Community Chat

[RedTop]

This has happened to me several times with tissue samples taken by my dermatologist, where she wanted a specific lab to look at the sample.   I have never been billed for, nor had to pay, for this "specialized" testing in a lab considered out of network.  

I agree with @Carmie to handle this in writing.   

[agb80]

Unless I get a bill I do not get into a dither.  It will be resubmitted as the office you went to will see it when they have not been paid.  I have never had to pay during those type of issues....instead I always just waited it out.  One time took a year, still it was their issue not mine and when they were ready to stop their inefficient ways and wanted to be paid,  it was sorted out by them. 

[Carmie]

@agb80    This type of issue is yours, not your doctors.  An out of network provider has no contract with your insurance company and cannot resubmit a bill that was already processed correctly.  It will just deny as a duplicate.

If you don't handle it yourself by getting in touch with your insurance company and appealing the claim and they want to get paid, you will be sent to collections.

You have been lucky to have avoided this action, but please do not suggest it to others. It is a bad idea.

[agb80]

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@Carmie wrote:

@agb80    This type of issue is yours, not your doctors.  An out of network provider has no contract with your insurance company and cannot resubmit a bill that was already processed correctly.  It will just deny as a duplicate.

If you don't handle it yourself by getting in touch with your insurance company and appealing the claim and they want to get paid, you will be sent to collections.

You have been lucky to have avoided this action, but please do not suggest it to others. It is a bad idea.

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@Carmieoops my mistake.....forgot that it was out of network. 

[agb80]

@Carmiealso want to mention that currently we have Plan G and so do not have out of network issues.  While working though there was one incident where at an In Network hospital there was an out of network doctor and he billed us.  I could have placed a call to question it but did not.....just paid it.  It was a little over $100.  Not a lab I know but a doctor charge in that case.

[Deree]

I had a similar issue a couple of years ago at a rheumatologist's office.  As always, I made sure the doc was in my network.  She ordered a slew of blood tests.  I was charged for one of them in full while all the other tests were under a co-pay.  I called the office and asked why I was billed for the one test (an expensive one). The Office Manager said because there was only one out of network lab that did that specialized test and it is an expensive test. When I said I should have been apprised of this beforehand and given the choice whether I wanted the test or not and to pay for it out of pocket, the Office Manager deleted the charge for me.  You can always try something like that.

[elated]

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@Nightowlz wrote:

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@KingstonsMom wrote:

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@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.

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ETA:

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

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@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?

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You needed to get a referral letter from your doctor before you go to the lab. I learned my lesson the hard way when my neurologist sent me to a hospital that was out of network. I had to get a letter of referral and send it to the insurance company. It took over three months. In the meantime, I agreed to be on a monthly payment plan. When the insurance finally paid the hospital, I got my money back. You always need a referral from your doctor. Lab Corp is where I go to get bloodwork but I need a referral from my doctor. 

[NYC Susan]

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@Lipstickdiva wrote:

I have never been asked at any doctor's office what lab(s) is covered by my insurance.  They ask who my insurance company is and they take a copy of my card. 

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Same here.  I've never been asked that either.  And when I worked in the medical field, my staff also didn't ask patients.  It was up to staff to know which labs were okay with which insurance.  If they messed up, the patient didn't have to pay because it wasn't their error.