The lab wants my signature to appeal the rejected claim

[MoneyJohn]

The doctor ordered a lab test from a company that I had never heard of. Before sending in the sample, I called them up to make sure that they are in-network. I was told, they are in-network. I was still uncomfortable so asked the customer service personnel, what happens if the insurance company rejects the claim, how much will I owe? I was told, I will owe nothing. That surprised me, but the doctor wanted the test results before proceeding, so sent the sample in.

After a couple of months, I get the EOB stating the claim rejection. The lab appeals, I get a copy from the insurance company that an appeal has been made. Now I get a letter from the company asking for my signature which they will use to go higher up in the appeals process.

DW is a physical therapist. She asked their office manager if this makes sense. The office manager had never heard of such a thing because according to her, they don't need my signature. If I call the billing department, of course, they will give me some reason (otherwise they wouldn't send such a letter). The signature is voluntary but I feel the lab should get a fair amount for the test.

Has anybody been through such situation? How would you recommend me to proceed?

 

[BMWTurboDzl]

Originally Posted by MoneyJohn
The doctor ordered a lab test from a company that I had never heard of. Before sending in the sample, I called them up to make sure that they are in-network. I was told, they are in-network. I was still uncomfortable so asked the customer service personnel, what happens if the insurance company rejects the claim, how much will I owe? I was told, I will owe nothing. That surprised me, but the doctor wanted the test results before proceeding, so sent the sample in.

After a couple of months, I get the EOB stating the claim rejection. The lab appeals, I get a copy from the insurance company that an appeal has been made. Now I get a letter from the company asking for my signature which they will use to go higher up in the appeals process.

DW is a physical therapist. She asked their office manager if this makes sense. The office manager had never heard of such a thing because according to her, they don't need my signature. If I call the billing department, of course, they will give me some reason (otherwise they wouldn't send such a letter). The signature is voluntary but I feel the lab should get a fair amount for the test.

Has anybody been through such situation? How would you recommend me to proceed?



I wonder if this is part of a policy borne out of fraudulent/over-billing. Your insurer gets a warm fuzzy feeling when they see your signature.

 

[mk378]

They need your signature on what? There is always text above where you sign. It sounds like it is a HIPAA permission to disclose some medical information to a third party. The fact that you were tested for something, even without revealing the results of the test, is protected medical information.

 

[Alfred_B]

Insurance companies keep their costs down by denying payment for services rendered. The lab is probably asking for your help to appeal the case. It is pretty much the last resort in trying to get reimbursed.

This has nothing to do with HIPAA because they can send your medical records to the insurance company as part of conducting day to day business.

It's very likely the contract between the provider and insurance company has a hold harmless clause to make sure that the patient doesn't get billed for denied service which makes the patients allies with the insurance company and not the provider.

 

[Hall]

If you don't mind, how much is the charge ?

You "confirmed" verbally that they were in-network but that doesn't mean ALL labs are always covered. But, the lab also told you "verbally" that if the insurance rejects it, you owe nothing. Now, don't you think that is unusual ? If you have proof you were told both of these things, the simplest solution for the lab might just be to eat the charge vs fighting it, i.e. "appealing" it with insurance.

 

[Alfred_B]

They deny payment for medical necessity. And that can be due to arbitrary rules unknown to anyone but the insurance company. They change the rules all the time and sometimes do so with the expectation of reversing upon appeal, hoping that some of the providers will not bother to go all the way in the appeal process, especially if it's expected to obtain the patients' signature.

Being in network or out of network is a different issue

 

[GumbyJarvis]

Medical companies and hospitals cannot disclose info to credit bureaus due to HIPPA unless you allow them to. Credit bureaus want to know what the reasoning behind the charge is, obviously they cant tell them due to HIPPA privacy acts.

Went through this with a local allergy clinic who tried charging me 300$ for a thermometer cover for 3 appointments (900$ total), VA denied paying it due to the fact I was only there for allergy testing and shots, not a temperature (go figure)

They hassled me everyday for 900$ I wasnt going to pay for a few pieces of plastic that was in my mouth for 10 seconds and thrown away.

Needless to say, they gave up, nothing on my credit reports, and I got a new allergist.

 

[talest]

Insurance is generally a scam. Some will jump through their screens at my statement. Insurance is usually, in most instances, a total scam.

