Denied Claim

[cerspamer]

What is the name of your state? Nebraska.

I am preganant and am going to an OB that is covered under my HMO. My OB sends all lab work to another facility. My insurance company is refusing to pay for the lab work due to the lab not being part of the network. I have no choice as to where my doctor sends my labs. Can they deny this claim and what can I do to legally to get this resolved.

 

[JETX]

Instruct your doctor to send the labwork to an 'in network' facility. If he doesn't, then you have a choice to make...
Change doctors (to one that will) or
pay the extra cost for the out-of-network labwork.

Simply, the insurance company is under no obligation to pay for the work done out of their network. However, most insurance plans (in my experience) do allow out of network billing... but at a set rate. If this is in your case (as I presume), then you would be liable for the difference between the set out of network rate and the actual billed rate.