Many patients with health insurance think that when they go to a laboratory their doctor sends them to for blood work or other tests, the lab is surely in-network. After all, the doctor is in-network, right? No. It’s a puzzling maze that the best of us get trapped inside at times.
I’ll give you a personal example. According to one rather crazy insurance rule of my specific plan, I can have blood drawn at my doctor’s office and sent to Lab A that’s not in network and it will be covered 100%. However, if the doctor sends me downstairs to the same Lab A, then it’s out of network since the doctor’s office didn’t draw the blood themselves. I spent nearly an hour on the phone with my insurance this morning to figure that one out.
It gets even worse since most specialist offices are sending patients out to labs (often in the same building) to get blood work. Have you noticed that only general physicians tend have in-office labs these days?
So, before you go to your next doctor’s appointment that may involve lab work, some tips for you:
- Verify which labs are in your network. If your plan has recently changed, verify this again.
- Write down and save the date you called and the name of the person you talk with. Administrators typically save all of this info in their phone logs, but it’s up to you to advocate for yourself.
- Ask about any specific coverage rules that may apply regarding your doctor’s office sending labwork versus you going to a lab.
- If your insurance is about to change, verify when calling about coverage that the person you’re speaking to is looking at the correct plan for your anticipated date of service.
Do you think that last tip is a bit too cautious? It’s not. I’ll give you a short version of my story. My health insurance plan is changing on January 1. I called my insurance in November to ask why two of my lab visits were out of network. I was told that was a mistake and that the lab I was going to was an in-network lab. I asked twice: “Are you sure? I’m going back there for another visit.”
I was assured that the lab I was going to was an in-network lab. Not so. I found out today that it was really out of network after all and I’d have to pay for all the visits. The person I was talking with was looking at my future coverage plan, not the current one. Of course, when I complained that I had been given the wrong info, I was reminded of the telephone disclaimer about benefits being paid at the time of processing, not based on the phone call.
I was told I’d have to appeal in writing, but I insisted on speaking to a supervisor who may or may not take care of me. I’m still waiting on that call.
Do you find it difficult navigate through the swamps of in-network or out-of-network services?
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Post from: Blisstree