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Heath Insurance Claim
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LTex
Posted 4/20/2022 14:57 (#9623067)
Subject: Heath Insurance Claim


West Texas
Had a family member that had a biopsy done last June 2021 in the Hospital (in network hospital). Insurance came back and denied the biopsy lab bill due to not getting preapproved. Hospital bill was covered. I went thru 3 rounds of appeals and ended up in the outside independent review. I won my appeal and the letter said the insurance provider had to pay the claim. This was done back in October 2021.

Got a letter from the lab a week ago claiming the bill had not been paid and I owed close to 5K. Called insurance provider and they claimed they did not have the 3rd party letter saying they had to pay, so I sent that to them. Now they claim the lab was out of network so they will not pay that claim. I don't control where the hospital sends biopsy's to so why should I be forced to pay for out of network services since that lab has been in network for the previous 4 years we have been dealing with everything. Insurance claims providers change all the time due to fee and contract negotiations. I think a law was passed that said a doctor practicing at an in network hospital had to also be in network but does that law not say labs sent off by the hospital do not fall under the same category.

Anyone have an idea how else to fight this claim? Seems like a very convenient way to get out of paying claims.
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