: Does anybody work with Health Insurance?



Boombotz
02-19-08, 10:40 PM
I have a question and don't know how to get a true answer. My doctor did a test on me in office and sent it to a lab. The Lab was covered originally but as of Jan 1st 2008 they were no longer in network. When I spoke to the doctors office today they stated that the updated list sent to them by the lab stated they accepted my insurance. When I spoke to the lab they stated they are not even aware at this current time that they are no longer a in network provider. They stated they would resubmit the claim so I should just wait. I spoke to the insurance and they claim it is out of network and I am responsable. The icing on the cake is they also stated to me they wont apply anything but $45.00 of it to my deductable which i also just dont understand. Needless to say I recieve a $740.00 bill for a lab that I had no choice in where it went. Do I have any defense or am I just screwed?

DILLIGAF
02-19-08, 10:50 PM
If the services were done when they were a network provider, it should be covered.I've been burnt on lab crap too.Not to the tune of $740 though,damn dude you alright?Thats a high lab bill!

Boombotz
02-19-08, 10:59 PM
If the services were done when they were a network provider, it should be covered.I've been burnt on lab crap too.Not to the tune of $740 though,damn dude you alright?Thats a high lab bill!

The test was done when they where no longer a network provider as per insurance. As far as the lab was concerned they were unaware that they were not a provider. This is actually the wife and I am fine. I am 35 weeks pregnant and having preterm labor. The test was a simple q-tip swab that determined if I needed to stand on my head for the next 2 weeks or not...lol. It came back negative so that is a good thing atleast.

DILLIGAF
02-19-08, 11:07 PM
You're probably screwed then.As far as your deductible,their gonna bend you over there too, because you didn't go to their approved place.We had Lab One for a year or 2 at work.All lab work had to go there,period!So people like me trying to get there cholesterol under control at a doctors office with an in office lab went thru all kind of crap.When it was all said an done I bit the bullit on all my blood work,and none was applied to my deductible.Baby on the way,,,,,,,,exciting!

Boombotz
02-19-08, 11:20 PM
You're probably screwed then.As far as your deductible,their gonna bend you over there too, because you didn't go to their approved place.We had Lab One for a year or 2 at work.All lab work had to go there,period!So people like me trying to get there cholesterol under control at a doctors office with an in office lab went thru all kind of crap.When it was all said an done I bit the bullit on all my blood work,and none was applied to my deductible.Baby on the way,,,,,,,,exciting!

See the deductable thing has got me for the biggest loop. I have a in-network deductable of 2000.00 and an out of network deductable of 2000.00
I have to hit the deductable before they start to pay 60/40 out of network so if this is a 740.00 dollar bill I would think that should go towards my 2000.00 out of network deductable but they state that only 45.00 of it applies. I just hate insurance and dont understand it. i figured somebody has to understand this stuff better than me. I hate that fact that I feel like i am totally screwed in this situation. Like babies dont cost enough now i am getting hit with a bill that didnt even have to exsist. I am kinda hoping the lab takes some responsability for this being they think they are still in-network.

Rolex
02-19-08, 11:30 PM
Julie you should tell your physician and ask him/her write a letter to your insurance carrier. That can be a great deal of help to persuade them to annie up the money to cover you, and no trouble to do. It will work out. Take care of yourself.

DILLIGAF
02-19-08, 11:38 PM
I think they can treat this situation like they could if you went to a specialist without a referrel from your primary physician.Your out of network deductible i'm sure deals with you not seeing a network provider.Either way,your deductible is high,I hope you can't cap it out at that.Mine is 500 for me,500 for the 2 kids,2 mil cap per person.My employer pays for ALL non ins covered expenses for babys.Where I work,kids are free.

Boombotz
02-19-08, 11:51 PM
Julie you should tell your physician and ask him/her write a letter to your insurance carrier. That can be a great deal of help to persuade them to annie up the money to cover you, and no trouble to do. It will work out. Take care of yourself.

I will do that thank you very much.


I think they can treat this situation like they could if you went to a specialist without a referrel from your primary physician.Your out of network deductible i'm sure deals with you not seeing a network provider.Either way,your deductible is high,I hope you can't cap it out at that.Mine is 500 for me,500 for the 2 kids,2 mil cap per person.My employer pays for ALL non ins covered expenses for babys.Where I work,kids are free.

Kids used to be free with my husbands company as well until January when the new plan went into effect this baby was costing us nothing. Now we are guaranteed atleast a cost of 2000.00 and if my anesthesiologist is in-network than we are all good and it stays at that cost. If my anesthesiologist is out of network than who knows. I know the cap on in-network per person is 2000. and per person out of network is 4000. It really sucks considering it was a 500 deal like what you have before the new year. Oh well C-sections are not cheap so I guess it is better than no coverage...lol

DILLIGAF
02-20-08, 12:09 AM
I hope you get some resolve here!It'll all work out for you,whats a couple extra bucks when your having a BABY!Best money you'll ever spend!Good luck,and we'll wait for pics.Congrats

Boombotz
02-20-08, 07:17 AM
I hope you get some resolve here!It'll all work out for you,whats a couple extra bucks when your having a BABY!Best money you'll ever spend!Good luck,and we'll wait for pics.Congrats

Yes I agree. This will be the best money ever spent along with the money for our 1st child. I just would love to have it to spend on better things than a mistake in lab choice that wasn't even my mistake to make. Thanks for the good wishes 3 more weeks and our little boy will be here.

Stoneage_Caddy
02-20-08, 09:35 PM
ohhhh yeeeah ...how you kids been doing ???

just relized i dont have my nextel anymore ...minor detail

JimmyH
02-20-08, 10:09 PM
I handle the HR for my company and can tell you more likely than not, you are gonna be stuck paying that bill.
$740 is not worth the time it would take to fight it. Even then your chances of beating the insurance company are slim.