Home > SO MAD!!


November 19th, 2014 at 03:32 pm

Yesterday I received a statement from the insurance company saying that we will be getting a bill shortly for some recent lab work, to the tune of $500!!!!

I am so furious. I was told it would be free! Our insurance is suppose to give free lab work, and our doctor personally suggested that place because it was supposed to be covered.

Before we had the tests I even asked the receptionist if we were in network and she said yes. She took our credit card, and said, "well it looks like your insurance covers everything but $35."

I thought that was odd, considering it was supposedly free, but I thought maybe we would just get reimbursed or something. Or it was a co-pay.

Well it turns out... yeah they take our insurance, but they are counted as "out-of-network", which is basically the same thing as not being covered!

Sure enough, I did some digging online. And it lists our healthcare as covered. Then at the very bottom is tiny fine print, it says, "will be counted as out-of-network."

What a bowl full of poo. Apparently this is a common problem with the company, and there is a lot of lawsuits against them.

What do I do? When I receive the actual bill I will be calling the company and giving them a piece of my mind. But how in the heck am I supposed to prove that they told me it was covered? Should I just pay it?


7 Responses to “SO MAD!!”

  1. Miz Pat Says:

    I think you may be stuck. But I also think you should discuss this at length with them and see if they come down on the billing. Also, tell your doctor and everyone about this so they are aware and warn off other patients.

    I share your sense of fury.

    Do you have an HSA? Then you would be paying them with tax free money.

  2. creditcardfree Says:

    I learned long ago that it is better to check directly with insurance when possible before getting services. I would definitely request a discount for paying in full. They may need to check with a manager/doctor before agreeing.

  3. snafu Says:

    Is there a 'class action' lawsuit? I suggest you join the effort. I'd call the receptionist and ask her for an explanation since she confirmed it was part of the network. I'd call the CC and explain the charge is in dispute as this is pretty underhanded. I'd discuss it with the insurer to see if there is anyway of protecting yourselves and determining what is and is not part of their network.

  4. VioletsMoney Says:

    I am currently in the same situation.....only my insurance company is saying that my routine blood work was marked as diagnostic instead of routine. It's only covered if it is called routine. So now I have to contact my doctor and find out why she called one blood test routine and three diagnostic? They should have all been routine.

  5. patientsaver Says:

    I would definitely complain vehemently to the insurance company and see what they could do. I feel that coverage of lab work (or, say, an anesthesiologist if you're going in for surgery) is a big problem these days....while it is easy for policyholders to check on whether a given doctor is part of their network, the average patient has no idea what lab their doctor is going to send their bloodwork to and probably don't have much say in the matter anyway. And if you're going in for surgery, you may meet your anesthesiologist right before you go under, which certainly doesn't leave you much time to make a phone call.

    If they say no, there's nothing we can do, keep persisting and escalate it. Ask to talk to a supervisor. If they still say no, ask them to explain the process of disputing a claim and if you have to, put your thoughts and what happened all down in writing. It may be that, given this has happened before and they are taking heat for it, they may relent on your particular situation. You won't know til you try.

    The whole health insurance payment system is not at all transparent. Not only do patients not know exactly what they are paying for a given service, they do not know how many individual health care providers are involved in their healthcare, or who will be billing them for services (like your anesthesiologist).

  6. Jenn Says:

    PS, what you described happened to me and it's not correct. I have a family member who is both an attorney & a benefits director so he told me to contact the provider. If you go to a hospital (that's in the network) and use the doctor (that's in the network), other charges like radiology, pathology, anesthesiology must be covered as in-network EVEN IF THEY AREN'T. It's called a 'hidden provider'.
    Because as you say, as a patient, you aren't going to interrogate every medical person that touches you. When I gave birth, my anesthesiologist was a 'hidden provider' and charged me full price. When I called them and used that terminology and said "You can't do that.", they corrected the bill.

  7. patientsaver Says:

    Thanks, Jenn, for that info. But if they only corrected the bill when you called to complain, are you sure it's really the law?

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