tested that the test is planned and that he or she has the right to refuse. Limited exceptions can be found in section 381.004(2)(h), Florida Statutes, and in Florida Administrative Code Rule 64D-2.004(1).
Notification may be oral or in writing. Refusal to test shall be documented in the medical record. Special provisions for hospitals are listed in section 381.004(2)(g), Florida Statutes.
3. Notification of Test Results
The person ordering the test, or that person's designee, shall ensure that all reasonable efforts are made to notify the test subject of his or her test result.

A call to the Florida Health Department which is in charge of this part of the law might be useful.
They may refer you back to the general statute FL 381.004 section (2a) (http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0381/Sections/0381.004.html) which says this:

2) HUMAN IMMUNODEFICIENCY VIRUS TESTING; INFORMED CONSENT; RESULTS; COUNSELING; CONFIDENTIALITY.—
(a) Before performing an HIV test:
1. In a health care setting, the person to be tested shall be notified orally or in writing that the test is planned and that he or she has the right to decline the test. If the person to be tested declines the test, such decision shall be documented in the medical record. A person who has signed a general consent form for medical care is not required to sign or otherwise provide a separate consent for an HIV test during the period in which the general consent form is in effect. [my bolding]

I would strenuously argue that this paragraph not requiring a separate consent does not relieve the requirement for notification. Those are not the same. But I am not a lawyer. I might just send a copy of this law to the medical office and ask if there is documentation that your parents were informed of their right to decline the test or even informed the test was to be done as the statute seems to require.
If the law doesn't require a separate consent form, it appears that the doctor technically complied with the law. Everyone should know that they can refuse any test or treatment that they don't want. However, this thread is really not about a medical issue with an HIV test. It is about a $500 bill from a lab. So, even if the doctor failed to meet the letter of the consent law, you would still need to make a case that the doctor should pay for the test. Most doctors require all patients to sign a form agreeing to pay for any treatment the doctor does that is not covered by insurance. When you see a doctor, you are basically agreeing to be treated for almost anything he/she believes is medically needed for you, and you agree to pay the cost. I don't think the OP has valid case against the doctor with respect to paying the bill. Some insurance plans would probably pay for the HIV test.

[blueash]

Is there more than one Premier Medical Associates? The reason I ask is that I recalled having read something negative wrt an organization by this name. I googled “Premier Medical Associates Medicare fraud.” I was unable to post the link but it was a DOJ document ordering them to pay $750,000 for fraudulent claims.

Here is the Link (https://www.justice.gov/usao-mdfl/pr/premier-medical-associates-agree-pay-750000-resolve-claims-false-billing#:~:text=Premier%20Medical%20Associates%20A gree%20To%20Pay%20%24750%2C000%20To%20Resolve%20Cl aims%20Of%20False%20Billing,-Tampa%2C%20FL%20%E2%80%93%20United&text=As%20part%20of%20the%20settlement,not%20medic ally%20necessary%20and%20reasonable.)
and the key paragraphs


FOR IMMEDIATE RELEASE
Wednesday, May 20, 2020
Premier Medical Associates Agree To Pay $750,000 To Resolve Claims Of False Billing
Tampa, FL – United States Attorney Maria Chapa Lopez announces today that Premier Medical Associates (PMA), a medical practice located in The Villages, Florida, has agreed to pay $750,000 to resolve allegations that it violated the False Claims Act. As part of the settlement, the United States contends that it has certain civil claims against PMA related to PMA’s billing of federal healthcare programs for services that were not medically necessary and reasonable.

Specifically, the government alleges that PMA knowingly billed for higher and more expensive levels of medical services than were actually performed and also billed for certain claims using “modifier 25,” indicating that a separate evaluation and management service was performed, even when there was no such separate service.

Now having linked the settlement it is worth mentioning that this has absolutely no relationship to the concerns of the OP. The medical practice does not profit from the lab testing unless of course it was an in house lab which I don't believe that practice would have for HIV testing. Any profit realized would go to Quest or whatever facility did the testing.

