Health insurance payment for a lab test. Am I responsible or not, should they have appealed if they say it was part of the test

Get Legal Help Today

 Secured with SHA-256 Encryption

Health insurance payment for a lab test. Am I responsible or not, should they have appealed if they say it was part of the test

I have Aetna HMO. A lab test was done at a place out of network ordered by a doctor. A special test so I think thats why it went out of network. Aetna paid on 2 of the 3 CPT codes that were need to do the test per the place doing the test and the company never appealed for the CPT code that wasn’t paid. Aetna claim says “The charge for this service does not meet the resuirement of the plan because this procedure usually is not performed in conjunction with another procedure which has been performed on the same date of service. You are not responsible for this amount.”

Asked on June 29, 2009 under Insurance Law, Colorado

Answers:

L.M., Member, California Bar / FreeAdvice Contributing Attorney

Answered 12 years ago | Contributor

I would get a letter from the dr. that ordered all three tests for you to explain why the test that is not being paid for was requested in conjunction with the others.  Take your dr.'s letter and appeal to Aetna for payment.  Even though Aetna said you are not responsible for this amount, if it was a test that was necessary and was ordered by your dr., you are responsible for it.  But don't let Aetna get away with not paying without appealing their decision.  But you must provide documentation from your dr.


IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

Get Legal Help Today

Find the right lawyer for your legal issue.

 Secured with SHA-256 Encryption