Can someone please explain this to me regarding insurance

I have Aetna and had genetic testing done because I am pregnant. I went to Enzo labs to have my blood drawn (they are in network for me) but they don't do the genetic testing, they send it out to Counsyl.

Counsyl charged my ins co $592 for the testing. This wasn't the member rate, this was the actual charge. My ins co covered it in full by the way.

My husband has Care Connect and had to have the same test done. Enzo is not in network for him so he went to a Care Connect lab. Counsyl did the actual testing. My husband just received an explanation of benefits from his ins co denying the claim which came from Enzo labs for over $8000!!!

What the hell?! As far as I can see, Enzo labs and Counsyl are not affiliated. He didn't go to an Enzo lab and they don't do the actual testing, Counsyl does.

Why the hell would they be charging my husband's insurance company for this service if he didn't go to Enzo lab and they don't do the testing? Also, why are they charging over $8K for the same exact test I had done which was $592. Again, this is not my member rate, this is the actual charge from Counsyl.

Anybody know what's going on here? Also, who do we call about this, Care connect, Enzo Labs or Counsyl? I don't know where to start but we can't afford over $8K for this test.

Message edited 12/7/2017 5:40:23 PM.

Re: Can someone please explain this to me regarding insurance

Call care connect. Do not pay

Can someone please explain this to me regarding insurance

Have your husband print out the surprise medical bill form on the careconnect website and mail it in with a copy of the explanation of benefits.

Re: Can someone please explain this to me regarding insurance

Keep in mind Care Connect is closing 12/31.

Can someone please explain this to me regarding insurance

Even though it was out of network for Aetna, the $592 was a contracted rate. For the insurance to have covered it in full, there would be a contracted rate in place.
Your husband could contact counsyl directly and explain the situation. They could lower the bill. If no one discussed the costs prior he does fall under the surprise bill law someone mentioned. I've had testing done that needs to be done at a specific lab that no one has coverage for. The lab knows this. When patients have no out of network coverage, they write off the bill and there is no charge at all.