[Stu from NYC]

Here is the Link (https://www.justice.gov/usao-mdfl/pr/premier-medical-associates-agree-pay-750000-resolve-claims-false-billing#:~:text=Premier%20Medical%20Associates%20A gree%20To%20Pay%20%24750%2C000%20To%20Resolve%20Cl aims%20Of%20False%20Billing,-Tampa%2C%20FL%20%E2%80%93%20United&text=As%20part%20of%20the%20settlement,not%20medic ally%20necessary%20and%20reasonable.)
and the key paragraphs



Now having linked the settlement it is worth mentioning that this has absolutely no relationship to the concerns of the OP. The medical practice does not profit from the lab testing unless of course it was an in house lab which I don't believe that practice would have for HIV testing. Any profit realized would go to Quest or whatever facility did the testing.

Is it possible the DR has an arrangement with the lab that they get a kickback on certain testing?

[rjm1cc]

I use Quest and if a test the doctor ordered is not covered by insurance they tell me the costs and ask if I want the test. They have also stated that their might be a charge and if there is a charge it will be x.
I would tell the lab that since they did not tell you how much the test would cost before doing the test and you relied on then accepting your insurance without any additional charge you owe them nothing.

[retiredguy123]

I use Quest and if a test the doctor ordered is not covered by insurance they tell me the costs and ask if I want the test. They have also stated that their might be a charge and if there is a charge it will be x.
I would tell the lab that since they did not tell you how much the test would cost before doing the test and you relied on then accepting your insurance without any additional charge you owe them nothing.
LOL. Good luck with that approach. Medical charges are almost never disclosed in advance. That is the problem with our overall health care industry.

[fdpaq0580]

Is it possible the DR has an arrangement with the lab that they get a kickback on certain testing?

It wouldn't be the first time, I'm sure. Dr might also have a financial interest in the company.
Who knows?

[fdpaq0580]

LOL. Good luck with that approach. Medical charges are almost never disclosed in advance. That is the problem with our overall health care industry.

I don't know if I would say "most charges", but we have certainly received separate bills after the fact when the price for care or procedures had been given.
One example was my cataract surgery. Local practice nearby quoted full price for procedure and lenses. After surgery we received bills for the surgery room, recovery, anesthetist,,. Found out the eye group didn't have their own facility and that they rent a surgical facility that bills separately. Those were the things that were not made clear before the surgery.
Another example. My wife had kidney stones and went into the local hospital where we lived in Wa state. We received the Dr bill and the hospital bill, soon after came bill from an imaging company for the xray and use of the room and facilities , a separate bill for the tech,,,. Tech came into her hospital room said Dr wants xray. He wheeled her to a room just a few doors down. Turns out that the imaging company rents/leases the room in the hospital. The tech was a contractor who worked for the imaging company and he did his own billing. We were never told about separate billing. Just thought all was part of the hospital services.
Sign me, "give me ONE price and ONE Bill".

[champion6]

I’m not sure, I know their AARP insurance isn’t accepted by a lot of providers in the villages, hens they have to go up to OcalaOP said they have Medicare. That being said, I'm assuming AARP is their Medicare Supplement. As we know, if Medicare doesn't cover a charge, the supplement won't cover it either.

[mtdjed]

I get two blood tests per year and never had an HIV test called for on the test prescription. All required test are in a code. If there was never a suggestion of a need for an HIV test, I would start with the test requirements form. Does it specify a code that calls for HIV testing. If it does not, the Lab had no authority and should be challenged. If it does request the HIV test, then you need to question the physician as to why he requested it. My form has codes that I have no idea what they are.

[retiredguy123]

I get two blood tests per year and never had an HIV test called for on the test prescription. All required test are in a code. If there was never a suggestion of a need for an HIV test, I would start with the test requirements form. Does it specify a code that calls for HIV testing. If it does not, the Lab had no authority and should be challenged. If it does request the HIV test, then you need to question the physician as to why he requested it. My form has codes that I have no idea what they are.
The OP already said that they questioned the doctor and the doctor said the test was routine. The lab just performs the tests that the doctor orders.

[queasy27]

Mother in law has disputed the bill with both the lab and Premier ...

