Out-of-network service

debodun

debodun

SF VIP
Location
way upstate in New York, USA
I go to a doctor that accepts my health insurance. However, if she needs a blood test or other diagnostic service, she sends the sample to a lab that my insurance doesn't cover. The last time that happened, I ended up owing the out-of-network lab close to $500! I've asked her if this happens again to write a prescription so I could go to a "participating provider" and have the work done. She refused saying that she only deals with this laboratory. Why is my doctor so set on having one lab do the analysis? What else can I do?
 

Why is my doctor so set on having one lab do the analysis? What else can I do?
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The First thing you might try would be to contact your Insurance Company, and see if there are any doctors in their network who also use lab services covered by your insurance company. You may have to change doctors, but if the co-pays, etc., are becoming a burden, changing doctors might be your best option.
 
This happens to a lot of people.. I have no idea why your doctor is so insistant on that lab. Most understand the craziness of insurance coverage and are willing to work with the patient. The word "kick-back" is creeping into my mind...or maybe she owns the lab? but who knows. The only thing you can do is find an in network doc who will be willing to let you go to an in network lab or hospital lab for blood work.. MY PMC doc likes to use his own lab, but understands that I can go to the hosptial I work at and have no co-pay or out of pocket for blood work. So I get a script from him and do just that.
 

It seems to me that one lab should be as good as any other - they all have to meet certain "quality controls" or they'd be shut down. The lab my doctor works with is in the hospital with which she's affiliated. My insurance is 2-part which means one part pays for out-patient doctor office visits and the other is for in-patient hospital. It may confuse the insurance when a hospital lab does the work. That's like hospital out-patient service which isn't covered.
 
Butterfly said:
My doc just gives me an "order" and I take it where I want to. I'd change doctors if I ended up paying huge bills every time I get routine lab work done.
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Here is our problem with that. Living in a sprawling, 7th. largest county in the U.S., only one or two providers are willing to provide coverage here. And, the list of doctors participating, or accepted by the plans, is very meager. My wife has the same problem as the OP here. I have no problem, as my new Dr. draws the blood, sends it off to some lab somewhere, I get results, costs me nothing. imp
 
I got a big whopping bill from a lab for a biopsy once that was sent to a non-participating lab. I argued with my insurance company that as #1 I hadn't anticipated that there would BE a biopsy and #2 I was under anesthesia at the time and wasn't in a position to say "hey, make sure you send that unexpected biopsy to a participating lab", that it should be paid. Thank goodness, the insurance company negotiated a price with the lab and paid the bill. They said they'd smack the doctor's hand for not sending the sample to an approved lab.

Now I know to ask all the questions and make sure anything that might possibly happen happens correctly.
 
I'd try telling the doc I just couldn't afford to have the blood tests sent to an out of network lab and I wasn't going to have the blood drawn (or whatever) for that reason, and see if that had any effect on his/her decision. If he practices in a group practice, I'd complain to the management and see if they would convince him. Sometimes group practices are more interested in not losing a patient than an individual doctor is. If that fails, I'd call the insurance carrier and see if they can convince him to use a network lab or threaten to drop him as a network provider.
 

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