A few months ago I took an optional genetic test which I understand is standardly done by pregnant women (the NIPT). My doctor by default was going to run the test with an out-of-network lab, who told me they had an arrangement where I’d only have to pay ~$100 out of pocket, instead of the full out-of-network cost.
I found out that Labcorp runs the same test, and I called up Labcorp and they confirmed that the test would be considered in-network and all costs would go towards my deductible and OOP costs. So I decided to do the test with Labcorp so that the costs could get included in my OOP max etc. (I’m expecting to hit my OOP max for the year anyway, so this cost would be wrapped up in that.)
I got the test done with Labcorp, and they billed over $1,000 to my insurance, who denied the claim. I called up my insurance to discuss, and they said that in order for the test to be covered, I would have needed prior authorization, which I did not have, and do not qualify for. This was never mentioned to me by Labcorp when I called to confirm coverage. I’m wondering if there is anything I can do to contest this bill, since I only went ahead with the test as I was under the understanding that it would be covered as an in-network test, as per my phone conversation with Labcorp. I haven’t gotten the bill yet but I’m nervous that I will.
One other thing to note – in the EOB for the denied claim, it says “PAYMENT FOR THIS SERVICE IS DENIED. A NETWORK PROVIDER MAY NOT BILL YOU UNLESS YOU GAVE WRITTEN PERMISSION BEFORE YOU RECEIVED THE SERVICE.” The representative I spoke to at my insurance believes that this refers to the prior authorization needed from the doctor, but I am skeptical because the verbiage here says “you”, i.e. me — that I would have needed to provide written permission. When I went into Labcorp for the test, they had me sign a page that said that my out-of-pocket costs might be up to ~$200, but that is the only written “permission” they obtained from me. Since they did not receive other written permission, could that be a reason to appeal the bill?
Thanks for reading and answering! Happy for ideas on the best way to contest this if I do get billed.
submitted by /u/sallygeorgia
[link] [comments]A few months ago I took an optional genetic test which I understand is standardly done by pregnant women (the NIPT). My doctor by default was going to run the test with an out-of-network lab, who told me they had an arrangement where I’d only have to pay ~$100 out of pocket, instead of the full out-of-network cost. I found out that Labcorp runs the same test, and I called up Labcorp and they confirmed that the test would be considered in-network and all costs would go towards my deductible and OOP costs. So I decided to do the test with Labcorp so that the costs could get included in my OOP max etc. (I’m expecting to hit my OOP max for the year anyway, so this cost would be wrapped up in that.) I got the test done with Labcorp, and they billed over $1,000 to my insurance, who denied the claim. I called up my insurance to discuss, and they said that in order for the test to be covered, I would have needed prior authorization, which I did not have, and do not qualify for. This was never mentioned to me by Labcorp when I called to confirm coverage. I’m wondering if there is anything I can do to contest this bill, since I only went ahead with the test as I was under the understanding that it would be covered as an in-network test, as per my phone conversation with Labcorp. I haven’t gotten the bill yet but I’m nervous that I will. One other thing to note – in the EOB for the denied claim, it says “PAYMENT FOR THIS SERVICE IS DENIED. A NETWORK PROVIDER MAY NOT BILL YOU UNLESS YOU GAVE WRITTEN PERMISSION BEFORE YOU RECEIVED THE SERVICE.” The representative I spoke to at my insurance believes that this refers to the prior authorization needed from the doctor, but I am skeptical because the verbiage here says “you”, i.e. me — that I would have needed to provide written permission. When I went into Labcorp for the test, they had me sign a page that said that my out-of-pocket costs might be up to ~$200, but that is the only written “permission” they obtained from me. Since they did not receive other written permission, could that be a reason to appeal the bill? Thanks for reading and answering! Happy for ideas on the best way to contest this if I do get billed. submitted by /u/sallygeorgia [link] [comments]Read Morer/HealthInsurance