I'm sorry for the troubles your in-laws are having. Getting the runaround like that is supremely frustrating.

Has your mother-in-law tried contacting AARP? They may be able to get more details from Premier and/or the lab and can explain why the claim was denied.

Also, I've never heard of a medical clinic that doesn't accept the same insurance at all their locations in the same area. Hopefully your in laws will find a different practice after this, but if they want to stay with Premier they should call the office in TV and confirm that their insurance is accepted.

Good luck.

[RARO1]

I'm sorry for the troubles your in-laws are having. Getting the runaround like that is supremely frustrating.

Has your mother-in-law tried contacting AARP? They may be able to get more details from Premier and/or the lab and can explain why the claim was denied.

Also, I've never heard of a medical clinic that doesn't accept the same insurance at all their locations in the same area. Hopefully your in laws will find a different practice after this, but if they want to stay with Premier they should call the office in TV and confirm that their insurance is accepted.

Good luck.

I believe it was AARP that told them the Ocala office was the only one that would accept them as new patients, apparently it was next to impossible to find a doctor who would take their plan in TV.

[Alicat5977]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.
Don’t know what medical laws Florida has, just moved here. In CT they can’t test you for HIV without your permission, you might want to look in to that a little further. Just a thought. Hope you get it resolved.

[Ele201]

I googled this:
Your doctor can't test you without your consent. HIV tests can only be done with the consent or at the request of the patient. Some states require written consent; for others, verbal consent is sufficient (visit Centers for Disease Control and Prevention (http://www.cdc.gov) for the requirements in your state).

Yes, you’re right! I remember that many years ago, my doctor at the time asked me if I wanted an HIV test. I declined and that was that. It requires consent.

[elevatorman]

Is it possible that the Insurance company has an advocate that can deal with the lab. Another option may be to try Seniors Vs Crime, Special Project of the Florida Attorney General. Maybe a call to the lab from them can help.

[gregcharlesnelson@gmail]

where is a good primary doc?

[mdieffenbach]

Your first mistake was picking Premier Medical as your primary. They are crooks. I got billed for a pain consultant which consisted of the physician asking if I ever have pain. Of course I do, I'm old. It was an extra $200 and I didn't even get any pain medication. I switched to Village Health. It's like night and day.

[sjeffries]

If the test is not covered by Medicare, then calling them or reporting it to them as fraud will be a waste of time. Also, complaining to the doctor that you did not consent to the test would also be a dead end because you probably did consent to it by signing forms in the doctor's office. I think the only way to be successful is to refuse to pay the bill. The lab may agree to negotiate a lower price, so they can avoid the collection agency fees, which are very high on a $500 bill.

If you HAVE to pay the bill, send them $5.00 a month. They have to accept it and you won’t be sued.

[tvbound]

A big thanks to the OP and all of the respondents. Information and comments like these, even they're just anecdotal, are valuable for those of us that are planning on moving there.

[mydavid]

Maybe they should look for a different provider, I have the same provider for the last 12 years and have never paid for any lab test order by my Doctor.

[woderfulwendy1]

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Call Crimes Against Senior's. Don't pay, ask for a breakdown of each test and if you pay, pay for the appropriate tests.

[Mike Shebel]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.

HIV Covered by Medicare if:

Medicare Part B Covers an HIV screening one time per year, if you meet the following conditions:

•. You are age 15–65;
•. Or your younger than 15 or older than 65 and are at an increased risk for HIV;

Or if you are pregnant, you can get three screenings for HIV during your pregnancy.

Otherwise, not covered.

[wirenail444]

Great advice

[gloriahoff@comcast.net]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.

I had a similar situation and her primary doctor did not have the right code for the order, so the Lab Corp. had to send me a bill. I took the bill 2 times to the doctor's office to get the doctor to put the right code for the tests. Try that, please.

[2mnydogs]

Great advice.

[jimbarb49@yahoo.com]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.

I would not pay before you talked to a senior advocate or lawyer. That organization has not had the best press. I have gotten routine blood tests and never HIV. I think it is a scam. That is cash in their hands.
Has your mother contacted the insurance carrier.
I hope you find someone to get a better answer. I know I would not pay. In addition when I have gone for labs they tell me what is not covered and take my charge card.

