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Sarah | Health insurance denied lab work?? Help!? |
I went to a doctor who is approved by my health insurance company (I have an EPO). Apparently, his office sent my blood work off to a lab that is not an "in network provider." My health insurance company consequently has now denied the $1500 claim for the lab fees. Help?!?!?! I did my research and made sure that the doctor I went to was in my network and approved by my health insurance...AND his office had my health insurance info...how was I supposed to know they would send my blood off to some place that my insurance company is not contracted with? I don't really have any control over that! What should I do to get either the doctor or my health insurance to cover the lab fees? It seems pretty unfair for me to get stuck with this $1500 bill. |
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thealphafemme
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I ALWAYS go over this with new employees and during open enrollment because I don't want them screaming at me later when this exact situation happens. It's VERY common and happens with X-rays too (mental note)
Your HR/Benefits person SHOULD go over this, but unfortunately - many don't. Likewise, your doctor should have mentioned they use a third party lab, but its not technically a "mistake" on the doctor's part...
The simplest solution is to talk to your doctor (the doctor is often MUCH more willing to negotiate than the Office Manager - talk directly to the Doctor!) and ask if they can have the lab company bill THEM and then the doctor's office bill your insurance company so that you get the in-network benefit. Many doctors will do this anyway, but you won't know if you don't ask.
If that doesn't work, try contacting the lab directly and explaining the situation and asking if you can at least get the network benefit (i.e. the portion that would have been written off by them had they been an in-network provider which is sometimes up to and even more than 50% of the private pay cost) and then ask if you can work out payment arrangements for the remaining amount.
Most people don't realize they can negotiate with their doctors because they feel like health care and insurance are necessary evils. Again - you don't know if you don't ask!
The insurance company absolutely will not re-process the claim as in-network unless it comes from the actual doctor's office though, so you won't make any headway there... (unless you can ask the lab to apply to be a part of your insurance company's network... )
Good luck! |
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curiam
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I would suggest that you write a letter to your doctor (all things should be done in writing) and explain to him/her that the reason you choose them was because they were on the network that is supported and that they should be responsible for making sure any outside facilities that they choose to use should also be on that network. I would also mention that you expect them to rectify this situation and that it should not be your responsibility to pay for that part since your insurance company would have paid for it if he/she used the proper facility.
Now if they do not own up to thier mistake then you will need to go to the liscensing board and file a complaint about the doctor and their offices practice. |
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sarah314
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The insurance company isn't going to process it as a network claim. (Even if you appeal it.) Unfortunately, as far as they are concerned, it is your responsibility to make sure that all of your work is done by network providers.
Definitely see if you can get the lab to work with you on the fees - most likely, they give insurers a big discount anyhow. (Perhaps your doctor's billing person can help you work with the lab, as someone else suggested.)
In the future, you definitely want to make sure that any labs, x-ray providers, etc. that are being used are in your network before any work is done. Many doctors offices will *try* to help you coordinate that, but ultimately the responsibility rests on your shoulders as far as the insurance company is concerned. |
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zippythejessi
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Okay. Here's what you do. Call the doctor's office and ask for either the billing manager or the office manager. Explain to them that the office sent your lab work to the wrong lab and ask if there's anything they can do to help. More than likely, they have a rep at the lab that can take care of it for them. (My office manager does.) If they refuse to help you, which I really can't see them doing - if you're reasonable about it - then call your insurance company and ask about appealing it.
In the future - every time they do any kind of testing - even if you just pee in a cup for them - tell them it needs to go to whatever lab. This way, they can't pull the "we didn't know." card. |
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Margarita D
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I would suggest that you contact the insurance company and have them go over the types of tests and how much they would have paid if it had been done through their authorized vendor--convince them to pay that amount. Then discuss the remaining figure with your doctor and tell him that you believe his office should pay this difference since you should not have to check and see if each lab or other medical facility they refer you to is in their network. If this does not work then its time to start writing letters, getting your state insurance commissioners office involved and maybe also getting an investigative reporter involved.
Good Luck. |
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mbrcatz
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You need to appeal it, in writing, with your health insurance company.
The doc isn't going to cover this, no way, no how. |
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PS
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don't pay for it, and tell the lab and your doctor that your bank account is not affiliated with that (fu$%ing) laboratory.
Politely apologize for any inconvenience, but tell them there's nothing you can do. Policy is policy, rules are rules. |
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