Posted: 8/12/2013 2:50:11 PM EDT
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So my friend(trust me you do NOT want pics) is pregnant and had the standard cystic fibrosis test done. Two weeks later she gets a bill for $800 for the test. So I sit down with her and her husband and we call the insurance company and we were told that the doctor used a lab that is not on their list of providers. If the doctor had sent it to a lab on the insurance companies list it would have been covered in full. What is their course of action if any? We are sitting here now and I figured I'd ask the knowledge of GD since they can't speak to the doctor until tomorrow. I figured maybe I'd get good news to calm her down for tonight. Thanks in advance. FBHO
Eta..$800 not 80 |
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Call the doctor...find out why he used an out of network provider. I had a similar issue and my doc did a "mea culpa," and HE paid for the bill (it was a smaller bill). There are ways around this shit... Chances are dr just used normal lab. They wouldn't know who is in or out of network unless advised. |
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Chances are dr just used normal lab. They wouldn't know who is in or out of network unless advised. Quoted:
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Call the doctor...find out why he used an out of network provider. I had a similar issue and my doc did a "mea culpa," and HE paid for the bill (it was a smaller bill). There are ways around this shit... Chances are dr just used normal lab. They wouldn't know who is in or out of network unless advised. Don't the doctors offices pay attention to their patients insurance? That's pretty fucked up if it is perfectly OK for the office to just pick any lab at random with out any regard for their patients. Glad I have a doctor who isn't a lazy POS. |
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Call the doctor...find out why he used an out of network provider. I had a similar issue and my doc did a "mea culpa," and HE paid for the bill (it was a smaller bill). There are ways around this shit... That'll work sometimes. May not work for an $800 bill though. Worth a try in any case. 
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| I know my insurance plays this game. If the doctor sends it to an out of network lab its still covered. But the insurance company will send me the bill. I just give it to my HR lady and she beats the insurance company over the head and they pay it. Bill as sent to me $100. What the insurance company pays: $20 |
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I know my insurance plays this game. If the doctor sends it to an out of network lab its still covered. But the insurance company will send me the bill. I just give it to my HR lady and she beats the insurance company over the head and they pay it. Bill as sent to me $100. What the insurance company pays: $20 Yep. Once I've used the in network doc, wherever he sends me or whatever tests he orders are also considered in network. Fought the battle once with the insurance company and have not had a repeat. |
Getting rid of the in network/out of network provider crap is a worthwhile healthcare reform step, in my opinion. An individual should be able to buy insurance, and go to the provider of their own choice, without the insurance company getting in the way. The insurance we had when I was a child was like this; what changed, and why? 
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Getting rid of the in network/out of network provider crap is a worthwhile healthcare reform step, in my opinion. An individual should be able to buy insurance, and go to the provider of their own choice, without the insurance company getting in the way. The insurance we had when I was a child was like this; what changed, and why? Not saying there isn't a drs office that checks but it is common for them not to. If you think about it you hand them a card. 4 blue sheild cards could have 4 different networks not listed on the cards. It would be some work and a least some of the time the person orderin the lab work won't even see the insurance card. It will be interesting to see what the ACA does for networks. It is still generally unknown who you will be able to use with what plans |
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Many times the doctors are in with certain labs, and certain other doctors they call in for consulations.
I would call the doctor, and the lab and tell them to deal with the ins company, as you are not going to pay one red cent. I would also contact the ins co and get a list of all care providers they will accept. and advise the next doctor you visit to consult with the ins co, before they do anything outside their office that costs you money. |
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Not saying there isn't a drs office that checks but it is common for them not to. If you think about it you hand them a card. 4 blue sheild cards could have 4 different networks not listed on the cards. It would be some work and a least some of the time the person orderin the lab work won't even see the insurance card. It will be interesting to see what the ACA does for networks. It is still generally unknown who you will be able to use with what plans Quoted:
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Getting rid of the in network/out of network provider crap is a worthwhile healthcare reform step, in my opinion. An individual should be able to buy insurance, and go to the provider of their own choice, without the insurance company getting in the way. The insurance we had when I was a child was like this; what changed, and why? Not saying there isn't a drs office that checks but it is common for them not to. If you think about it you hand them a card. 4 blue sheild cards could have 4 different networks not listed on the cards. It would be some work and a least some of the time the person orderin the lab work won't even see the insurance card. It will be interesting to see what the ACA does for networks. It is still generally unknown who you will be able to use with what plans IMHO it should be the job of the person ordering the lab work to verify that it is covered for that patient before sending out for the work. If it is not covered the patient should be informed prior to sending out for the work. This should be an actual law to protect uniformed patients and I'm actually shocked that many say this is normal behavior. |
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IMHO it should be the job of the person ordering the lab work to verify that it is covered for that patient before sending out for the work. If it is not covered the patient should be informed prior to sending out for the work. This should be an actual law to protect uniformed patients and I'm actually shocked that many say this is normal behavior. Quoted:
