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Lab Work Costs
Apr 23, 2010

I have health insurance through my employer and I see the doctor 4 times a year and each time I visit, I also have lab work done. I thought my insurance also covers my lab work but in Dec.2009, I received 4 bills in the mail for lab-work which dates back to January 2009 in succession for the past month or so at expensive rates. My question is what do I do about this since I cannot afford these charges when I have insurance. Also during each doctor visit, shouldn't I have been informed if my insurance does not cover lab work if this is the case?? This is very frustrating and its very unfair for the patients to be the last person informed about something like this.

Response from Ms. Franzoi

I need a little more information. Did you or your doctor's office submit the lab work bills to your health plan? If so, you would've received an explanation of benefits (EOB) which explains why the charges were not covered. It is unusual for a plan not to cover labwork unless the labwork was not medically necessary. If it was denied and you think it should've been covered, you can follow the appeal provcess in the plan to appeal the denial. If you do not have an EOB denying the claim, the claims should be submitted to your plan. Often a doctor's office will bill a patient before the claim has been adjudicated. Or the doctor's office might not submit the claim. With respect to what your doctor's office should've told you, it is really your responsibility to know what your plan covers. You should have a summary plan description describing covered and non-covered expenses. Since there are so many different plan, unless you are in an HMO or on Medicare, it is unlikely that a doctor's office would be able to advise a patient what his plan covers or does not cover.

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