[willbush]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.

Anytime I go to have blood work if there is one that may not be covered they will tell me and I must sign a statement I still want the test. Does the place where they had their blood work have a copy of a document they signed? If not then they should call Medicare as someone had mentioned. Good Luck

[Sunflower33]

I would definitely call an attorney they will give you the best result.

[wiltma]

For this test to be done , they would have had to sign a form that they were informed that some testing might not be paid for by Medicare.

[Kgcetm]

I would decline to pay the bill on the basis that you did not authorize the test and that it is not routine by any measure. I have had blood tests administered at TV hospital, Leesburg Hospital, Rush University Hospital, Mass General Hospital and numerous doctor’s offices in TV. Not once have I been tested for HIV. The test was unnecessary and likely a profit builder for the lab/doctor. Did the doctor specifically request the test?

No, I wouldn’t pay that portion of the bill and I would clearly explain that to the physician involved.

I also wouldn’t go to Ocala for simple medical services.

[retiredguy123]

I would definitely call an attorney they will give you the best result.
The lab bill is only $500. How much would you expect to pay the lawyer?

[OhioBuckeye]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.
WOW, I think I would get some legal help because this just another thing these services in a retirement area are taking advantage of the older people. To me I think you just got goudged.

[jrieker68]

Maybe they should look for a different provider, I have the same provider for the last 12 years and have never paid for any lab test order by my Doctor.

I would definitely get a new doctor, but I would also consider changing my Medicare Supplemental company when the change period opens up; there are plenty of doctors in TV.

[blueash]

I would decline to pay the bill on the basis that you did not authorize the test and that it is not routine by any measure.... Did the doctor specifically request the test?

No, I wouldn’t pay that portion of the bill and I would clearly explain that to the physician involved.



Sorry, but you seem to not understand how it happened. Telling the doctor you won't pay this bill means nothing. The bill is not from the doctor it is from the lab. It's like telling your electric company you won't pay your phone bill. They are not involved.

Yes the doctor ordered the test. The OP clearly indicated it was ordered. No lab can do a test on its own. They only do what the doctor ordered.
As to authorization, when you gave the showed up at the lab for the tests the doctor ordered, whether with a paper order or for an electronic order, that is consent for them to draw blood. It is also routine at most encounters that you sign a form saying you will pay for any costs not paid by your insurance. That thus includes any copay, coinsurance, deductible, or non-covered tests.

The doctor ordered the test. The lab ran the test as ordered. The insurance companies declined to pay, correctly. The patient got billed.

Whether the lab did or did not specifically advise that the HIV test might not be covered is absolutely not an issue. The people working in the lab are not experts in codes and have no way of knowing whether the person having the test is having it routinely or because of a concern.

If this were my practice I would resolve it by apologizing to the couple for the misunderstanding and offer to pay the lab cost. Then I would change my office routine to be sure that if I were going to order HIV testing on people over 64 that I documented a reason they needed it or that I explained it was routine, not covered by insurance, and they patient was given an option to decline.

Then I would call the lab, explain what happened and ask that the bill be redirected to me and that I'd appreciate it if they would bill it at their insurance covered rate.

I am mystified at the cost billed. Quest does HIV screening for $89 thru their Quest Direct program

Both Quest and Labcorp offer HIV testing for $79 via this website:
STD Testing | Pricing & STD Test Packages - STDcheck.com (https://www.stdcheck.com/std-test-pricing.php) and there is even a $15 off coupon so the lab is accepting $64 as payment in full for the test.

Perhaps a call to the lab to ask for billing at their advertised price might work even though the test was not ordered via the specific program.

[maribob01]

A Would find a new DR immediately if not sooner.
B I would think their is a state licensing board in Florida would complain to them.

Here is the phone number for the Florida Medical Licensing Board, Customer Contact
Center
(850) 488-0595
I would definitely call them before paying that bill. Sounds like maybe it's going in someone's pocket!

