Excessive Billing for Post-injury Drug Testing is a Problem in Comp Too

A recent story in the Albuquerque Journal highlighted a medical billing practice that workers’ comp carriers see from time to time on Texas claims.

The story described the plight of Elizabeth Moreno, who had back surgery in late 2015. Following her surgery, the surgeon prescribed an opioid painkiller and a follow-up drug test that seemed routine — until the lab slapped Moreno with a bill for thousands of dollars. The bill was from a Houston lab that had tested Moreno’s urine for a constellation of legal and illicit drugs, many of which, she told the newspaper, she had never heard of, let alone taken.

Her bill shows that Sunset Labs charged $4,675 to check her urine for different types of opioids; $2,975 for benzodiazepines, a class of drugs for treating anxiety; and $1,700 more for amphetamines. Tests to detect cocaine, marijuana and phencyclidine, an illegal hallucinogenic drug also known as PCP or angel dust, added $1,275 more.

The lab also billed $850 to test for buprenorphine, a drug used to treat opioid addiction, and tacked on an $850 fee for two tests to verify that nobody had tampered with her urine specimen.

Total bill: $17,850 for lab tests that her insurer, Blue Cross and Blue Shield of Texas, refused to cover, apparently because the lab was not in her insurance network. The insurer sent Moreno an “explanation of benefits” that says it would have valued the work at just $100.92.

We occasionally see similar practices on Texas comp cases. Comp carriers should consider two potential defenses that may be raised by the evidence in their cases: whether the drug testing is medically necessary under the facts of the claim; and whether the charges are consistent with the Texas fee schedules. If the charges are not covered by the fee schedule, then carriers should only be making fair and reasonable payments on the bill.

If you encounter one of these cases, you should work closely with your medical bill processing department or vendor to develop a comprehensive strategy to assure that you are only paying for medically necessary care at the appropriate rate.