Quick doctor/insurance question!!

My doctor took a blood test and sent the results to a lab that doesn't take my insurance--and I am now responsible for the bill, which is $721!!!!!!!!!!!!!!

I called my insurance and they said after the deductible, which is something around $350, they would pay 80% of usual and customary...

meaning I'm out over 500 probably!!!!!

my question is... is it my doc's responsibility (his billing office) to send to the correct lab, or I am SOL? I just called his office and of course the woman is not there.

TIA!

Re: Quick doctor/insurance question!!

I used to work in a Dr's office and unfortunately, you should know which labs except your insurance and mention it when you are there, or at the very least remind the person drawing blood of your insurance and to make sure that it goes to the lab that excepts it.

Re: Quick doctor/insurance question!!

I didn't know my insurance didn't deal with this lab--OMG I am so mad!!!!!!!!!!!!!!!!!!!!!!!!!!
ETA: we had a whole big discussion of my insurance that day too because they made a copy of my new card and made a big deal about it because it is a prescription card and an insurance card in one!!

my gyno has a big chart of all of the labs and which ones they should send to--

I am going to be sick. I am not made of money

Message edited 9/25/2006 4:11:26 PM.

Re: Quick doctor/insurance question!!

You may have to fight with your docs office. You may also be able to fight your insurance as well. They may be able to cover the costs based on an in network basis. Your doctor will have to write or letter or suck it up and cover the difference.

The other choice may be for the lab to bill your insurance company from a partner lab or another provider that is in network. This is done all the time at hospitals.

Re: Quick doctor/insurance question!!

That happened to me once. I kept fighting and resubmitting until the doctor dropped it and ate the cost. It was HIS fault not mine! I didn't need the particular x-rays that he requested, how am I supposed to know that, he is the DOCTOR! Keep fighting, don't pay a thing!

Re: Quick doctor/insurance question!!

Thank you ladies!!

I went to the office today to pick up a referral and asked to speak to the billing person--well, she happens to be on vacation!

I spoke to the receptionish, however, and she said that they just did that with someone else, and that it wasn't my fault, and she would take care of it.

She took a copy of my invoice and is going to call them tomorrow. Hopefully they will just pay it or do whatever. She told me to now tell the office not to use Quest anymore--and she wrote it in my chart.

Cross your fingers that she really does it!!

Re: Quick doctor/insurance question!!

80% sounds like a out of network dr, lab, etc....

since you company does both in and out of network...any time u see a new dr, make sure its in network....

Re: Quick doctor/insurance question!!

That is actually very common. It really stinks. I hope the doctors office comes through for you!

Re: Quick doctor/insurance question!!

Ok...I work in insurance, I can probably get you out of this, but you will have to call the insurance and be Forceful.

First-What insurance company do you have?
Second- What Type of Policy is it? ( HMO? PPO?)
third- you didnt physically go to the lab, the Drs office sent it there right?

you can FM me if you want. I will tell you what to say to the insurance.
WE overturn these on an hourly basis....

Re: Quick doctor/insurance question!!

Thank you all!!! I will keep you posted on what they do!!

I have been going to this doctor for 8 years now, they should know!!! I have had this insurance for the past 4!

Oh well. Hopefully they will stick to their word!

Donna, FM!

Re: Quick doctor/insurance question!!

Definitely pursue it (sounds like you already did) - I had a surgeon do this once - sent my biopsies to a pathologist who didn't take my insurance. They have an entire dept of "patient coordinators" who pave the way for you, make everything easier, check all the insurance, etc.
So - I called to complain since obviously my coordinator dropped the ball - it took a while - but the office eventually ate the cost.

Re: Quick doctor/insurance question!!

i had something simular happen but it was not for blood work, but a biopsy they said after all was said and done that the doc did not take my insurance it was a big fight but after i told them well you have my card you know what the doc takes and doesn't , i finaily won, to make a long story short, but it took a while ! good luck

Re: Quick doctor/insurance question!!

I had my kidney surgery earlier this month and for pre-op testing, I had to go to the hospital where they did bloodwork. Now I know the hospital took my insurance, what I found out later was that their lab did not! I am out over $370 because of it, so I know exactly what you are feeling! I have no idea why they didn't send me to Quest labs where I always go.