tl/dr: My doctor told me some lab work would be fully covered, but the doctor didn't do the work themselves. They sent it off to a 3rd party lab service. Turns out that one particular test wasn't covered by my insurance and it tripled my bill. The insurance company says I don't have to pay for uncovered services in this circumstance. The lab service naturally disagrees. I don't have any agreements with the lab service. Who is right?
So here's the situation:
- Visited a new doctor for a "new patient" visit.
- Doctor ordered some blood work
- I asked if the blood work would be covered by my insurance
- Doctor came back and said everything was covered and I owe no money
- The blood work was sent to/performed by a 3rd party lab service
- A few weeks later I got a letter from my insurance company informing me of a bill that will show up from lab service
- There were about a dozen labs ordered total, all of which were a few hundred dollars. However the "negotiated" rate for services covered by the insurance company was on average ~$10
- There was one uncovered lab with a cost of $200
- The total bill was therefore ~$300 (~$100 total for covered services, $200 for a non-covered service)
- The insurance company insists that I am not responsible for uncovered services if I was not told about them before hand (I asked and was told they were covered, so this is definitely the case)
- The lab company of course disagrees, and says that according to their policy I must pay full price for uncovered services
As I was discussing this with the lab company one item struck me. A rep said that, "Obviously the insurance company has a different policy than us, but our policy is that you must pay the full amount for uncovered services".
It occurs to me that the use of the world "policy" may be important here. I don't really care what someone's policy says unless I've actually agreed to them in writing. Of course I have signed agreements with my insurance company, and signed agreements with my doctor, but I expect that I don't have any signed agreements with this lab services provider (I'm checking to see if something about this may have been signed while filling out intake paperwork with the doctor).
While I don't object to paying my bills, I get very tired of my inability to figure out what health care will cost beforehand. This is not the first time I've asked about costs before hand only to get a much higher bill later, and my patience for it is low these days. Therefore, presuming I have any legal ground to stand on, I would really like to push back more with the lab service provider and insist that they discount this uncovered test.
Therefore I need to know what laws/regulations may be applicable here, and whether or not this lab services provider can charge me arbitrary prices for uncovered services despite my best attempts to find out the cost of services before hand.
Is their "policy" legally binding? Are there any laws/regulations that influence my responsibility in cases like this?
