Will labs bill insurance separately after a set amount of time?

Question

Short background: Had a well patient checkup on 8/20/07 which included a blood draw and a UA. Insurance info was incorrect initially, provider rebilled correct insurance, eligibility needed to be confirmed, and here we are almost a year later.

Now instead of one claim by my provider, there are two: an additional coming from the lab where the tests were run. My insurance plan at the time covered labs ordered by the physician, yet these are being denied.

Do labs eventually jump the PCP and bill directly if they are not paid, or is it always two separate claims? How come my insurance co does not recognize that these were done on site at my PCP office and were ordered by him?

Answer 1

Yes, they will eventually bill the patient, for services rendered, if the insurance doesn't pay.

Likely, your insurer requires them to submit the bill within six months of the service date.  If they didn't, YOU pay for it, or the lab eats it.

Answer 2

I think the insurers use a "shotgun" approach to billing for services.  Without going through your history of the claim, I just think if you have adequate money the best approach is to pay your do-pay and forget about it.  You may get a refund check.  It is just a matter of keeping a solid relationship with your medical provider vs. a fight over small amount of money.  Physicians are in for the money. Do not think your doctor has your health as the first concern in the medical practice.  It is not fair in your mind; but, it is not worth the loss sleep and working the phones where you get a voice mailbox.  It is just part of monopoly the doctors have over medical care and an improvement over Canada and U.K. plans.

Answer 3

Labs generally are billed separately.

The blood may be drawn in your PCPs office, but generally they have a lab company actually run the test.

When the lab company bills the claim, there is a "place of service" code that indicates where the services were performed.  That should indicate to the insurer that the labs were done in the doctor's office.

If your insurer is denying the lab claim stating that it wasn't done in the doctor's office, you may want to confirm that the correct place of service was indicated on the claim.

Also...the lab gets your insurance information from the doctor's office, so it makes sense that they wouldn't have been able to bill your claim until your doctor's office got correct insurance information.

P.S.  Or is the problem that your doctor sent the labs somewhere that's not in your network?  That can happen too - one more question to ask when you're trying to figure out why the claim wasn't paid.