What is the name of your state? NJ
My health insurance is Horizon Blue of NJ. I have a Basic EPO, which turns out to be the same as an HMO. I never knew that because all the info from Horizon never mentions the term HMO. My health insurance card has the PPO logo on it, so I made the mistake of going to a doctor who was listed under PPO coverage but doesn't participate in the HMO.
I called the doctor's office to tell them my health insurance coverage. They said they were in the network & collected my $30 copay at the office. I had a physical & a lot of blood work was done. The lab work was handled by Quest. It turns out that Horizon Blue of NJ only covers lab work done at Lab Corp. I was not asked where to send the blood work, nor was I informed as to who was doing it. I thought the doctor's office should know if they were in-network or not, and that they would send my lab work to the correct lab. I was wrong.
I eventually settled the doctor's bill at a "cash" rate because Horizon wouldn't cover it. It was only after incurring lots of bills that I was informed to the fact that the EPO was really an HMO & Horizon refused to pay.
I just received an EOB for $1800 worth of lab work done by Quest & which Horizon won't pay. If the work isn't done by Lab Corp, they will not pay for it, they said. Now I am frantic because of this huge lab bill. I have not received a bill yet for Quest, but now that they have been denied by the insurance company, they will surely come after me.
Do I have any options other than paying the lab bill in full? The doctor's office led me to believe they were in-network by telling me so on the phone when I made the appointment and by collecting my copay. They sent the blood work to a lab of their choosing, not of mine. I feel very helpless because this is an awful lot of money for me to owe.
Would Quest accept less than the full amount? Is the doctor's office in any way responsible for this situation? I feel as if they erred by telling me I had coverage & then sending my lab work to Quest.
I am sick to my stomach over this situation & I would really appreciate any advice you can give me on this matter. By the way, the doctor's office is in New York because that's where I work. Horizon's HMO says they do not cover doctor visits outside NJ unless it's an emergency - another thing they didn't clarify when I purchased the policy.
Thank you in advance for any help you can give me.What is the name of your state? NJ