Dr sent labs to out of network-what can I do?

[4HOLIDAYS]

My Endo sent labs to an out of network lab to be done. I made sure to ask the office to ck if I needed Pre-authorization for this-they ck'd and said no. It was a FNA with Ultrssound done in his office, and was sent out.

I called my ins-BCBS-but basically they said I am responsible for the $800 charge.

Has anyone had this happen? Anything I can do? This is a huge amount for me and it won't even go to my deductable for the yr.

 

[Juliet25]

I'm sorry! I've heard of this happening. I was just talking about that this past week with some co-workers. I would plan on appealing through your insurance company. As I understand it, the appeals are processed by a neutral party. It sounds like you did everything right, and $800 is a huge amount to be on the hook for.

 

[lanejudy]

I would appeal it. This happened to me several years ago when my company was changing insurances and I had an appointment scheduled before they got me the new card. I had a letter on company letterhead with all the details of the new insurance (group number, id #, etc.) but my doctor's office still sent bloodwork through the wrong lab. It took a few months of back-and-forth, but I did end up getting it covered.

I guess my only question is whether there is an in-network lab that will process the same tests? I know some labs do not perform certain kinds of tests and therefore it has to go out-of-network (if there isn't an in-network lab to do the work).

Good luck!

 

[PlainJane]

Have you tried calling the doctor's office? If it's on your patient profile that your insurance requires a certain lab to be used, then they made the mistake.

 

[im4pacers1]

You just need to appeal. They'll pay for it. I work for an insurance company and our system will automatically deny the claim, but it gets paid for 100% of the time on appeal.

 

[mommajo143]

Appeal. Do not relent. Document each time you make contact with anyone. They will probably pay.

Another thing we learned is that the fee may be negotiable - in case you are stuck paying it be sure to remain in contact with the lab throughout the process.. Go see them in person if possible. We had a C/T that we were appealing with BCBS & ended up talking to the provider and after almost a year of appeals they wrote off the debt. We paid $0.

Another time (long long ago) we were able to negotiate the fee for an ER visit and get it down ALOT.

Of course I would be sure to have your MD note in your chart only use in network or something similar.

 

[sibesx2]

You just need to appeal. They'll pay for it. I work for an insurance company and our system will automatically deny the claim, but it gets paid for 100% of the time on appeal.

I wish this were true. My BIL had end stage cancer and was moved from 1 hospital to a more equipped one via helicopter. Turns out that the helicopter service was not in network (and BIL even asked them when they came to pick him up and was told they take all insurance). My sister has appealed as far as she can but is stuck with an over $30,000 bill.

 

[4HOLIDAYS]

Thanks for so many replies. I spoke with my agent-he will contact BCBS and see what he can do. He says he is hoping to get BCBS to contact the dr's office and lab to see if they can do anything.

I went in to the dr's office this afternoon and spoke with several of the girls there. They said they ck'd with BCBS to see if they could do the procedure without prior auth. and were told it was ok but the one girl did told me they DID NOT ask about where to send the lab because what they use to do the biopsy is a kit? and it goes only to the lab that provides/makes the kit. I was also told they have not had a problem with BCBS not paying as they have lots of patients with the ins and this is the ONLY kit they use at their office.

Another girl gave me a form for the lab co. to ask for help paying. She had it right on hand-they had print outs readily available. The form shows if you qualify (which we would income wise) that it could pay 75 to 100% of the bill. That to me sounds like they know it can be a problem. The lab is Afirma or Veracyte, same company. I have never heard of such things.

I am definately going to contimue persuing this. Too much money to just forget about it.

 

[Judique]

I just had this happen to me. I didn't even know that an out of network lab was used until I received a check from the insurance company.

When I received the check I had no idea what was going on - the testing was about 6 months ago. Called the insurance company and they said they denied the claim from the lab but paid me what they would allow so that I could pay the lab.

The difference in the bill is over $400, but - the insurance company suggested I speak to my dr's office and ask them to negotiate a discount on my behalf. They said I should wait to get the bill from the lab. No bill has showed yet.