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Getting rid of the in network/out of network provider crap is a worthwhile healthcare reform step, in my opinion. An individual should be able to buy insurance, and go to the provider of their own choice, without the insurance company getting in the way. The insurance we had when I was a child was like this; what changed, and why? Not saying there isn't a drs office that checks but it is common for them not to. If you think about it you hand them a card. 4 blue sheild cards could have 4 different networks not listed on the cards. It would be some work and a least some of the time the person orderin the lab work won't even see the insurance card. It will be interesting to see what the ACA does for networks. It is still generally unknown who you will be able to use with what plans IMHO it should be the job of the person ordering the lab work to verify that it is covered for that patient before sending out for the work. If it is not covered the patient should be informed prior to sending out for the work. This should be an actual law to protect uniformed patients and I'm actually shocked that many say this is normal behavior. The lab work was probably covered, but the lab they sent it to was probably out of their network. If she has out of network benefits (check the insurance contract), the insurance company should still pay. If she does not have OON benefits, then she is going to be on the hook for the money. She can try to negotiate with the lab for a reduced fee or payment plan, but she is going to be at their mercy. The doctor's office should try to send the order to the right lab, but this is a customer service failure, not a fiduciary failure. She should talk to the doc's office about the issue, and it might be worth it to them to do something about the bill, but I wouldn't hold my breath. Bottom line, however, is that it is ultimately the patient's responsibility to make sure they are staying within the bounds of their own insurance plan. |
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IMHO it should be the job of the person ordering the lab work to verify that it is covered for that patient before sending out for the work. If it is not covered the patient should be informed prior to sending out for the work. This should be an actual law to protect uniformed patients and I'm actually shocked that many say this is normal behavior. Alternatively, it could be the patient's job to understand what the patient's insurance company subsidizes before the patient submits himself to potentially expensive medical testing. Not that I"m implying that people who have insurance need to understand the benefits their insurance company stands behind or anything crazy like that. 
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Alternatively, it could be the patient's job to understand what the patient's insurance company subsidizes before the patient submits himself to potentially expensive medical testing. Not that I"m implying that people who have insurance need to understand the benefits their insurance company stands behind or anything crazy like that.
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IMHO it should be the job of the person ordering the lab work to verify that it is covered for that patient before sending out for the work. If it is not covered the patient should be informed prior to sending out for the work. This should be an actual law to protect uniformed patients and I'm actually shocked that many say this is normal behavior. Alternatively, it could be the patient's job to understand what the patient's insurance company subsidizes before the patient submits himself to potentially expensive medical testing. Not that I"m implying that people who have insurance need to understand the benefits their insurance company stands behind or anything crazy like that.
Na. I do believe it is in someones best interests to know their insurance but in this case I totally disagree. I'm actually looking out for the little guy on this one. There were multiple other labs the office could have used and cost the patient zero dollars. They never gave them options as to what lab they were using. They are not in the medical field and were told this is a routine test, left completly in the dark by the office that this was an $800 test.This is just an open door to scam money out of the lower end of the intelligence scale or elderly..etc.It is all that is soulless and wrong with this world. What if it was $100k not $800? What if it was your grandmother? Why not do it on purpose just to fuck with people? |
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Na. I do believe it is in someones best interests to know their insurance but in this case I totally disagree. I'm actually looking out for the little guy on this one. There were multiple other labs the office could have used and cost the patient zero dollars. They never gave them options as to what lab they were using. They are not in the medical field and were told this is a routine test, left completly in the dark by the office that this was an $800 test.This is just an open door to scam money out of the lower end of the intelligence scale or elderly..etc.It is all that is soulless and wrong with this world. What if it was $100k not $800? What if it was your grandmother? Why not do it on purpose just to fuck with people? Quoted:
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IMHO it should be the job of the person ordering the lab work to verify that it is covered for that patient before sending out for the work. If it is not covered the patient should be informed prior to sending out for the work. This should be an actual law to protect uniformed patients and I'm actually shocked that many say this is normal behavior. Alternatively, it could be the patient's job to understand what the patient's insurance company subsidizes before the patient submits himself to potentially expensive medical testing. Not that I"m implying that people who have insurance need to understand the benefits their insurance company stands behind or anything crazy like that.
Na. I do believe it is in someones best interests to know their insurance but in this case I totally disagree. I'm actually looking out for the little guy on this one. There were multiple other labs the office could have used and cost the patient zero dollars. They never gave them options as to what lab they were using. They are not in the medical field and were told this is a routine test, left completly in the dark by the office that this was an $800 test.This is just an open door to scam money out of the lower end of the intelligence scale or elderly..etc.It is all that is soulless and wrong with this world. What if it was $100k not $800? What if it was your grandmother? Why not do it on purpose just to fuck with people? I'd bet if they know its being paid out of pocket they will accept 1/3 of the 800. |
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OP, my wife deals with this professionally. Here is her info/advise.
