The insurance didn't pay lab bill.

mayerinate · Post by **mayerinate** » 23 Jan 2007 09:18

I have Aetna In Network Point Of Service health insurance through work . About 3 months ago I went for a physical exam . I had a physical a year ago as well but i never had blood work done . All i had was a pap smear test.( I assume a phisical exam is supposed to have at least a basic blood work.??) Anyway, this time i mentioned to my doctor that my hair had been thinning and falling out like crazy and over the last couple years i lost about 50% of it. She sent me to take a blood test for TSH. Later on i got a bill from the lab for $ 15.00 . A month later i got an explanation of benefits letter from my insurance that the lab may biil me $300.00 and that the insurance paid only $31.00.It said $300.00 was pending or not payable as charges to be experimental or investigational and excluded from coverage under my plan.... Today i got a bill from the lab for $300... I dont understand why i have to pay it . Sorry if i sound stupid, but as far as I understand anytime I'll have some health concerns and will need some tests i won't be covered? is that right? It doesnt make any sense to me of having a health insurance.. Is there anyway to appeal that? And why then the first bill from the lab was only $15.00 and it said the rest was covered? Could someone explain ,please,what i shoud do ? Even if i call the insurance what shall I say to make them pay? Thanks for any suggestions.

SK · Post by SK » 23 Jan 2007 15:27

Скажите, что анализ был запрошен врачом, и что TSH никак не может считаться экспериментальным тестом. Попросите врача подтвердить lab order.
Что касается разницы сумм - да, тарифы, по которым страховка платит провайдерам, в разы ниже, чем "list price"

Lil'Yul · Post by **Lil'Yul** » 24 Jan 2007 02:28

1. Сначала убедитесь, что ваш анализ был отправлен в лабораторию, которая входит в network. В США в основном анализы не делаются в маленьких врачебных оффисах, а посылаются в большие лаборатории.

2. Выглядит, как будто лаборатория сначала запросила только co-payment, а потом по неизвестной причине потребовала оплаты по out-of-network тарифу. Одной из главных причин может быть их ошибка.

3. Позвоните в вашу страховку и уточните все данные - если лаборатория входит в network, они не имеют права требовать никакой дополнительной оплаты, за исключением co-payment.

4. Позвоните в лабораторию и узнайте, если у них есть какие-то проблемы со страховкой.

Звучит абслютно по-идиотски, но везде сидят достаточно примитивные клерки и делают дурацкие ошибки.

mayerinate · Post by **mayerinate** » 24 Jan 2007 10:35

Ok , I called the insurance and they said that yes it did denied the claim from the lab because the test was in fact experimental and that it was determined by the insurance what test are considered experimental and which are not. They suggested to appeal the decision .. Then I called the lab to let them know that wouldn't pay the bill untill I hear back from my insurance .Just in case I asked them the exact test code for the blood work that had been performed and they said that insurance DID pay for the blood test and it's the Papsmear test that the insurance is refusing to pay.I was like "WHAT"? It covered it before......So, I guess my doctor submitted a Pap with HPV level in it, which I wasn't even aware of... .. Then I called the doctors office and asked why i got this test done cuz a year before it was just a normal test and they were like "...well, did you request it?" No, I didn't request it and I didn't even know it was being done until today and my insurance won't pay for it. "...well you have to talk to your insurance.." So is it Ok for PCP to do sthg like that without even letting a patient know? Because I went for a once a year routine exam and ended up getting sthg else. It seems like a circle with now way out. Is it even worth appealing or might as well pay and save myself time af talking on the phone with insurance ? if anybody had a similiar experience ,share you thoughts and suggestions...It's like now I have to call the insurance again and say"Oh, sorry I was bitching yesterday about one thing, but today I found out its completely another thing... bla,bla,bla,." It's just ridiculous that i didn't even know what freaking tests I was getting going to the routine check up. Very mad about paying $300.00 and very frustrated .Any thoughts?

Lil'Yul · Post by **Lil'Yul** » 24 Jan 2007 13:23

HPV тест в настоящее время не считается экспериментальным - он разрешен FDA и широко используется. Он является обычным screening test для женщин старше 30 лет.
Так что есть вероятность, что если бы младше 30, страховка не хочет платить.

Посмотрите на линке http://www.thehpvtest.com/over-30/HPV-t ... tml#canhpv

uncle_Pasha · Post by **uncle_Pasha** » 24 Jan 2007 14:16

mayerinate wrote:is it Ok for PCP to do sthg like that without even letting a patient know?

Нет, это ненормально.
Вы имеете право
- expect diagnosis, prognosis, and methods to be explained clearly.
- have an opportunity to participate in decisions related to your health care
- refuse treatment against your doctor's advice

Тем не менее, надо иметь ввиду, что заполняя стандартную форму в офисе у доктора, вы вполне могли подписать какую-нибудь гадость написанную мелким шрифтом, которая может осложнить вам жизнь.
Обычно добиться оплаты спорного била от страховки куда проще, чем добиться от офиса доктора извининий, а уж тем более анулирования счета.

Удачи!

Sashylya · Post by **Sashylya** » 24 Jan 2007 14:56

У нас было такое, только на 8К. Госпиталь присылал биллы, а страховка говорила что все оплатила :pain1:

. По совету американцев с работы :fr:

мы попросили прислать расшифровку у госпиталя за что с нас хотят денег прямо по пунктикам. Продолжалось это три месяца :angry:

, каждую неделю по письму от госпиталя. Каждая расшифровка была разной, пункты те же, а оплаты разные :angry:

. В конце концов счет уменьшился до $200 на етом и сошлись.
Через шесть месяцев госпиталь вернул нам наши 200, причем сами :great:

.