United Healthcare Denying a Legit Claim

[Anonymous]

Hi there,

Most of us have had one or more experiences with our health insurance - I've been screwed over and lied to openly and been forced to pay couple of grand by one of them years ago - but today something so odd happened that I'm kind of confused. My wife is pregnant, and before she picked her doctor she did what all people should do: she checked if that doctor and the clinic were in her network. They were, and she's been seeing him for the last two months.

Today she received a bill for $2600, from some lab. She calls her insurer - United Healthcare - and they tell her that the reason they didn't pay for that was because the lab her doctor uses isn't in-network. Now I've been seeing doctors for a while in my life, and the idea that I should have been checking if my doctor's subcontractors are in-network makes me laugh. I wonder if I should also be checking if this lab's subcontractors are in-network!?

Healthcare insurers are like cops; just like NYC cops have a quota for the number of arrests they have to make and number of tickets they have to write, healthcare insurers have to deny a number of legitimate claims.

Have you ever experienced this before or even heard of something similar?

Thanks!

[Anonymous]

Yes!

I have government United Health. The lab for that plan is Quest. The lab for most other United plans is Labcorp. We've been to two doctors who will arrange for blood to be sent to either lab who automatically sent the blood to Labcorp because we have United. What a mess sorting it out--received threatening notices from Labcorp for months. This is one more thing to remember when you go to the doctor.

[Anonymous]

I haven't, but I did see a similar story on here about the pediatrician their newborn saw after delivery was not in network although the hospital was in network as was their OB. Wound up paying thousands. You may want to confirm labs and pediatrician at the hospital you are scheduled to deliver.

[Anonymous]

You always have to check. Was the lab AT her doctors office? They really should have checked. My insurance covered lab work and sonos at my OB's office, but a friend who used the same practice had to go elsewhere for labs and sonos (weren't covered by her crappy insurance). Fight it with insurance, and ask your OB WTH he/she didn't flag it for you. Lesson learned.

PS - should look into the anesthesiologist at the hospital for delivery as well as the pediatrician.

[Anonymous]

Make sure it wasn't a billing mistake. I have united healthcare and got a similar bill. Turns out somewhere along the line either the lab or my insurance claimed the lab was out of network, but upon review we figured out the we're in network. Big relief.

[Anonymous]

Call your doctors office. Usually the doctors are good about getting your labwork to the right lab for your health plan. But, yes you do need to check on all providers, including those that you deem to be subcontractors. It's up to you to inform your doctors office of the acceptable providers.

[Anonymous]

Yes, I have heard of something similar. Surgeon covered by insurance but anesthesiologist not. .. Just wrong!

[Anonymous]

I have heard about this for routine colonoscopies. The outpt facility where it is done is in contract, but the lab, anesthesiologist, pathologist, etc may or may not be. I had heard horror stories about this, so checked before my colonoscopy. It was quite a bit of work as it is not always immediately clear who the providers are for some of the services. PITA!

[Anonymous]

When I had United they sent us separate "lab cards". Always had to go to a separate facility (quest) to get blood drawn. Not at dr's office.

[Anonymous]

OP here. Thanks to all for responses. A quick update: doctor's office advised us to call the lab and say we couldn't pay $2600, and they would cut it down to $200. That's what happened when we called. You figure it out. Another idiocy in our healthcare system. Lesson learned. Thanks again!

[Anonymous]

OP here again....just wanted to share an interesting thing that came from the doctor's office (Reiter, Hill, Johnson and Nevin). When we asked why they would send the test to a lab that's not in our network, or at least tell us before doing so, they said "we really like that lab."

[Anonymous]

Anonymous wrote:OP here again....just wanted to share an interesting thing that came from the doctor's office (Reiter, Hill, Johnson and Nevin). When we asked why they would send the test to a lab that's not in our network, or at least tell us before doing so, they said "we really like that lab."

So they were aware that the lab was out of network for your insurance but sent the work there anyway, knowing that you'd get stuck with the bill?! I'd find a new doctor, pronto.

[Anonymous]

I had a baby who needed the NICU. All the dr's were out of network.

[Anonymous]

This is common. Most doctors are really good about knowing which insurance companies take Quest and which take LabCorp. Your insurance company will most likely make you pay. Call your OB and tell him. I would make sure to tell him even if you have to wait until your next appt. the billing dept doesn't care.

Also, use this time to call your insurance company to find out about out of network providers in your in net work hospital. Some plans will make you pay for the anesthiologist. Even if you don't plan on getting an epidural still call in case you gave to have a C-section.

[Anonymous]

Anonymous wrote:OP here again....just wanted to share an interesting thing that came from the doctor's office (Reiter, Hill, Johnson and Nevin). When we asked why they would send the test to a lab that's not in our network, or at least tell us before doing so, they said "we really like that lab."

I'm pretty sure they were just covering their asses. The two labs are the same. Tell your OB.