M

[retiredguy123]

Sorry, but you seem to not understand how it happened. Telling the doctor you won't pay this bill means nothing. The bill is not from the doctor it is from the lab. It's like telling your electric company you won't pay your phone bill. They are not involved.

Yes the doctor ordered the test. The OP clearly indicated it was ordered. No lab can do a test on its own. They only do what the doctor ordered.
As to authorization, when you gave the showed up at the lab for the tests the doctor ordered, whether with a paper order or for an electronic order, that is consent for them to draw blood. It is also routine at most encounters that you sign a form saying you will pay for any costs not paid by your insurance. That thus includes any copay, coinsurance, deductible, or non-covered tests.

The doctor ordered the test. The lab ran the test as ordered. The insurance companies declined to pay, correctly. The patient got billed.

Whether the lab did or did not specifically advise that the HIV test might not be covered is absolutely not an issue. The people working in the lab are not experts in codes and have no way of knowing whether the person having the test is having it routinely or because of a concern.

If this were my practice I would resolve it by apologizing to the couple for the misunderstanding and offer to pay the lab cost. Then I would change my office routine to be sure that if I were going to order HIV testing on people over 64 that I documented a reason they needed it or that I explained it was routine, not covered by insurance, and they patient was given an option to decline.

Then I would call the lab, explain what happened and ask that the bill be redirected to me and that I'd appreciate it if they would bill it at their insurance covered rate.

I am mystified at the cost billed. Quest does HIV screening for $89 thru their Quest Direct program

Both Quest and Labcorp offer HIV testing for $79 via this website:
STD Testing | Pricing & STD Test Packages - STDcheck.com (https://www.stdcheck.com/std-test-pricing.php) and there is even a $15 off coupon so the lab is accepting $64 as payment in full for the test.

Perhaps a call to the lab to ask for billing at their advertised price might work even though the test was not ordered via the specific program.
I agree. The lab probably billed $500 for the test because they assumed that it would be covered by insurance. They always overcharge for lab tests. The last time I had routine blood work done by Quest, they charged $654. But, the insurance company only paid them $45 and Quest billed me for $8, so they apparently lost $601. But, they were not allowed to charge me the difference because their contract with the insurance company requires them to accept the insurance company's determination of the "reasonable" cost for the tests.

I would suggest that the OP refuse to pay the bill and attempt to negotiate with the lab to pay what an out-of-pocket patient would pay for the test. But, once you pay the bill, you will never get your money back.

[BeauJangles]

Why did not they feel it was necessary to leave the area?

[theruizs]

This firm advertises on TV constantly, a call to them may clear things up for you.
Morgan & Morgan For the People

Morgan & Morgan Law Firm | Personal Injury Lawyers For The People (https://www.forthepeople.com/)

If they call this firm, or any other lawyer, I would be interested in knowing how it goes. My impression is that unless you are suing someone for a lot of money the fees are high and it may cost more than the $1000 or so they owe.

[PugMom]

Your first mistake was picking Premier Medical as your primary. They are crooks. I got billed for a pain consultant which consisted of the physician asking if I ever have pain. Of course I do, I'm old. It was an extra $200 and I didn't even get any pain medication. I switched to Village Health. It's like night and day.

dittos, only they charged me for an anti-smoking conference(?). i called the office & they explained it was a charge for the dr. to talk to me re:smoking for 10 minutes. LOOL. i got them to remove the charge, & am now in the villages health system--everything i need is @ my fingertips & all costs explained. i've read some 'bad' things re: villages health, but they're #1 for us. we havent wanted for care, & whatever isn't covered is carefully explained by the financial staff.

[airdale2]

Check out Florida Primary in Summerfield across from walmart, Good people, good doc's.

[airdale2]

where is a good primary doc?
Mid- Florida Primary Summerfield

[NavyVet]

Sounds to me like that is an exorbitant amount to charge for one blood test. With their already tarnished reputation, it seems like a bold scam on unsuspecting new patients. I wouldn't pay it and would definitely dig deeper for explanations. Make them refile with correct codes or something. That happens a lot. Also, report to Medicare. I use Alliance Labs for labwork and they always let you know if an ordered test might not be covered by Medicare. I recommend you give Rivers Family Practice (near hospital) a try for primary care. We have always gotten good care and treatment there. Good luck!

