patients' rights to make informed decisions??

[wallywally]

What is the name of your state? California

I visited my doctor recently and she orderd some lab work to be done on me. I was given an order form to XYZ Lab and asked to go there for my lab work. Without knowing that I had a choice to go to any other lab, I went to XYZ lab. I presented my insurance card at XYZ lab. My card clearly states the insurance carrier, group #, and phone number to call for authorizations. It says on it "FOR AUTHORIZATIONS CALL: zzz AT 123, SEND CLAIMS & INQUIRIES TO: YYY". I presented the card and the receptionist at XYZ Lab made copies of the card and asked me to wait. After about 45 mins. they asked me to proceed to draw blood. I was not given anything to sign, disclaimer to read,...etc. A few weeks later, I get a substantial bill for the cost of my blood work because my insurance will not cover it.

My insurance claims that Lab XYZ is not in their provided network. My doctor says that I could've gone to another lab regardless of the form they gave me. The lab tells me they are not responsible for checking my insurance even though they accepted and photocopied my card. I don't know what my patient's rights are but I feel very ill-informed and misled. If I had even been warned to check with my insurance first, or notified of my rights to other labs, I would've done more research. I feel that this is a loosing battle against large institutions that don't care. I need to know my rights and take necessary actions. Any advice is much appreciated!

 

[cbg]

Sorry, but it is YOUR responsibility to know what is in your insurance policy. It is YOUR responsibility to ask about network participation. It is NOT the responsibility of either the doctor's office or the lab to check for you, or even to remind you to check.

 

[lkc15507]

I am sorry too. This happens way too much. My personal opinion is that any provider who accepts or implies acceptance of assignment of benefits should have an obligation to comply with and or assist the patient to comply with the terms of the plan. But then, I am an idealist at times. (Many times providers know when they are in or out of a particular network, but why should they turn away a warm, breathing victim.) Poster, I suggest that you might try contacting your insurer to see if they can / will contact XYZ lab and try to assist in getting XYZ to accept what they have paid as payment in full (if they paid any out-of-network benefits at all). You could contact XYZ yourself to try to negotiate a better payment arrangement. As far as your insurer goes, unless you had some mighty expensive lab work, it's not likely they will help, but it could be worth a try. Lastly, read, read, read, your insurance plan document and call them beforehand the next time you need services!

best wishes,
lkc15507