If their plan clearly states in network providers must be used, and insured member is responsible to verify that, then they are stuck. However, 1 - who sent the specimen to that lab? It is possible the Dr. sent it to an in network lab, that does not do that test, and it got sent on to a second "specialty" lab. In that situation it should be covered. 2 - If there is no network approved lab that can do that test located within a reasonable distance ( say 25 - 50 mi.) they should be able to get it covered. 3 - They can try to explain to the insurance co. that this was done without their knowledge/input, and see if ins. co. will cover what they would have paid to approved, in network lab, reducing what they have to pay. Whatever happens, they can always use the formal appeals process. Decisions can be, and often are, reversed after all the facts are made clear. Process is multi-step/multi-level, so do not just accept first refusal. |
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Quoted: Chances are dr just used normal lab. They wouldn't know who is in or out of network unless advised. Quoted: Quoted: Call the doctor...find out why he used an out of network provider. I had a similar issue and my doc did a "mea culpa," and HE paid for the bill (it was a smaller bill). There are ways around this shit... Chances are dr just used normal lab. They wouldn't know who is in or out of network unless advised.  |
Be advised, though...some labs (Prometheus in CA) do not accept most insurances...fuckers also have patented certain tests (US Govt is getting involved in that process) so that docs don't have a choice...right now, I have a hefty bill for a test (that came back inconclusive) because of this...I could pay it off...but I decided to piece-mail it because if their test can't "conclude" they can wait for the end of year before they get payment in full.  |
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If this happened to me I would tell the DR he is on the hook. I have no control over which lab he sends a specimen to, but he does. I can control which in-network doctor I see, which MRI facility I choose but the doctor chose the lab and he chose poorly (Indiana Jones reference there).
I wouldn't pay it. Now, if he said, "Go get this test done" and you went to an out of network provider, you're problem. Even if he said "Go to this place and get this test" you're still on the hook. You had an opportunity to verify the lab is in network. |
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Getting rid of the in network/out of network provider crap is a worthwhile healthcare reform step, in my opinion. An individual should be able to buy insurance, and go to the provider of their own choice, without the insurance company getting in the way. The insurance we had when I was a child was like this; what changed, and why? You can get that if you want. I think the last time I had it the insurance cost something like $4,000 per month for my wife and myself. Look at Cigna International. Any licensed physician anywhere in the world is in network. |
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You can get that if you want. I think the last time I had it the insurance cost something like $4,000 per month for my wife and myself. Look at Cigna International. Any licensed physician anywhere in the world is in network. Quoted:
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Getting rid of the in network/out of network provider crap is a worthwhile healthcare reform step, in my opinion. An individual should be able to buy insurance, and go to the provider of their own choice, without the insurance company getting in the way. The insurance we had when I was a child was like this; what changed, and why? You can get that if you want. I think the last time I had it the insurance cost something like $4,000 per month for my wife and myself. Look at Cigna International. Any licensed physician anywhere in the world is in network. Your insurance was $48,000 per year?? I find that hard to comprehend. |
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If they had the patient's insurance info (and we know they did) they were advised.
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Call the doctor...find out why he used an out of network provider. I had a similar issue and my doc did a "mea culpa," and HE paid for the bill (it was a smaller bill). There are ways around this shit... Chances are dr just used normal lab. They wouldn't know who is in or out of network unless advised.
Handing them a insurance card isn't providing them with what labs are in network. 6 cards from same ins co can have 6 networks. You need to Give them a copy of the list of in network labs. I agree it sucks It happens A LOT. |
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Quoted: Handing them a insurance card isn't providing them with what labs are in network. 6 cards from same ins co can have 6 networks. You need to Give them a copy of the list of in network labs. I agree it sucks It happens A LOT. Quoted: Quoted: Quoted: Quoted: Call the doctor...find out why he used an out of network provider. I had a similar issue and my doc did a "mea culpa," and HE paid for the bill (it was a smaller bill). There are ways around this shit... Chances are dr just used normal lab. They wouldn't know who is in or out of network unless advised. Handing them a insurance card isn't providing them with what labs are in network. 6 cards from same ins co can have 6 networks. You need to Give them a copy of the list of in network labs. I agree it sucks It happens A LOT. And guess what? It's binding. I agreed with conditions. They didn't negate the condition. That means they accept the responsibility of picking up the phone and finding out which lab they need to use. Done.
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Your insurance was $48,000 per year?? I find that hard to comprehend. Quoted:
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Getting rid of the in network/out of network provider crap is a worthwhile healthcare reform step, in my opinion. An individual should be able to buy insurance, and go to the provider of their own choice, without the insurance company getting in the way. The insurance we had when I was a child was like this; what changed, and why? You can get that if you want. I think the last time I had it the insurance cost something like $4,000 per month for my wife and myself. Look at Cigna International. Any licensed physician anywhere in the world is in network. Your insurance was $48,000 per year?? I find that hard to comprehend. The company paid for it while I was in Kuwait and Qatar. |