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Should a Company Check on In Provider Network?
I had knee surgery in Sept and in Nov it became infected. I had to have the partial knee removed and a PICC installed. After three weeks, I was released to a home care agency. They came out once a week, change he dressing and drew some blood. However, I did not find out until it was too late that they sent it to Quest Diagnostics which is out of network. LabCorp is my preferred provider.
Of course this happened around the time that my new year (15 Dec) started. So paying $500 co-pay for things, $1,000 coinsurance and then I find out $2,000 for the out of network provider
I am in Colorado and I have been looking thru the DOI to see if it is the health care agency to check on this. I have called them many times, but they do not return my phone call.
If you have a state code or something for me to reference, that would be great!
Thank you!
After speaking to the insurance company, the home health care agency, and an attorney, the home health care agency should have checked - they admitted they did not even bother. The home health care agency is going to take care of the bills. The insurance company said they will usually do a one time administrative decision. And usually the insurance company will call the provider to tell them that they were sending them to the wrong place.
I would hope the provider would check, I understand the insurance business quite a bit and I keep up with it as much as I can. But the home health care agency admitted they should have asked me and checked since they were sending the blood to the lab, I was not going to the lab because I was homebound.
So it is somewhat 50/0, yes, you should know of course. But since the did not ask me it falls on their shoulder.
I called the home health care agency - they said they should have asked me what lab company I used since I was not going to the facility. The insurance company said they will sometime do an administrative adjustment and make sure I go to an in-network provider. But since I was home-bound, that fell on the home health care agency and they are taking care of the bills.
Which helps because my new year started on 15 Dec and they started submitting everything to Quest, which I have a $2,000 deductible. My in network is $500 and then 20% up to $1,000 (so $1,500).
Since I did not go to the (wrong) lab, the agency is taking care of it.
5 Answers
- Anonymous8 years ago
first off it is your responsibility to know your health insurance plan, not the doctors. second call your insurance company and tell them that it was out of your control. ask them if they provide coverage for a blind provider. tell them the nurse sent it to quest and not lab corp and see if they will cover it. the worse they will tell you is no....but if you read the paperwork from the insurance company you do have the right to appeal their denial
- StephenWeinsteinLv 78 years ago
No. If any checking has to be done, then you should do it yourself. The company is not required to do it, and it is doubtful whether they are even allowed to do it.
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