THIS PAGE DISPLAYS CASE STUDIES FROM CLIENTS WITH MEDICAL BILLING AND INSURANCE DIFFICULTIES SUCCESSFULLY RESOLVED BY HUMAN HEALTH ADVOCATES, LLC.

CASE STUDY #1Mrs. Terrence went to a new endocrinologist after her prior physician passed away. The doctor ordered extensive blood testing, which was performed in his office. Mrs. Terrence had an excellent Affordable Care Act- compliant insurance policy with an extensive network of providers. However, the network contained only one in-network laboratory group –with numerous offices within the metropolitan area where Mrs. Terrence lived.

She provided her insurance information to the registration desk at the doctor’s office (which was in-network). She was not told which laboratory the blood work would be sent for processing or given a choice. Mrs. Terrence assumed that because the doctor’s office had her insurance information, and that they were in-network, the samples would be sent to the very large in-network laboratory. She should have asked.

Her lab work was sent to an out-of-network laboratory. The bill was over $2600. Her insurance processed the claim against her out-of-network deductible. She was responsible for the total billed charges. She filed an appeal arguing that she had no choice in the matter and did not authorize the samples being sent anywhere but an in-network lab. Her insurance company responded that because the lab work was sent to an out-of-network provider the claim would not be processed towards her in-network benefits. The appeal was unsuccessful.

Mrs. Terrence then came to Human Health Advocates for help. After reviewing her situation, we advised that, in fact, it was her responsibility to be certain that her bloodwork was sent to an in-network laboratory. We spoke with her doctor, who was gracious and assisted in having the laboratory adjust the charge down to $500. Even this was approximately $200 more than what the charge would have been had she used an in-network lab. The moral of this story is that it is the patient’s responsibility to verify that the lab work is being sent to it in-network lab whenever possible.