Question
What is the name of your state? CA
I went to doctors clinic for regular checkup and they drawed my blood. They had my insurance information. Without my knowledge they sent my blood for test to the hospital that was not in network.
Now my insurance has denied the payment. And the hospital sent me a bill. Who should be responsible for the changes ? What can be done ?
Answer
Ultimately, you are. It is ALWAYS the responsibility of the one who received the care, to see that the bills are paid.
However, you MAY be able to hold the doctor's office liable for the cost of the tests. Whether you can or not depends on the terms of your insurance plan. In some insurance plans, the hospital or doctor's office has the responsibility of seeing that all your care is coordinated through network providers and nothing but network providers. If you have one of these contracts, then you cannot be required to pay for non-network charges that were incurred due to the influence of the doctor's clinic. You can't just refuse to pay, however; you will have to get the insurance carrier involved. Most managed care plans have a department called "Provider Relations" or something of the kind; you would need to contact them, explain what happened and let them handle it. It is their contract with the provider that has been breached; they have to be the ones to manage it.
If you do not have one of these insurance plans, then it was your responsibility to remind the doctor's office to use network plans and to confirm that the hospital or lab that was to be used, was in network. If that is the case, then it's up to you to pay the bill since you neglected to remind the doctor to stay in network.
Answer
Thank you so much for the reply. It is really helpful.