I'm anxious to get this settled - the bill per the insurance statement was over $1100 and the insurance allowed $700.

I obviously don't want to pay the whole tab as an in network lab would have cost me nothing.

 

[Belle0101]

My doctor's office has signs up at the check-in desk, in the waiting area, in the exam room, at checkout and the room where they draw blood, that they use "XYZ Lab" and that it's your responsibility as the patient to know which labs your particular insurance company considers in-network and out-of network.

It goes on to state that you should check with your insurance company prior to each lab test and that if you want / need the tests sent to another lab it is your (the patient's) responsibility to inform them before any lab work is done in order for them to accommodate you.

I know that doesn't help anyone after the fact but in the future, I would be sure to ask my insurance company which labs are in-network and insist that the office only use them for any lab work.

 

[dja14]

Do not pay it! (yet anyway) We had this happen multiple times in the last couple years. I have spent tons of time on phone. The dr's offices (two different places) sent it out of network. One office sent it to their own lab and one sends it somewhere else.
Both times I said where to send it. One time I made the lab tech write it in big letters across the lab paper. Didn't matter, they sent it wherever.

I call the insurance and they blame the dr, who blames the ins, etc. Once son's lab results were lost for 4 months (lab sent it to another dr in another state), took dr's office and a nice lady at insurance company who finally listened to me (took two years). Bottom line was it got either paid what the insurance was willing to pay, or it had to be written off completely.

My best advice is to #1 don't pay (I am still waiting for a $400 refund 'review' from a major hospital, we know we will never see) and #2 document everything, every name and time of anyone you speak to. It wasn't until I had two years of multiple calls I could recite when I called before a worker took pity on me and checked into and brought her manager in and they dug around and straightened it all out. I am almost positive it was my list of detailed phone records that got them looking.

 

[Judique]

I just had this happen to me. I didn't even know that an out of network lab was used until I received a check from the insurance company.

When I received the check I had no idea what was going on - the testing was about 6 months ago. Called the insurance company and they said they denied the claim from the lab but paid me what they would allow so that I could pay the lab.

The difference in the bill is over $400, but - the insurance company suggested I speak to my dr's office and ask them to negotiate a discount on my behalf. They said I should wait to get the bill from the lab. No bill has showed yet.

I'm anxious to get this settled - the bill per the insurance statement was over $1100 and the insurance allowed $700.

I obviously don't want to pay the whole tab as an in network lab would have cost me nothing.

Bringing back an old thread to let all know my resolution.

AS stated above my insurance company said to wait for the bill from the Lab.

So I did! Meanwhile I deposited the check from the insurance into my savings account.

Today, I received a bill from the Lab. There was a credit on it for the difference between the full amount and what the insurance paid me.

So I immediately sent them the insurance pay out through my online bill pay.

I had actually kind of forgot about this since it has been 10 months since the original testing.

But happy to have it all resolved so easily!

I also received a $20 check from Centra in Florida today. Went to Centra urgent care in November 2015 (near Downtown Disney) and they asked for $60. I had given my insurance and knew I had no deductible. But I wanted to be treated so rather than a prolonged argument, I offered them $20 saying that's the highest deductible I know of on my plan. Which it is for a specialist. They took it and I got treated and today got my $20 back, lol.

 

[4HOLIDAYS]

OP here- our claim was resolved where I did not have to pay. The lab basically said we did not have to pay. I filled out a form, they sent a letter confirming that the difference of what ins paid (only a small allowable amount) to the bill was covered. they were considered out-of-network and even though we appealed, ins claimed that it IS covered-just part of our out-of-network portion of insurance,...so we get to pay for it according to them.

So from this point on I feel like I need to get it in writing or something of where any tests will be sent and what will be covered. The Dr office did not bill for the test, he also is part of one the hospital groups so my bill for visits is from the group not his office. This entire bill was from the outside lab. This is the first time I ever had this experience.