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  1. #1
    Join Date
    Nov 2013
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    Default Billed for Unauthorized Testing by an Out-of-Network Lab

    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?

  2. #2
    Join Date
    Sep 2011
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    OH10
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    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    Nothing. Crap happens. You should have made sure the tests only went to an approved lab or gotten a script and gone to an in network lab personally.

  3. #3
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    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    Quote Quoting Disagreeable
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    Nothing. Crap happens. You should have made sure the tests only went to an approved lab or gotten a script and gone to an in network lab personally.
    Yes, crap happens but I couldn't make sure the lab was in-network because I didn't know the test was going to be done again. No one said anything to me about it and it was absolutely unnecessary to duplicate the test.

  4. #4
    Join Date
    Sep 2005
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    98,846

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

    Somebody ordered the test. Who ordered it and, given the recency of the same test at the in-network facility, why?

    When you say "I made sure that the Dr. and the facility were in my network" are you talking about the lab that turned out not to be in-network? If so, how is it that you obtained incorrect information about the lab? If not, and you knew lab tests were being run, should we infer that it didn't occur to you to verify that their lab was also in-network? (I know that a lot of this stuff can be overwhelming, and is easier to think about after-the-fact when you find out something went wrong.)

  5. #5
    Join Date
    Apr 2009
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    Somewhere near Canada
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    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    I'm asking this for a reason, and I need clarification.

    The question is was it a repeat of the original labs, or was this a new test?

  6. #6
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    Nov 2013
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    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    OK, I see that I have to be more specific here. Went to a urologist for a problem. They took urine sample and sent it out for cystopathology test. It came back normal. That was all covered by insurance. At the same visit, they found microscopic blood in urine which lead to a CT scan that came back normal. Also covered by insurance. The Dr. also wanted a cystoscopy done. At the facility where the test was to be done they asked for another urine sample. I went through the cystoscopy test and everything was again normal. But apparently they sent the urine sample for another cystopathology test to a lab that was not in my network and I knew nothing about it.

    So it was a duplication of testing within a 3 week period with no authorization from me, or my insurance company. I have only just found out about it and will be asking my Dr. about the results tomorrow and why the test was done again and why in an out of network lab.

    You can see my frustration? There was no reason for the duplication of testing and I had no idea that the test was going to be done. I hope to find out the details tomorrow.

  7. #7
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,389

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

    After you have seen the doctor and asked him about the test and the lab, come back again and let us know the answers.

  8. #8
    Join Date
    Sep 2011
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    OH10
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    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    At the point they asked for the urine sample you should have interjected its direction.

  9. #9
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    Nov 2013
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    Default Re: Billed for Unauthorized Testing by an Out-of-Network Lab

    Quote Quoting Disagreeable
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    At the point they asked for the urine sample you should have interjected its direction.
    Asking for a urine sample is pretty normal. In most cases it goes to a local lab (most times in the facility) for a quick centrifuge spin down and micro exam for blood cells. So it never occurred to me what was going to happen to the sample from there. And considering that I was about to undergo a cystoscopy, my mind was occupied with some apprehension.

    - - - Updated - - -

    Quote Quoting cbg
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    After you have seen the doctor and asked him about the test and the lab, come back again and let us know the answers.
    The good news is the test came back normal. The bad news is that the Dr.'s office said that the surgical facility ordered the test as they routinely do and the surgical facility said that the Dr. ordered the test. It's football time. So I have to wait until tomorrow to speak to the head nurse at the surgical facility so she can check the records and find out if the Dr. specifically order the test.

  10. #10
    Join Date
    Apr 2009
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    Somewhere near Canada
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    35,894

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

    What I'm getting that is this:

    I have to get labs done every.damn.week at the moment.

    Now, out of every blood draw there is one test that, even though it's my normal lab taking the blood, sometimes it can't actually be done in-house (it's time-sensitive) and must be sent out to a second lab STAT. When this happens, the bill comes from the normal lab, but the lab won't cover it because (I think I'm getting this right - I'll drop a note to cbg) they're not contracted to pay that bit.

    So essentially, Monday's two vials may or may not be completely covered. Same with Wed's labs.

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