12 replies to this topic

[gianfranko]

So,

Last month my girlfriend went to her oncologist and they performed a BM aspiration and sent out the sample out to be analyzed for FISH and PCR.

Instead of sending the sample to the usual laboratory, Quest Diagnositcs, they sent it to a lab in california called Genoptix Medical Laboratory based of California.

Today we found out that there had been a $17,000 charge into my girlfriend's insurance from the lab tests and they weren't going to pay any of it stating "out of state physician"

My question: who is responsible for this charges?  We had no idea the doctor would send the sample to some lab in CA; we just assumed it would be going to Quest Diagnostics just like all the others.

We are unable to pay $17,000.

[janne]

Gianfranko,

Am wondering:  Has Quest Diagnostics done any PCR or FISH analysis on specimens previously? If Quest had not done this type of analysis before, was this lab in California the one chosen because of their capability of performing such analysis ?

Also, If your doctor's office is in your network, it is probable that he/she would know also what labs are in your network being that you were not consulted for your preference of lab providers. Whoever was responsible for sending this specimen out should have determined that fact, or had someone on staff to make that specific determination. It is completely unreasonable to expect the patient to be liable for these charges. Sounds like a big OOPS to me and no one wants to take responsbility for this.

I know I had my bone marrow sample go to another lab and was not advised beforehand. Because I then had more than one medical facility billing be for services, I was quite inconvenienced, so I emphathize with your situation tremendously.

I did find some dicussion on this topic (although the amount not covered is much less than your amount).

I hope this gives you some ideas:

http://forum.freeadv...ork-408318.html

Good luck with this issue.  I have found billing issues to be quite an annoyance to say the least, especially when the CML patient was not advised appropriately.

Sincerely,

Janne

[gianfranko]

Quest has done PCR for us before.  The samples sent to them were always blood samples.  This was our first ever Bone Marrow sample that was scheduled for 12months post diagnosis - FISH and PCR.

It was the first ever FISH test done too.

More info about insurance: It is a PPO, Blue Cross Blue Shield of Florida, BlueOptions.

[janne]

Responsibilities of Participating Providers

Below are "highlights" of responsibilities generally associated with provider agreements. This listing is not all-inclusive.

General

• Provide covered services to members with BCBSF coverage.
  

Would this tell you that it is the provider's responsibility to insure that you are receiving covered services ?

(I only highlighted the very first provision in this list).

I think you need to push this issue with your BCBS.   Janne

[simone4]

Gianfranco, this happened to me when my BMB was sent to Genoptix in Ca.

However, I received a pamplet from them explaining that

they would be considered "In-network".  I also have

BCBS, PPO.  Call Genoptix (check their toll-free number

on their website) and talk to them.  They will appeal

to BCBS and when insurance co. sends you a check for

the amount they deem fair, then you send that check to

Genoptix with your EOB. I never paid any money out-of

pocket for this procedure.  If they take issue with the

doctor being out of network, Genoptix will appeal that

as well. Don't fret, just call them.

Good luck.

Simone

[gianfranko]

Simone,

Do you also have BCBS of Florida?  So Genoptix was able to resolve this issue for you?

I am wondering if there is a reason as to why the doctor would send the sample to them and not Quest Diagnostics

Maybe Quest doesn't do work with BM or something...

[gianfranko]

Janne wrote:
Responsibilities of Participating Providers
Below are "highlights" of responsibilities generally associated with provider agreements. This listing is not all-inclusive.
General
Provide covered services to members with BCBSF coverage.
Would this tell you that it is the provider's responsibility to insure that you are receiving covered services ?

(I only highlighted the very first provision in this list).

I think you need to push this issue with your BCBS.   Janne

Janne,

I am trying to understand this.  Does this mean that Genoptix should be covered by BCBS of Florida?

[simone4]

No, I have BC/BS of Georgia. But Quest would not handle

this kind of testing.  This lab is who my provider uses and

Genoptix understands that.  They are who sent you the

bill, right?  Call them. It took them to appeal BC/BS decision

but ultimately they got paid and I did not receive any more

bills from them.

[Susan61]

Hi:  I hate when these things happen with medical bills.  I always make phone calls and fight when I know I should not pay.  Simone seems to have a good handle on this situation.  I would follow the advice she gave you, even if you have to appeal it.  All these labs and office help make mistakes all the time.

I get PCR testing at Quest Labs, and my insurance pays for it.  I only pay a $30.00 co-pay for my labs.  I have not had a BMB or FISH in quite sometime, and I cannot remember where they sent my specimen to be analyzed.  I just know it was always in-network, and I never got a bill.  I hope you get this all straightened out soon.

     My mother gets into situations like this all the time with her medical bills, and she goes into a panic and pays them.  Then I find out she did not owe anything.  I keep telling her to send me her bills and let me check them out before she makes any payments.

Susan

[janne]

Gianfranko,

This list of "responsibilities of participating providers" I found on a Florida BCBS site.

It appears to be a general list which would most likely be consistent with the responsibilities of any participating provider with any insurance company. Insurance companies generally use the same language.

My understanding of that list, specifically the one I copied to you, is that the providers share a responsiblity along with the insurance company in seeing to it that you folks, as the insureds, get services provided to you that are covered under your plan. It also suggests to me because of that statement that there is a way to be found clearing you of financial responsibility and I do believe that Simone has the answer.

I am most encouraged by Simone's advice as she has had specific interaction with BCBS for the same thing with the same "out of network" provider. 

I vote with her and Susan on that direction for your dilemma.  Thanks Simone and Susan !!

What great support we have here !

Good luck and please keep us posted !

[gianfranko]

Thanks to everyone for their replies.

We are going to have BCBS look at this charge again and hopefully the matter is resolved.

I will post an update once I get some information.

Again, thanks for taking the time to reply; doing so has eased our anxiety.

[Susan61]

So glad our answers helped you.  Yes, please post to let us know how you make out.  Someone else could run into a problem like this also.

I was in the hospital back in February, and I have been making payments on my bill for what my insurance did not pay.  I keep very accurate records, and I just got a phone call a few minutes ago telling me that they have not received anything which could result in me going to collections.  I called with all my proof of payments etc.  Hopefully its resolved now for me.  I was furious.  That is my other issue.  Computers are not accurate, and mistakes are constantly being made just from a person punching in the wrong information.  Everything will work out just fine.