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Insurance not paying lab bill



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amother
Purple


 

Post Sun, Oct 15 2017, 10:21 pm
Sorry if long.

My kid has a diagnosed hearing loss, and we were sent for some genetic testing.

Lab took script, did the test and billed insurance. Claim denied, now they're billing us.

Insurance denied payment claiming test is investigational/experimental.
Insurance policy specifies that this test is considered medically necessary and is covered for patients with hearing loss.

I've been going back and forth with insurance for several months.
First they wanted letter from dr confirming diagnosis (despite the fact that it was written in the script). They said that an authorization was necessary (how come lab didn't mention it?), and they would issue one retroactively.
For the record, kid was diagnosed a long time ago, and insurance had been covering her hearing tests and other related services; so it's not like they didn't have her diagnosis.

I got Drs office to send them a letter. Then insurance wanted my permission to have the dr appeal on my behalf. Before they didn't mention it would be an appeal, just authorization.

Now they sent me a letter denying appeal and claiming they had requested information from doctor, and received insufficient info.


What do I do now?

Thank you!
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tichellady




 
 
    
 

Post Sun, Oct 15 2017, 10:36 pm
No advice but totally feel for you. Sounds so frustrating! I have been on other end, representing the doctor when the insurance won’t cover basic things and it’s so ridiculous!
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RebekahsMom




 
 
    
 

Post Sun, Oct 15 2017, 10:37 pm
Definitely appeal as many times as necessary. You may even need to go to mediation. Call the insurance company and ask what specific medical info they need from your doctor, and request he send them that.

Also, ask the doctor to send copies of that information to you. Some insurances are notorious for “not receiving” the requested info and delaying their decision. There’s something very satisfying about telling them “please give me your direct line. I will call you before I fax it this afternoon to make sure you receive it”.

Good luck.
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amother
Purple


 

Post Sun, Oct 15 2017, 10:41 pm
tichellady wrote:
No advice but totally feel for you. Sounds so frustrating! I have been on other end, representing the doctor when the insurance won’t cover basic things and it’s so ridiculous!

Tichellady, from your experience would you say lab has to be involved and willing to help? After all, they didn't ask me for anything other than the script and insurance info.
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amother
Purple


 

Post Sun, Oct 15 2017, 10:45 pm
RebekahsMom wrote:
Definitely appeal as many times as necessary. You may even need to go to mediation. Call the insurance company and ask what specific medical info they need from your doctor, and request he send them that.

Also, ask the doctor to send copies of that information to you. Some insurances are notorious for “not receiving” the requested info and delaying their decision. There’s something very satisfying about telling them “please give me your direct line. I will call you before I fax it this afternoon to make sure you receive it”.

Good luck.


That's the thing: they first wanted just a confirmation of diagnosis.
Then switched their tune from "retroactive authorization" to "appeal."
I feel insurance is either playing games or they don't knwl what they're doing. Btw, it's horizon of nj.

Dr sent me the copy of their letter.
I'll follow up with Drs office tomorrow, they appear to be willing to help.

Legally, what is my recourse? I also don't want bill to go into collection while this mess is being sorted out. It's around $760, so I'm not really jumping to pay it; in the meantime it's taking months.
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tichellady




 
 
    
 

Post Sun, Oct 15 2017, 11:05 pm
I’m not sure I have great advice but I would ask the practice if you can get the contact info for their account manager from the lab company. Often the client services people are better to deal with then than the people you get when you call the 1800 number and can communicate within the different departments to find some sort of resolution. I turn to our account manager when there are weird billing issues from insurance. I’m not sure how much you can help if it’s all an insurance issue, but it would be likely that the account manager would be able to drastically reduce the bill ( we got a bill for $1400 down to about $300).
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amother
Purple


 

Post Sun, Oct 15 2017, 11:25 pm
Tichel lady, thank you for advice, I'll try to do that too.
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amother
cornflower


 

Post Sun, Oct 15 2017, 11:28 pm
appeal, appeal, appeal.

For sure call the lab and speak to the billing people and explain the situation and ask if you can have an extension for paying the bill and also ask what will happen if you don't pay on time. I don't think they have anything to do with this mess or at fault in any way so I'm just advising you to let them know in order for them to know why you are late in payment and to make sure it wont have a negative impact on you.

