[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]

Originally Posted by 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.

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 for the requirements in your state).

[blueash]

Originally Posted by golfing eagles

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
Informed consent is required if it is being done outside of a health care setting such as a community center.
The CDC recommends 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]

Originally Posted by blueash

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
Informed consent is required if it is being done outside of a health care setting such as a community center.
The CDC recommends 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.

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[blueash]

Additional information. Florida has a rule regarding HIV testing in a health care setting. The link is HERE . 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) 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]

Originally Posted by RARO1

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 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]

Originally Posted by gatorbill1

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