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boilerette72 | I have a medical bill I don't think I should pay. |
Almost a year ago I had a medical procedure which required a biopsy. The biopsied tissue was sent to the pathology lab. Without my knowledge or the knowledge of the doctor who took the biopsy, the pathology lab was "inconclusive" for the results and sent the sample to a secondary pathology lab for further review.
I now have a bill for $4500 from the second pathology lab which my insurance BCBS denies payment on as unnecessary.
When I asked the Second pathology about who gave permission to do this test they said, "You did when you signed the paperwork that you would pay all bills insurance didn't."
But I thought that agreement was between me and my doctor and those parties with whom he gives consent to do further tests. The second pathology lab is a THIRD party to this situation... Any advice is much appreciated.
Additional Details
It was a special DNA test on the biopsied tissue looking for specific signs. Luckily the second lab is doing all the appeals for me, but it's still $4500 and insurance will only pay "customary charges" which is only about $500. I could be liable for the other $4000 when neither me, nor my doctor ordered this test. It sounds like a scam to me!
To make a good thing of all this, the second lab determined I was OK, which the first lab couldn't w/o the DNA test on the tissue. |
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Zefina
 |
You should call BCBS and ask them why they feel the claim is not necessary. Then, ask them what you appeal rights are with both your group and your DOL ERISA rights. Depending on what type of coverage you have, the appeal process can vary. If you have HMO or POS this would be considered Purchased Service and you would, most likely, not be responsible for the charge. If you have BCBS Indemnity, Comprehensive, or PPO, then you contract probably states you are responsible the bill. Any policy that is not considered managed care, would say that you are responsible for finding this out. If you are going to file an appeal, you should do it soon. Most policies that I have seen state that you have 180 days to file an appeal. Unfortunately, if you signed a letter saying you would pay for it, then you are responsible for the bill.
If this still does not resolve the issue you could call the insurance commission in your state to appeal the charges at the state level. And at the very least, you can call the insurance company to file a complaint against the provider. If it was me I would file a complaint against the lab that sent it to the 3rd party with out asking first. |
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katiesquilts
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My suggestion is to go to your Benefits Department and ask them for assistance. This is not an uncommon practice (sending it to multiple labsl), unfortunately. Your Benny Dept may be able to help you get teh necessary paperwork together for an appeal, because it wasn't your fault that the first lab could not handle the work.
If your benefit department will not or cannot assist you, call the Plan Administrator (usually a TPA) and ask them what the appeal process is. You are allowed to appeal any claim. |
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mbrcatz
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You need to appeal the denial from BCBS. If you still have time.
Otherwise, you're on the hook for it. |
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Phil S
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Ask them to supply you with the signed paperwork authorizing them. Then take the same position as BCBS, that either you only authorized necessary treatment, or that since they were a sub-contractor to the original lab, they should bill them. Since you cannot request laboratory work, only a doctor can, and your doctor did not order this, then you are not paying. Make sure you keep a running dialog with them, keep copies of everything you send them. They will eventually send it to collections, then you tell the collection company that you have been in constant communications with the lab and they are billing you in error. The collection company will only be paid if they can collect, and if it is a valid claim. Once you show them your letters and BCBS denial, they won't accept the claim. Good luck, it will be an uphill battle, but you can win. |
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Lori S
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Your doctor would have needed to "OK" the second opinion. Have him send an explanation of the medical necessity of it to the insurance company to appeal the denial. |
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Tami H
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Sorry to tell ya but you owe the bill. You did sign consent for required testing to be done, and when the first lab found it inconclusive and sent it to the second because they couldn't figure it out. This has nothing to do with the hospital, unfortunantly it is not their responsibility to see if you insurance will cover it. Believe me I am in a battle right now with the same insurance company over a supposed "elective procedure" (They thought I had a blood clot in my leg and had to do an ultrasound, tell me how that is elective?) Its the insurance company. If you don't pay it then it will go on your credit, but i have talked to several people in finance that have all said when they look at your report they overlook it. |
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zippythejessi
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The long and short of it is, you recieved the services, so you owe the bill. BUT, you should also fight it out with BCBS, because generally, as a patient, you have a right to a second opinion. (In this case, a second test.) |
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Insurance Pickle.com
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You can fight it. I had a doctor's office send something to an out of network lab and at the end of the day I paid nothing
You might have to fight it with both the lab and insurance company. One thing for sure is make sure the lab isn't out of network and the amount they're billing you for isn't MORE than the amount of the bill for the first lab. |
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Mike D
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The second pathology lab is correct that you are liable for any bills that the insurance company does not pay. However you need to call and talk to the first lab and get any and all documentation about why they sent it to the second lab. Tell them that your insurance has denied the claim due to it being unnecessary and you need to show them that it was in fact a necessary action. Then call your insurance company and tell them why the first lab said it was necessary and see where you should send the paperwork. Fight this. |
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maxmom56
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You need to appeal BCBS' denial of payment for the second biopsy. |
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Rajesh K
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you are concern with your doctor only,you permit only your doctor to do the necessary action you are liable to pay your doctor only |
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