Health insurance question (company, cost, work, between)

[rlrl]

I had Empire BC/BS health insurance until 4/30 and on 5/1 I picked up Oxford

On 8/2 I forgot to inform my specialist that I had new coverage thru Oxford. A lab test was done and I got a bill from the lab (my former Empire plan did not cover me for lab tests whereas my new Oxford plan does)

I contacted my specialist who made the appropriate changes in coverage and I sent the lab an update about my new Oxford Insurance telling them that i no longer had Empire

I got a form in the mail from the lab stating that they could not verify my coverage with Empire(which was true) and to send them a copy of my card. However I think they are saying to send them my Empire card but it's really my Oxford card they need to see

my question is are they going to tell me that i should not have forgotten to tell my specialist about the change because the labwork was already done or can this be corrected?

thanks for reading

[myrc60]

just send them a copy of your new card...chances are they will file the claim with them...but yes you should have thought of this beforehand.

[Briolat21]

As long as your new coverage was in effect at the time, they can resubmit the bill to your new insurance company. We had a mix up with a provider for my father (couldn't get a Dr in a nursing home to sign off on a form for over a YEAR).... as soon as the Dr. signed off (15 months after services were provided!!) - services were billed to insurance and insurance paid it. Because it was in effect when the services were rendered.

Don't forget to update them in a timely manner in the future, but this should not prevent your service from being covered this time.

[rlrl]

when i called my new insurance plan, they told me I would actually have to eat the cost of the labwork because they would not pay for the lab that was used because it was considered an out of network provider

but then when i called the rep from my new insurance plan, he told me just what Briola21 said, to have the doctor resubmit the bill to my new insurance company and that i do not have to pay for the labwork (such labwork is covered under the office co pay under my new plan)

[Briolat21]

to clarify: If it is an item that is covered under your insurance at a PARTICIPATING location, then it IS covered - whether or not the service provider had your correct info at the time of service.

If it was an out of network on the new plan, you may have a problem. However, it sounds like they're giving you contradictory info (one saying its out of network, and another saying resubmit)...

Politely ask your Dr to resubmit to the new insurance, explaining that it was in effect at the time but that in all the chaos you forgot to give them the new card. Then you can begin to get some real answers as to what's going on...

Good Luck!!

[texdav]

Originally Posted by rlrl

when i called my new insurance plan, they told me I would actually have to eat the cost of the labwork because they would not pay for the lab that was used because it was considered an out of network provider

but then when i called the rep from my new insurance plan, he told me just what Briola21 said, to have the doctor resubmit the bill to my new insurance company and that i do not have to pay for the labwork (such labwork is covered under the office co pay under my new plan)

t would be easy to call the lab abd sak if tehy are withi the network of your new insurnace. If not they may not pay or may pay lessor amout for going out of network. You alos should be able to either get o line or have a netwrok provisder list for your new insurance.Normally doctor will call the insurance to make sure they send you to a in netwrok lab but i thsi case you had notified the doctor of the change.

[rlrl]

that my current plan told me that they will not reimburse a non-participating lab, but my rep said it doesn't matter, to simply have the doctor resubmit the claim, and he mentioned some kind of process that goes on between my new plan and the lab


my current plan(let's call it plan "O") covers me 100% for labwork with the office co-pay

now what's confusing is my doctor assumed i was still with my old plan (plan "E") and they simply used the lab associated with the old plan. the total came to $135, but that was because i came up as uninsured. had i been covered with plan E, those costs would probably have been no more than $40-50

I assume had they used new plan O, they would have routed the tests to the lab that plan O contracts with. as of 2007, plan O no longer contracts with the lab that E uses

so, when they resubmit the bill to plan O for the tests, how would plan O work it when I have already had the tests done by the lab?

[rlrl]

that charged me $135 going to go out of business if they don't receive 100% reimbursement from my new plan?!