I just got a notice that my insurance won’t pay a claim for some blood work, based on the fact that it was performed by an out-of-network lab. The doctor that ordered it was an in-network doctor, and so far the insurance hasn’t had any problems paying for her at all, and also pays for lab work done at the in-network lab.
Can I fight this? Any pointers?
For the record, I had no clue that the lab work in question was not done on-site, nor that it would be performed by an out-of-network lab. It was just another test as far as I was concerned, and I figured it was covered because the doc & clinic I was going to was in-network.
Oh, and the insurance does say it’s covered, just at my out-of-network rate which has some crazy deductible like $8000, so for all intents and purposes it’s not covered and I have to pay the bill.
No clue. This is the first time I went to this particular place.
Most of the lab work they did was in their own lab, and that was covered. But there were a few tests that they sent away to have processed - all in all, about $700 worth. It is these tests that were not covered.
Ahhh, that’s a tough one.
I can’t say I know what to do here. Then only thing I can think of is to call them up and ask why you were charged for this. They’ll give you an answer, to which you can replay “And how was I supposed to know this, my insurance said they covered you and YOUR lab, when was I going to be told that you would be sending some of the work to another lab, if you had told me that I could have asked my insurance company if they were covered and if they said no you could have sent it to a different lab or (if applicable) skipped those tests”
Come to think of it, I think at some doctors that I’ve been to I’ve even received a list of labs they may be using, just for this purpose.
Call your doctor’s office and speak to the administrator; NOT BILLING. Tell them they screwed up. By doing this they more than likely violated their contract with your insurance company. They are obligated to sent outside testing to in network providers. The doctor needs to eat the cost. If you don’t get satisfaction from the office, call your insurance company directly and report the violation. They will take care of it.
Good luck.