I wish you luck, OP.

 

[Alfred_B]

@GambiJarvis medical debts not affecting your credit score is Obamacare, not HIPAA.

The VA is notorious for screwing providers and the providers can pursue you for debts if they choose to.

 

[Sunnyinhollister]

Maybe I missed it, what was the reason on the EOB for the denial?

 

[demarpaint]

I had a similar problem and did exactly what you did. I also told the doctor to make sure the lab took my insurance, he claimed to have checked and did the test. As it turns out the lab didn't take the insurance, the doctor had to eat it.

 

[user52165]

Originally Posted by talest
Insurance is generally a scam. Some will jump through their screens at my statement. Insurance is usually, in most instances, a total scam.

I wish you luck, OP.


Generalizations like this are ridiculous. Insurance, yes with all its defects, works for the benefit of the insured.

I hope it doesn't take a life threatening event like I had for you to realize this.

 

[Wolf359]

Originally Posted by user52165
Originally Posted by talest
Insurance is generally a scam. Some will jump through their screens at my statement. Insurance is usually, in most instances, a total scam.

I wish you luck, OP.


Generalizations like this are ridiculous. Insurance, yes with all its defects, works for the benefit of the insured.


It's the basis for most of the faulty thinking here. I have medical and dental and have been paying for it for years. I get statements every month on the items covered. Hard to say it's a scam when everything is covered. People here seem to confuse the exception for the norm.

 

[ArrestMeRedZ]

I have run into something similar with Medicare reimbursement to Quest labs. Dr. orders tests. Quest knows Medicare won't authorize based on past results from other patients. Quest makes me sign a form saying I will pay if Medicare rejects.

I wouldn't mind if i paid the same as Medicare reimbursement rates, which are usually around 10% of the billed rate, but if Medicare rejects, Quest bills me the full "rack" rate. If I get 8 lab tests, Medicare pays about 50 bucks or less for 7 of them, and I have to pay anywhere from 60 to 150 bucks for the rejected one. Thus the lab has an incentive to have Medicare reject certain tests. After getting overcharged once, I just reject the tests that Medicare needs additional justification on.

 

[Alfred_B]

@arrestmeredz I'm surprised your doctor orders tests that Medicare seems not necessary. Quest has no control on what tests they do, and having you sign an ABN is good practice of not presenting you with a surprise bill later once Medicare denies payment.

 

[MoneyJohn]

Apologies, couldn't visit the forum all day.

The details,
- The rejection reason is not stated, but the code, D13M. No idea what it means.
- By signing the paper, I am accepting the following things

I have no problem with these points except the number 4, that they will disclose it to others and no HIPAA is applicable. There is nothing in my medical records that needs hiding, still, why do others to whom this lab may disclose need to know if they are not providers or the insurance company?

Somebody above said if I didn't find it iffy that they won't charge me. On one part, I did, on the other part, I didn't because when many labs launch new tests, they want to see how much the insurance companies would pay for the test. During this period, they take whatever the insurance company pays them and eat the charges for those who don't pay. Not very common but not unheard of either.

 

[Alfred_B]

They want to hire a company to fight the denial.

 

[alarmguy]

Originally Posted by MoneyJohn
T..

After a couple of months, I get the EOB stating the claim rejection. The lab appeals, I get a copy from the insurance company that an appeal has been made. Now I get a letter from the company asking for my signature which they will use to go higher up in the appeals process.

DW is a physical therapist. She asked their office manager if this makes sense. The office manager had never heard of such a thing because according to her, they don't need my signature. If I call the billing department, of course, they will give me some reason (otherwise they wouldn't send such a letter). The signature is voluntary but I feel the lab should get a fair amount for the test.

Has anybody been through such situation? How would you recommend me to proceed?


Why not give them your signature?
They did a test or provided a product/service for you on your doctors/therapist orders, dont you think they should get paid for their work?

 

[MoneyJohn]

Originally Posted by alarmguy

They did a test or provided a product/service for you on your doctors/therapist orders, dont you think they should get paid for their work?

What I mentioned in the OP
Originally Posted by MoneyJohn
The signature is voluntary but I feel the lab should get a fair amount for the test.

 

[ArrestMeRedZ]

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