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  1. #11
    Join Date
    Nov 2013
    Posts
    7,056

    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    I have not gotten to the bottom yet but I have learned a lot along the way so far and it seems that I have discovered a very large can of worms. I am still waiting for documents from my files to be sent to me. This is what I have found out so far.

    I have found out that (and remember this is in NJ) that contracts that are signed between providers and insurers stipulate that lab testing be sent to in-network labs. If a specimen is sent to an out of network lab, that lab is supposed to check the insurance coverage and if the test is not covered they are supposed to forward the specimen to an in-network lab and if not, the specimen is supposed to be discarded and the provider is notified.

    "Standing orders are not legal or ethical" in that some doctors that use the same facilities, like outpatient surgical facilities, have "standing orders" to do certain test sent to certain labs as a matter of course. The test is not in the patient chart and therefore, is not considered ordered by the Dr. for that patient. I have been told (hearsay I know) that providers have "arrangements" with certain labs to funnel work to them. I don't know if this is by some contract or not but seems highly unethical and I don't yet know how this benefits the Dr. although I could guess.

    And you should give your provider a letter stating that all testing should be done through an In-network lab to insure coverage unless there are extenuating circumstances such that they cannot preform the test and then you need to be contacted for approval.

  2. #12
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    At this point my advice would be to contact your insurance carrier. They will have a department called Provider Relations or something on that order - you are looking for the department that oversees the contracts between the providers and the insurance carrier. They will be able to assist you with charges incurred because of the use of a non-network lab.

  3. #13
    Join Date
    Nov 2013
    Posts
    7,056

    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    Quote Quoting cbg
    View Post
    At this point my advice would be to contact your insurance carrier. They will have a department called Provider Relations or something on that order - you are looking for the department that oversees the contracts between the providers and the insurance carrier. They will be able to assist you with charges incurred because of the use of a non-network lab.
    Thanks cbg I'm working on that as well. But what is the purpose of having insurance if the providers can order tests without your knowledge or approval, outside of coverage, that end up costing you thousands of dollars that do not add to your deductible or limites?

  4. #14
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    That's the whole point. They shouldn't be. If they'd used an in-network lab there wouldn't be an issue. That's what Provider Relations is for - to slap their hands, tell them to cut it out, and see that you don't get charged when you shouldn't be.

  5. #15

    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    Washington State passed a law making this kind of surprise billing illegal. If you get a procedure at an in-network facility, all of the billing will be at the in-network rate. You may be able to question why the same test was done twice.

  6. #16
    Join Date
    Oct 2016
    Posts
    4,301

    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    Quote Quoting JQx5Rc9
    View Post
    Washington State passed a law making this kind of surprise billing illegal. If you get a procedure at an in-network facility, all of the billing will be at the in-network rate. You may be able to question why the same test was done twice.
    This post is from 2014.

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