[HappyRetired]

Some of Premier's offices have been fined for Medicare fraud. This sounds like a case. Dispute this with Medicare as a fraud case. Why did they go to Ocala when there are 2 offices close to The Villages? I don't know which office is the problem, but it sounds like part of the problem. Don't pay. Wasn't disclosed. Does the EOB say you might be charged? and, if so, how much? Won't be the billed rate. I'd also report this to the state's licencing board for doctors.

[rswegles]

What lab did they go to. Normally if your insurance will not pay for a specific test The lab staff make the patient sign a release form!!!

[RARO1]

Sorry, but you seem to not understand how it happened. Telling the doctor you won't pay this bill means nothing. The bill is not from the doctor it is from the lab. It's like telling your electric company you won't pay your phone bill. They are not involved.

Yes the doctor ordered the test. The OP clearly indicated it was ordered. No lab can do a test on its own. They only do what the doctor ordered.
As to authorization, when you gave the showed up at the lab for the tests the doctor ordered, whether with a paper order or for an electronic order, that is consent for them to draw blood. It is also routine at most encounters that you sign a form saying you will pay for any costs not paid by your insurance. That thus includes any copay, coinsurance, deductible, or non-covered tests.

The doctor ordered the test. The lab ran the test as ordered. The insurance companies declined to pay, correctly. The patient got billed.

Whether the lab did or did not specifically advise that the HIV test might not be covered is absolutely not an issue. The people working in the lab are not experts in codes and have no way of knowing whether the person having the test is having it routinely or because of a concern.

If this were my practice I would resolve it by apologizing to the couple for the misunderstanding and offer to pay the lab cost. Then I would change my office routine to be sure that if I were going to order HIV testing on people over 64 that I documented a reason they needed it or that I explained it was routine, not covered by insurance, and they patient was given an option to decline.

Then I would call the lab, explain what happened and ask that the bill be redirected to me and that I'd appreciate it if they would bill it at their insurance covered rate.

I am mystified at the cost billed. Quest does HIV screening for $89 thru their Quest Direct program

Both Quest and Labcorp offer HIV testing for $79 via this website:
STD Testing | Pricing & STD Test Packages - STDcheck.com (https://www.stdcheck.com/std-test-pricing.php) and there is even a $15 off coupon so the lab is accepting $64 as payment in full for the test.

Perhaps a call to the lab to ask for billing at their advertised price might work even though the test was not ordered via the specific program.

I agree with you, it’s strange that they list is as $79 test but charged in laws $500 each...

I’m not sure if it’s related to this thread but my father in law got an email from premier yesterday out of the blue asking for copies of the lab bills from quest... it’s possible premier noticed this thread, and the uproar it’s causing. They do have a sponsor sticky on top of this forum advertising their services... will update if I hear anything.

[queasy27]

I believe it was AARP that told them the Ocala office was the only one that would accept them as new patients, apparently it was next to impossible to find a doctor who would take their plan in TV.

Oh, that's awful. As others have said, I strongly recommend that you encourage your in laws to investigate other insurance plans during the open enrollment period in October. AARP offers both supplement and advantage plans through United Healthcare but if they're not widely accepted here, it's kind of worse than nothing.

Medicare can be confusing. There are SHINE (http://www.floridashine.org/Counseling-Sites.aspx) (Serving Health Insurance Needs of Elders) clinics here staffed by volunteers who can help explain all the options without bias.

The Villages has its own health care system that is highly regarded by many posters here and may be the easiest choice for one-stop shopping.

You're very kind to help your in laws with this. I once ended up paying $742 that I didn't owe just to get the tears and stress over with, so I truly sympathize.

[rdwalls]

Recommend you call Mid Florida Primary Care in Leesburg.

[Carlsondm]

I wish I knew which doctor requested the tests. The first doctor I interviewed to be my primary care doctor pulled some of what you describe but I questioned it and switched doctors. Yep Premier Medical. Definitely a charger pumper. He had been promoted to a lead worker .. likely because of the money he brought in. Not what I was looking for.

