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Started By
Message
UPDATE!! Filing an appeal w/ Blue Cross/Blue Shield
Posted on 7/7/14 at 3:50 pm
Posted on 7/7/14 at 3:50 pm
My wife is currently pregnant (I know, congrats on the sex) and there were some minor complications with a single cyst on the kidney. Everything is fine with the baby but our doctor suggested we do a genetic blood test and stated it was covered under our insurance plan. Being first time parents and scared of what was/is going on, said yes. Unknowingly to us, the doctor sent this out to a lab that isn't within the BCBS network and we are stuck with an enormous bill.
When I called the insurance company, they told me I should have called and asked them if it was covered. Now, I'm not an OT genius or all knowing like most of you, but given the situation and enormous amount of stress and concern we were under at the time as well as our doctor saying we were covered, I'm assuming the majority of people would never call their provider or even ask what lab the doctor was sending it to and if it was in network. We are now filing an appeal to see if we can get some of it covered.
My question to the OT is have you ever had anything like this happen or have you ever won an appeal with the insurance company. I'm feeling like I won't win this battle and am going to be stuck paying off this small car payment for the next few months.
UPDATE: My wife called multiple times today and finally go in touch with a supervisor. They lowered it down to our normal co-pay and we only have to pay the 10%. Yes, total beta move on my part having my wife, the bulldog, take care of it but this beta just saved a ton of money and DGAF about being a beta. I might even buy a new fedora with all the money my wife just saved us.
In all seriousness, thanks for all the advice and I'm glad we didn't just bend over and take it.
When I called the insurance company, they told me I should have called and asked them if it was covered. Now, I'm not an OT genius or all knowing like most of you, but given the situation and enormous amount of stress and concern we were under at the time as well as our doctor saying we were covered, I'm assuming the majority of people would never call their provider or even ask what lab the doctor was sending it to and if it was in network. We are now filing an appeal to see if we can get some of it covered.
My question to the OT is have you ever had anything like this happen or have you ever won an appeal with the insurance company. I'm feeling like I won't win this battle and am going to be stuck paying off this small car payment for the next few months.
UPDATE: My wife called multiple times today and finally go in touch with a supervisor. They lowered it down to our normal co-pay and we only have to pay the 10%. Yes, total beta move on my part having my wife, the bulldog, take care of it but this beta just saved a ton of money and DGAF about being a beta. I might even buy a new fedora with all the money my wife just saved us.
In all seriousness, thanks for all the advice and I'm glad we didn't just bend over and take it.
This post was edited on 7/8/14 at 12:57 pm
19
Posted on 7/7/14 at 3:53 pm to jscrims
Lesson learned. Always assume they will deny your claim where possible.
Good luck.
Good luck.
Posted on 7/7/14 at 3:54 pm to jscrims
I've never had Blue Cross/Blue Shield deny anything. Good luck.
Posted on 7/7/14 at 3:55 pm to jscrims
Oh yeah. Thanks, Obamacare.
Posted on 7/7/14 at 3:56 pm to High C
quote:
I've never had Blue Cross/Blue Shield deny anything
Let me clarify. They paid 40% of it which is nice but they are saying my in-network doctor sent it to an out of network lab which is why I have to pay.
Posted on 7/7/14 at 3:56 pm to jscrims
If you keep those giant packet the BCBS sends its insured's ...now would be a good time to break it out
Posted on 7/7/14 at 3:57 pm to jscrims
quote:
My question to the OT is have you ever had anything like this happen or have you ever won an appeal with the insurance company
Call the lab and find out if they are willing to contract with your insrance company for this procedure and likewise with the insurance company. Also, where your doctor sends out his tests is not for you OR your insurance company to question. Make sure they know that. Call the doctor's office and let them know what's going on and see if they are willing to write a letter to the insurance company explaining why he uses that lab. Contact your HR plan administrator or your company's broker if it continues to be an issue and have them contact the insurance company on your behalf.
Do not give up. You have insurance for a reason. Good luck!!
