Hi all,
First time poster here and have been running into some issues with the NPI of the PA that had requested some blood work for me.
I had gone to a clinic in NYC that was under my insurance and the Physician’s Assistant there had requested blood work by a lab that was also in network. The bill from the clinic itself was processed in network (under the group NPI I believe), although the lab bill was not (resulting in an invoice of $1500 to me). Digging further, I found out that the lab is required to bill my insurance under the NPI of the PA as she was the one requesting the blood work when it was processed in the system. That said, i looked up the PA’s NPI, which was last updated in 2009 and stated that she was working in the state of Georgia. This led the lab to bill my insurance in Georgia, and thus being processed as out of network, even though the blood was drawn in NYC and tested in NJ (both labs in network). I called the doctors office who mentioned that the MD’s NPI is supposed to be used as the PA is being supervised by the MD – though note that they are not doing anything to remedy / update this issue, and are consistently ignoring my requests to speak to someone who can fix this.
So now i’m in collections with a $1500 bill to my name, with the doctors office not being cooperative in fixing this and my insurance stating they can’t change anything until lab / doctor updates the initial request. I’m sure it has to be illegal to use a 13 year old stale NPI with incorrect practice information to bill insurance. Do I have any remedies here? Is there anything I can do to fix this? Any information / direction would be really appreciated. Can I threaten legal action on this because of the doctor being uncooperative?
Thank you in advance.
submitted by /u/whosalil
[link] [comments]Hi all, First time poster here and have been running into some issues with the NPI of the PA that had requested some blood work for me. I had gone to a clinic in NYC that was under my insurance and the Physician’s Assistant there had requested blood work by a lab that was also in network. The bill from the clinic itself was processed in network (under the group NPI I believe), although the lab bill was not (resulting in an invoice of $1500 to me). Digging further, I found out that the lab is required to bill my insurance under the NPI of the PA as she was the one requesting the blood work when it was processed in the system. That said, i looked up the PA’s NPI, which was last updated in 2009 and stated that she was working in the state of Georgia. This led the lab to bill my insurance in Georgia, and thus being processed as out of network, even though the blood was drawn in NYC and tested in NJ (both labs in network). I called the doctors office who mentioned that the MD’s NPI is supposed to be used as the PA is being supervised by the MD – though note that they are not doing anything to remedy / update this issue, and are consistently ignoring my requests to speak to someone who can fix this. So now i’m in collections with a $1500 bill to my name, with the doctors office not being cooperative in fixing this and my insurance stating they can’t change anything until lab / doctor updates the initial request. I’m sure it has to be illegal to use a 13 year old stale NPI with incorrect practice information to bill insurance. Do I have any remedies here? Is there anything I can do to fix this? Any information / direction would be really appreciated. Can I threaten legal action on this because of the doctor being uncooperative? Thank you in advance. submitted by /u/whosalil [link] [comments]Read Morer/HealthInsurance