Blue Cross/Blue shield refuses to pay for blood work

Question

I have worked for the same company for 25 years. I have Blue Cross/Blue Shield indemnity program. Until recently I did no have a problem with their paying for my blood work. About a year and a half ago my doctor changed lab company. Ever since then Blue Cross Blue shield has refused to pay for my blood work unless they get a copy of the results. They have submitted my name to a collection agency and I have been getting threatening letters. Do I have any legal recourse to force them to pay, considering that I am still working and paying for medical coverage?

Answer

Are they asking for the test results or the tests that were done? Most insurance companies require the lab to list each test that was done with the ICD-9 code for the test and the associated cost. This is to assist the plan administrator in determining whether or not the charge was within their guidelines of reasonable and customary, whether or not the test was a covered test under the plan, etc. and to help them adjudicate the claim. With respect to knowing the actual test results, I would want to know why they needed to know this. It seems unnecssary for claims adjudication.

Have you contacted Blue Cross to determine what they need and why? If not, this should be your first step.

Lynn L. Franzoi