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.