is there anything i can do?? doc sent to out of network lab!!!

i went to a new podiatrist a few months ago because my toenail was separating from the nail bed. i knew as soon as i walked in that the doc wasn't right. i should have walked out but i was scared about my nail.

to make a long story short, he clipped a part of my toenail and sent it to a lab to see if it was a fungal infection.

i just got a $400 bill from the lab since it's not in network! i am beyond angry! i made sure they participated in my plan (empire government) and double checked before i left. i never knew i had to tell them to send it to a lab in network!!

my mother did insurance billing for 15 years and never even heard of this lab. the lab my insurance covers does cover pathology, so he can't say this is the only lab. i've been trying to call for 2 days but they're always closed. strike 2.

is there anything i can do? i shouldn't have to pay $400 for a test that should be covered. i am so upset about this

i will definitely be telling my GP, who gave me the podiatrist's name, my experiences in his office.

Re: is there anything i can do?? doc sent to out of network lab!!!

After exhausting your options with the doctor and the insurance company you could try calling the lab to negotiate, telling them that they are not covered by your insurance. I know from a recent situation with an anesthesiologist that they billed at top rates, had me negotiate as much as I could from the insurance company, then they dropped the amount due on the remaining balance to about half of what was left.

I think it's a game some of the services play, when they know the insurance won't pay the full amount they jack it up to get as high a percent as possible before negotiating a lower amount with the patient.

Re: is there anything i can do?? doc sent to out of network lab!!!

bump!

Re: is there anything i can do?? doc sent to out of network lab!!!

I had that problem NUMEROUS times. I just called my insurance company and told them I was given no choice. It was all figured out and billed as in network.

Re: is there anything i can do?? doc sent to out of network lab!!!

Message edited 7/29/2010 8:31:32 AM.

Re: is there anything i can do?? doc sent to out of network lab!!!

I have empire government too and have had this happen to me. I did NOT pay the bill. It will work out. Did you receive just the bill from the lab or did you receive the statement from the insurance? When this happened to me I got the bill first then the statement and the statement showed it was taken care of.

Re: is there anything i can do?? doc sent to out of network lab!!!

Call the lab directly. Sometimes it is an oversight. Also, when you call them and explain it was out of your hands and the office made a mistake they usually will do something for you. It is not the dr's fault- it was the person who sent it off to the lab, and then it could not have been the person who sent it off to the lab, it could be the lab dropped out of the plan and did not tell the office etc. Sometimes some labs do not do what was ordered directly from the dr, and this lab does. ( one lab in particular is notorious for doing this w/ nail specimens.) HTH- I have been working for a dr. for 19 yrs and this can happen. Alot of times the insurance carrier does not tell the dr the correct info- so please do not blame the office outright. Sorry- just my opinion. I hope it gets cleared up asap.

Re: is there anything i can do?? doc sent to out of network lab!!!

My OB's office did this at the start of my pregnancy...i have the same insurance as you and I think it was right when they switched to only using one lab....

I called the OB's office and told them the issue - they worked it out and I didn't have to pay the bill.

At my OB's office at least, the person in charge of check in / billing KNOWS what insurance companies allow what labs, and they are supposed to either send the sample to that lab, or send me to that lab....I would think that if a Dr.'s office is sending out a sample themselves, not giving you a choice of labs, it is THEIR responsibility to make sure it co-incides with insurance card you give them when you arrive....

Re: is there anything i can do?? doc sent to out of network lab!!!

thanks everyone. i'm still trying to get ahold of the doctor. apparently he sent it to the lab HIMSELF. that's what the receptionist (who is related to him) said. i have to call back to talk to him but he's never there.

so what is the right order--doctor, insurance, lab? i got a bill from the lab directly, and my EOB from my insurance that i got a few weeks ago also shows a similar amount.

Re: is there anything i can do?? doc sent to out of network lab!!!

If you can get in touch with the drs office speak to the office manager. If this is a lab they use often they should be able to call and have the charges dropped.