My question involves insurance law for the state of: NJ
Members, I find myself in a situation (I found out about it yesterday) and although I have my own thoughts on how to deal with it, I am looking for your thoughts and advice.
I had a health insurance plan with the same company for more than 30 years that covered everything. Due to the changes in health care insurance, I was forced onto a plan that required authorizations and referrals for everything except a yearly physical and visits to my PCP.
I'm going to make this narrative short. I had seen a Dr. and had some lab work done. Everything was in my network and covered by my insurance, the Dr. and the labs. One of the test was a pathology test that came back negative (thankfully).
Three weeks later, I was scheduled for another dynastic test. I made sure that the Dr. and the facility were in my network and that the proper authorization were issued for the test. They were.
I received an EOB (explanation or benefits) that said I owed a substantial amount of money to a company that did the exact same pathology test as was done three weeks earlier from a lab that was not in my network. My EOB states that the lab that did this last test is not in network and therefore, I am responsible for the billed cost.
I had to go to the facilities website before my appointment and read there legal forms. There were no affirmative actions to agree to the terms of their care. I now find out that by virtue of just reading them, that I supposedly agreed to them and of course, there is one document that states that I am responsible for the lab costs even though I never approved it, my insurance didn't approve it, and I was never told that the test would be done. It was actually ancillary to the procedure being done and I never got any lab results.
So I think that push-comes-to-shove, I will have to pay for the lab work. What do you think and is there anything I can do to dispute this charge?