Posted on 7/7/14 at 3:57 pm to jscrims
Call your hr rep. Ours handle these issues for us
My coworkers husband had surgery and she made sure everything was in network. But they called a dr in to assist that wasn't. HR said they'd handle it and got it covered
My coworkers husband had surgery and she made sure everything was in network. But they called a dr in to assist that wasn't. HR said they'd handle it and got it covered
Posted on 7/7/14 at 3:58 pm to jscrims
quote:Something similar happened to me a few years ago with United Health Care. I got really sick over the weekend and needed to see a doctor. I called United Health Care and was told that Lake After Hours was in network and that I would be covered. They failed to tell me that, although the clinic itself is in network, not all doctors who work there are in network. I didn't realize this at the time, but I got a $1200 bill in the mail a few weeks later. When I called them about it I was told that I should have called back to verify whether the doctor was in network. I bitched, but they wouldn't do anything about it. I dropped them and I'm now on my wife's BCBS plan
My question to the OT is have you ever had anything like this happen
This post was edited on 7/7/14 at 3:59 pm
Posted on 7/7/14 at 3:58 pm to jscrims
quote:
Let me clarify. They paid 40% of it which is nice but they are saying my in-network doctor sent it to an out of network lab which is why I have to pay.
Sounds like your doctor's fault. I'm sure they are well aware of providers' networks.
Posted on 7/7/14 at 4:00 pm to jscrims
quote:
We are now filing an appeal
Just hit your head with a hammer a few times and you'll get the same results. Good luck.
Posted on 7/7/14 at 4:00 pm to jscrims
quote:That's not your fault. The doctor's office should know which labs are in network regarding your insurance. Depending on how much you owe, I would probably raise some hell
but they are saying my in-network doctor sent it to an out of network lab which is why I have to pay.
Posted on 7/7/14 at 4:01 pm to ForeverLSU02
How would the dr know?
Posted on 7/7/14 at 4:01 pm to jscrims
I had this EXACT same thing happen (but no sex) it was for a test run on me.
I pitched an enormous shitfit with BC/BS and went through about four manager's before one of them got tired of me calling every day. They paid the entire charge but warned me to "check with them next time."
So my advice is:
1. Quit knocking her up. That gets expensive.
2. Stay on their arse until they give in. Remember that the people you are talking to aren't spending their money. Badger them until it makes sense to pay you off to go away.
I pitched an enormous shitfit with BC/BS and went through about four manager's before one of them got tired of me calling every day. They paid the entire charge but warned me to "check with them next time."
So my advice is:
1. Quit knocking her up. That gets expensive.
2. Stay on their arse until they give in. Remember that the people you are talking to aren't spending their money. Badger them until it makes sense to pay you off to go away.
Posted on 7/7/14 at 4:01 pm to jscrims
quote:
Unknowingly to us, the doctor sent this out to a lab that isn't within the BCBS network and we are stuck with an enormous bill.
I'm a healthcare provider, and I didn't even know labs were in or out of network, although I rarely use labs. Maybe someone that handles my billing knows that, but this is interesting to me.
Personally, I think it's a little bit out of the scope of what the patient is responsible for knowing when it comes to labs and where blood work is sent. I think you have a legitimate gripe with your doctor, but an ob/gyn would probably be better to answer this specific question.
Posted on 7/7/14 at 4:02 pm to ForeverLSU02
quote:
but they are saying my in-network doctor sent it to an out of network lab which is why I have to pay.
quote:
The doctor's office should know which labs are in network regarding your insurance
Whatever gets them more money in their pocket is what they choose.
Posted on 7/7/14 at 4:02 pm to jscrims
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.
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.
This post was edited on 7/7/14 at 4:08 pm
Posted on 7/7/14 at 4:03 pm to au21tigers
The drs office doesn't get paid by the lab. That makes no sense
Posted on 7/7/14 at 4:04 pm to Paige
It's all a cycle like the court system.
Posted on 7/7/14 at 4:04 pm to Paige
quote:I'm assuming this is something they deal with on a daily basis. I would think that they are more informed to prevent problems like this. If they do not know, then they should have contacted the OP and let him find out himself. I guess I'm giving them too much credit though
How would the dr know?
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