What is the name of your state (only U.S. law)? Virginia
Hello all! I was hoping that someone could give me an advice on the following situation.
A month ago I went to OB for an annual checkup. During the visit she offered a prenatal testing because I mentioned that I m thinking about having a baby. The test includes some genetic testing. I addressed my concern about gen tests being expensive (as I heard) and she said that the very basic one always are covered by insurances. So I agreed. They took my bloodwork right there at the office and then sent them to another lab that did the tests.
A couple of weeks later I found out that the lab submitted a claim to my insurance for over $4000. At some point I called the insurance (worrying that the claim took long time to be processed - it's still under processing). They told me that at this time my patient responsibility is about $200 (which is fine). But they also told me, that they did not pay for gen tests and those amounts have been added to negotiated thing, because the health provider did not obtain prior authorization and technically it's their fault.
Now my question is the following. I have Cigna PPO. The doctor who prescribed tests is out-of-network, but the lab is in-network. My insurance policy states that for in-network it's the health professional should obtain prior authorizations. And for out-of-network - it's my responsibility.
So at this point I m confused - was it my error or the lab who did the tests should have obtained that authorization?
I am completely lost and stressed now. As being new to the whole system (foreigner) I kind of relied on doctor's confidence about telling that basic gen tests are covered. And I do not know what to do, if the lab will decide to bill me for the amount that has not been paid for those genetic tests, because it will be over $2000.
Please, any advice is appreciated.
Hello all! I was hoping that someone could give me an advice on the following situation.
A month ago I went to OB for an annual checkup. During the visit she offered a prenatal testing because I mentioned that I m thinking about having a baby. The test includes some genetic testing. I addressed my concern about gen tests being expensive (as I heard) and she said that the very basic one always are covered by insurances. So I agreed. They took my bloodwork right there at the office and then sent them to another lab that did the tests.
A couple of weeks later I found out that the lab submitted a claim to my insurance for over $4000. At some point I called the insurance (worrying that the claim took long time to be processed - it's still under processing). They told me that at this time my patient responsibility is about $200 (which is fine). But they also told me, that they did not pay for gen tests and those amounts have been added to negotiated thing, because the health provider did not obtain prior authorization and technically it's their fault.
Now my question is the following. I have Cigna PPO. The doctor who prescribed tests is out-of-network, but the lab is in-network. My insurance policy states that for in-network it's the health professional should obtain prior authorizations. And for out-of-network - it's my responsibility.
So at this point I m confused - was it my error or the lab who did the tests should have obtained that authorization?
I am completely lost and stressed now. As being new to the whole system (foreigner) I kind of relied on doctor's confidence about telling that basic gen tests are covered. And I do not know what to do, if the lab will decide to bill me for the amount that has not been paid for those genetic tests, because it will be over $2000.
Please, any advice is appreciated.