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Trusted Contributor
Posts: 1,395
Registered: ‎03-06-2020

Suggestions on dealing with "lab not in network" situation....

Though I did not mention it at the time, it was thought that DH had cancer back in November. I will spare you the issues and hoops we went through to finally get him in for a biopsy; it happened the day before Thanksgiving. Due to the locations and issues with not 1 but 2 tumors, the hospital sent it out to the lab considered best with this type of cancer/biopsy, whatever. 

 

He does NOT have cancer. 

 

 

Bill arrived yesterday for a tad over $2000 marked "lab not in network". Now, the hospital, the docs, the surgery crew all are. Is it the norm for a patient who knows nothing about cancer or the labs to dictate to the specialist and the hospital which lab they must use? Is this something we SHOULD have asked before surgery? Not kidding as this is the first time we've ever had this occur.

 

In your experience, what is the best way to handle this? Yes, I know to call the insurance company and I will... AFTER hearing from others who have been down this path. It doesn't help that a call to our CS means at LEAST 2 hours on the phone due to not being able to understand what the person is saying. I DREAD having to deal with this company but there it is. 

 

Thank you in advance! Smiley Happy

"Coming to ya from Florida"
Frequent Contributor
Posts: 113
Registered: ‎04-12-2010

Re: Suggestions on dealing with "lab not in network" situation....

Congress passed surprise medical protection as part to the recent stimulus bill.  Unfortunately, these protections do not take effect until 2022.   Meanwhile, Google "how to contest surprise medical bills" and you will find some practical advice on how to try to get your bill reduced.

Honored Contributor
Posts: 19,658
Registered: ‎03-09-2010

Re: Suggestions on dealing with "lab not in network" situation....

@FiddleDeeDee 

 

ALL of our Dr./medical facilities ask what your 'approved Lab Companies ' are according to your insurance on our first visit with them.

 

It's usually asked on your 'new patient' sign up sheet, if it's an office that you've never used before and then it should remain in your file for future lab work to be sent to.

 

You never know how strong you are until being strong is the only choice you have.
Honored Contributor
Posts: 19,658
Registered: ‎03-09-2010

Re: Suggestions on dealing with "lab not in network" situation....


@KingstonsMom wrote:

@FiddleDeeDee 

 

ALL of our Dr./medical facilities ask what your 'approved Lab Companies ' are according to your insurance on our first visit with them.

 

It's usually asked on your 'new patient' sign up sheet, if it's an office that you've never used before and then it should remain in your file for future lab work to be sent to.

 


ETA:

 

If they didn't ask you for your 'approved' lab in accordance with your Insurance Co., then the responsibility is on them.

You never know how strong you are until being strong is the only choice you have.
Honored Contributor
Posts: 13,779
Registered: ‎03-11-2010

Re: Suggestions on dealing with "lab not in network" situation....

Glad to hear your DH does not have cancer.

Don't know if you are talking about regular Ins or Medicare.

Don't know about Medicare.

With our Ins when I had to have surgery I was asking how much am I going to pay? Does Ins cover this, are the doctors in network etc. If they are not telling you I would be asking.

I would not pay the bill until you receive the EOB from your Ins that shows how much they paid & how much you owe.

Honored Contributor
Posts: 13,779
Registered: ‎03-11-2010

Re: Suggestions on dealing with "lab not in network" situation....


@KingstonsMom wrote:

@KingstonsMom wrote:

@FiddleDeeDee 

 

ALL of our Dr./medical facilities ask what your 'approved Lab Companies ' are according to your insurance on our first visit with them.

 

It's usually asked on your 'new patient' sign up sheet, if it's an office that you've never used before and then it should remain in your file for future lab work to be sent to.

 


ETA:

 

If they didn't ask you for your 'approved' lab in accordance with your Insurance Co., then the responsibility is on them.


@KingstonsMom 

 

I don't remember ever being asked what lab we use?

They always send them over to Lab Corp. Maybe it's the only lab in town. I don't even know. 

I have been asked what pharmacy do you use?

Super Contributor
Posts: 419
Registered: ‎06-02-2010

Re: Suggestions on dealing with "lab not in network" situation....

I've done medical billing for 20+ years.  Best thing to do is look at the EOB (Explaination of Benefits) from the insurance company before calling them.  Make sure what they tell you is what the EOB says.  If you are told something different make them explain.  If it not explained for you to understand or to your satsification, ask to talk to the person above the rep that answers the phone.  If you get a really good rep on the phone ask if they will do a three way call to the lab's billing office.  There could have been a mistake made in billing. 

 

If in the end the claim was billed and processed correctly ask for a discount, especially if you can pay the bill in full.  Explain that all the other providers for these services are contracted/in network.  Start at 50% of the balance due.  

 

Don't give up.  Most people do and pay the bill in full.  

Honored Contributor
Posts: 16,281
Registered: ‎07-26-2014

Re: Suggestions on dealing with "lab not in network" situation....

"I would not pay the bill until you receive the EOB from your Ins that shows how much they paid & how much you owe."

 

EOB's also will state why a particular medical provider was NOT paid or partially paid.

I would think if an "in network" hosp refers something to an "out of network" provider, your ins should/must pay.

 

FWIW.....

When it comes to medical billings (as well as treatment(s) ), YOU have to be YOUR OWN advocate. 

Even though my ins covers me 100% I still go over dr bills & the EOB's w/a fine tooth comb.  Any discrepancies, I contact my ins co & I let them battle it out w/the medical providers.

"Never argue with a fool. Onlookers may not be able to tell the difference."


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Honored Contributor
Posts: 19,658
Registered: ‎03-09-2010

Re: Suggestions on dealing with "lab not in network" situation....

@FiddleDeeDee 

 

I would contact your insurance company and find out who your preferred lab is with them and if their preferred lab is not available in your area, they HAVE to process the claim as if the lab you used IS in network.

 

LabCorp is the preferred lab with our insurance, but we've had other medical services that were initially considered 'out of network by our insurance company, but when we called the insurance company informing them that their 'preferred' service was not available in our area, they covered the claim as if it were  'in-network'

You never know how strong you are until being strong is the only choice you have.
Trusted Contributor
Posts: 1,395
Registered: ‎03-06-2020

Re: Suggestions on dealing with "lab not in network" situation....

Thank you everyone.

 

We have not received the bill from the provider; this WAS the EOB we received and that's how we found out.

 

I read through all the documentation with it and since it was out of network it does not apply to our deductible either. Here's my thing: it's a PPO so we're supposed to go anywhere without issue. We have Lab Corp and Quest...are there others that hospitals use? Nowhere on the hospital in patient paperwork does it state which lab will be used for the work. 

 

Again, this has never happened in all our years with insurance. That said, this is the FIRST time we are not using BCBS but United National. Guess we've learned a huge lesson. Great. Smiley Sad

"Coming to ya from Florida"