re: UPDATE!! Filing an appeal w/ Blue Cross/Blue Shield

What state are you in?


OON charges are a bitch to fight, but it can be done. I'll start with the bad news...it is your responsibility to call and check the network status of the lab ahead of time.

The physician either lied and knew the facility was OON, or he lied by telling you he knew they would be in network with your insurance. Either way...he lied.

Look at your EOB and see if your insurance paid anything towards the bill. If they did, and your getting billed for the balance, that's "balance billing" and can be reported to the states dept. of insurance. If thats the case, then your physicians administrator can most likely get that balance written off. If not, call the lab and request the same thing. If both refuse to help you, report the lab's name to the insurance board for balance billing out of network charges. Most medical offices with these OON models will ahppily write off your "balance" b/c dealing with the board is a pain in the arse.

Believe it or now, most people just pay that "balance bill" without question. If it's questioned, it gets written off most of the time.

If your insurance paid nothing to the lab, then it's up to you to TRY and negotiate a payment with the lab. Offer to pay Medicare rates and see what kind of response you get. But you will have to pay them something.


ETA: I saw it's a balance bill. That's dirty business and you should not have much trouble getting it written off if you FIRMLY address the right people.