I always review and question the lab orders. Mistakes have been made for me.

Go to the supervisor of the person who ordered the tests. Who authorized the tests? Likely that doctor. Explain that unnecessary tests were done and that you request that the charges be removed. Perhaps they were intended for someone else and a mistake was made.

[vinnyfla]

Premiere is in the Villages also , and I left them for poor service, no one sets an HIV test unless you suspect something wrong?

[Spike380]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.
GET OUT OF PREMIER. My husband was with them 10 yrs-10 yrs of middiagnosis; never getting approvals for tests; kept telling my husband he had pneumonia when he actually has a paralyzed diaphragm; only refers to their buddies; we were told they will not approve referrals to anyone out of network. Have to call tons of times before rx gets called in. It is a HORROR story. I know some people like them-but the majority do not. BEWARE

[dpmers]

Stay as far away as possible from Premier Medical, they belong to HMO,'s and control expenses. They refused my mother in law an MRI, turns out she had a fractured pelvis and ended up with a life saving colostomy. We tried to use, turns out no malpractice insurance.

[nn0wheremann]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.
Premier Medical is best avoided. Somehow they attract providers with impeccable credentials, but then saddle them with support staff dredged from the bottom slime of the labor pool, staff with zero ethics, fewer skills, and no supervision or training. Their website never works, providers are not available by telephone or email, and they just recently paid a huge fine for Medicare fraud. On her way out the door my wife was asked by a clerk if she had a living will. The EOB showed a billing for a 30 minute in-depth discussion of advanced planning alternatives for a hospice patient. Do not pay the bill. Raise Cain with Medicare’s fraud squad.

[nn0wheremann]

I’m not sure, I know their AARP insurance isn’t accepted by a lot of providers in the villages, hens they have to go up to Ocala
When you call PMA they will direct you to their most underutilized office. They do not give a hoot for your preference or convenience

[pabotticelli]

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.
I would go back to the Doctor who wrote the script for blood work. They must have made a mistake in the type of test they ordered. If so they should be responsible for clearing up the issue or paying the bill.

[RARO1]

Oh, that's awful. As others have said, I strongly recommend that you encourage your in laws to investigate other insurance plans during the open enrollment period in October. AARP offers both supplement and advantage plans through United Healthcare but if they're not widely accepted here, it's kind of worse than nothing.

Medicare can be confusing. There are SHINE (http://www.floridashine.org/Counseling-Sites.aspx) (Serving Health Insurance Needs of Elders) clinics here staffed by volunteers who can help explain all the options without bias.

The Villages has its own health care system that is highly regarded by many posters here and may be the easiest choice for one-stop shopping.

You're very kind to help your in laws with this. I once ended up paying $742 that I didn't owe just to get the tears and stress over with, so I truly sympathize.

I will pass on your suggestions, I know they like the plan they have now because even though they pay quite a lot a month, it doesn’t have any copays and almost no deductible, if they ever have any big health issues they like the fact that the won’t have to pay 10s of thousands out of pocket.

[Carla B]

I’m not sure, I know their AARP insurance isn’t accepted by a lot of providers in the villages, hens they have to go up to Ocala

If they have Original Medicare plus AARP supplemental, it's simply not true that a lot of providers in The Villages will not accept their insurance (aside from The Villages Health). in 12 years of living here or anywhere else, we haven't had that experience at all. Hopefully, they will ditch Premier Medical and find a normal practice. Rivers Family Medicine is one that is recommended.

[RARO1]

It’s been a while but seems like this debacle has been solved.

According to the Doc these were supposed to be Hepatitis tests not HIV test. There was apparently some kind of paperwork mistake at some point. Anyhow, the doctors office is apparently going to eat the cost. Still waiting for confirmation from quest...

Thanks for all the suggestions and ideas from all of you!

[Carla B]

Thank you for getting back to us. I'm happy it seems to be resolved and was a coding mistake by Premier. Now, if your parents will just find another practice besides Premier, I think they'll be happier. Thousands of people in The Villages have Medicare plus AARP supplemental, and numerous doctors accept that insurance.