Ask to speak to someone higher up in the insurance company. The people who answer the phones often give conflicting info IME. Keep calling the dr. office and ask for all the annoying things the insurance co. is asking for. Call the insurance company and ask for specifically what they meant when they said that not sufficient info was given. Hopefully you'll get someone helpful eventually.
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RebekahsMom




 
 
    
 

Post Sun, Oct 15 2017, 11:38 pm
amother wrote:
That's the thing: they first wanted just a confirmation of diagnosis.
Then switched their tune from "retroactive authorization" to "appeal."
I feel insurance is either playing games or they don't knwl what they're doing. Btw, it's horizon of nj.

Dr sent me the copy of their letter.
I'll follow up with Drs office tomorrow, they appear to be willing to help.

Legally, what is my recourse? I also don't want bill to go into collection while this mess is being sorted out. It's around $760, so I'm not really jumping to pay it; in the meantime it's taking months.


Funny- it was Horizon that “never received the information”. In their worst case with me, they paid/ took back/ paid at a different rate 7 times on a visit. (Multiplied by dozens of visits that year). They’re quite clueless, and they aren’t going to do you any favors to pay your bill. Which is why I said fight/ appeal/ do it all again.
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amother
Salmon


 

Post Mon, Oct 16 2017, 1:03 am
tichellady wrote:
I’m not sure I have great advice but I would ask the practice if you can get the contact info for their account manager from the lab company. Often the client services people are better to deal with then than the people you get when you call the 1800 number and can communicate within the different departments to find some sort of resolution. I turn to our account manager when there are weird billing issues from insurance. I’m not sure how much you can help if it’s all an insurance issue, but it would be likely that the account manager would be able to drastically reduce the bill ( we got a bill for $1400 down to about $300).

I strongly agree. Team up with the lab and they may be willing and able to put some muscle into fighting the insurance company. Also, if you demonstrate to the lab that you're taking the bill seriously, they are less motivated to send the account to collections.
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amother
Purple


 

Post Mon, Oct 16 2017, 2:10 am
RebekahsMom wrote:
Funny- it was Horizon that “never received the information”. In their worst case with me, they paid/ took back/ paid at a different rate 7 times on a visit. (Multiplied by dozens of visits that year). They’re quite clueless, and they aren’t going to do you any favors to pay your bill. Which is why I said fight/ appeal/ do it all again.


Thank you for the encouragement, as I feel quite distraught and helpless fighting against them. They're breaking their own policy, yet they technically have an upper hand. I'm not clear on how to "make" them reconsider, other than get into some legal battle. Basically, I'm convincing them they should pay- why should they agree, no?

Strangely enough, in previous smaller cases they advised me how to get a service rebilled, or adjusted claims and paid them.
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amother
Purple


 

Post Mon, Oct 16 2017, 2:11 am
amother wrote:
I strongly agree. Team up with the lab and they may be willing and able to put some muscle into fighting the insurance company. Also, if you demonstrate to the lab that you're taking the bill seriously, they are less motivated to send the account to collections.


I'll try to speak with them tomorrow.
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saw50st8




 
 
    
 

Post Mon, Oct 16 2017, 7:54 am
Do you get your insurance through your job? If so, get the benefits department to help.
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vicki




 
 
    
 

Post Mon, Oct 16 2017, 7:59 am
Keep playing their game and get politely indignant when you speak to them on the phone. Remind them that they already have this information. Remind them that they asked for different information last time. Remind them you've been at this for xx months now. Remind them that they've changed their denial reasons.
You'll get that money yet.
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amother
Mint


 

Post Mon, Oct 16 2017, 7:04 pm
amother wrote:
Sorry if long.

My kid has a diagnosed hearing loss, and we were sent for some genetic testing.

Lab took script, did the test and billed insurance. Claim denied, now they're billing us.

Insurance denied payment claiming test is investigational/experimental.
Insurance policy specifies that this test is considered medically necessary and is covered for patients with hearing loss.

I've been going back and forth with insurance for several months.
First they wanted letter from dr confirming diagnosis (despite the fact that it was written in the script). They said that an authorization was necessary (how come lab didn't mention it?), and they would issue one retroactively.
For the record, kid was diagnosed a long time ago, and insurance had been covering her hearing tests and other related services; so it's not like they didn't have her diagnosis.

I got Drs office to send them a letter. Then insurance wanted my permission to have the dr appeal on my behalf. Before they didn't mention it would be an appeal, just authorization.

Now they sent me a letter denying appeal and claiming they had requested information from doctor, and received insufficient info.


What do I do now?

Thank you!

Just had the exact same thing today but was with labcorp and was a stool test for my dd. We were not told that it wasn’t covered by the lab or the doctor. Our broker is fighting it for us
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