but having recently went to an ER near Leo-Cedarville, I thought I would share this.
Last month, I had to make an emergency trip to the ER as I thought I was having a heart attack. I'm a healthy person with a good blood pressure and good choloestrol and younger than 50 so I couldn't believe I was having one. Thankfully, it turned out I just had Pleurisy. The pain that causes makes you think you are having a heart attack, but to be safe, it's always better to get it checked out.
Anyhow, now that we are a month past, the bills from the visit are coming in. Having worked 10 years in the Medical field before my oldest was born, I know that sometimes things get billed in error and things happen.
Yesterday I received two bills. One from the hospital for the ER visit and then one from the LABORATORY! To backstep a bit, our insurance company is through one of the major insurance companies as my husband works for a large corporation. We pay so much out of his check his month for our insurance and we are suppose to have a good plan. According to our insurance paperwork, if you go to the ER, you are only responsible for your co-pay. So that would make one believe that you would only get a bill for that visit and only for your co-pay, correct??
Well, that's not the case! In addition to our hospital bill, we got a bill from the laboratory billing company.
For the past year, I have had to call our insurance company several times due to billings and denials that make no sense. Especially after they changed our plan and coverage last July without much warning. I'm guessing they have probably flagged our account that I'm a crazy lady who will call in about every claim that is denied. Yes, I will call in. I know what our plan covers and what it doesn't. I don't like games. Process our claims accordingly and follow the guidelines our insurance has. What is the problem?
When I called the insurance company, the rep I talked to, transferred me almost immediately after I told her who I was and she pulled up the account and told me she would transfer me to the Resolution Department.
The rep in the Resolution Department explained to me that the Drs part of the visit is billed by a separate company and isn't included on the ER charge portion. And that this charge was for the lab work that was ordered by the ER doctor and it was DENIED because the laboratory that processes the labs and the pathology at this hospital ISN'T IN OUR NETWORK! Say what? This is one of the largest hospitals in our area. Our insurance company is a very large insurance company and this laboratory isn't in our network? What is up with that?
So of course then I'm getting upset and I told her that that isn't fair. Is it getting to the point to where insured people have to stop treatment in the ER to ask what lab everything will be processed through and to call our insurance company to make sure they are a covered lab? SERIOUSLY?
She told me they would resubmit this claim for review and will let us know within 30 days the result. Now I get to call the billing company and let them know the insurance company is reprocessing the claim and I'm not paying anything until I see what the insurance company pays.
This is the second time I have dealt with this laboratory billing company in the past six months. They recently sent us a bill for pathology services from a surgery my youngest had to have done. Since they are out of network, our insurance didn't want to pay for the normal tissue testing that is ALWAYS DONE WITH THIS SURGERY. Thankfully after several phone calls, they did reconsider the charges and paid the majority of the bill except for our co-insurance amount.
The point of this post is that something has got to change when a large hospital uses a laboratory to process laboratory work for them that isn't in no ones network. What it is doing is making people who are insured pay more then what they expect to pay and that isn't fair.
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