Who is responsible for these medical bills?

You are given a prescription for a blood test, you then go to a hospital to have that blood drawn. The blood test is then sent to a laboratory which is the only laboratory in the country that performs the test prescribed. However, the laboratory is out-of-network from your healthcare insurance. So now you are left with hundreds of dollars of bills because your insurance would only cover 20%. Who is responsible? The doctor for not telling you that the lab is out-of-network, the hospital for the same reason, or you for not inquiring before hand. Keep in mind, you as a patient do not know exactly where the blood will be tested. Or are you supposed to ask?

The doctor, lab staff, etc. are not required to try to keep up with whose insurance is good where, etc. (and I wouldn't want them to try to keep up with that ....I'd prefer they know their medicine).

I, too, have been in a similar situation, and I found that filing a "grievance" (or something like that) with my insurance prodded them into paying for the lab fees, etc.

Best of everything!

Unfortunately you are responsible to be self informed and are responsible for the bills.

You are responsible. You are supposed to ask. You have to be your own, best advocate. You are responsible for your insurance and asking if there is somewhere IN network and if not, you are responsible for the remainder of the bill.

You needed to read your inusuance policy when you got it so you KNEW what you were responsible for. YOU are responsible for the bills as you agreed to have the blood work done. That is one reason why they tell you to read your policy book when you get it so you know what is and isn't covered and how much your portion will be if you do use out of network providers etc. Do we all read our policy booklets that closely ??????????????/ No we don't but we should. Since you agreed to the test you are responsible as it is your repsonsiblitly to know what is covered and what isn't.

You are. Sucks I know. Had something similar happen and am paying off nearly $1000 in bills. The hospital may be able to rebill as a service from them instead of the lab. Try asking them.
Good Luck

Sorry, but it is your primary doctors fault as well as your for not reading your benefits. However, financially you are responsible. (you can change your primary care physician anytime, call the p# at the back of your insurance card and talk to a service representative).

HMO if they do not have their own lab you need a referral, so that the HMO can cover at the same level as it was done by the HMO lab. (physicians get paid a set amount of $$ wether you go see them or not)


IN-Net = is a network of physicians who will render services to their members with only a small co-payment from you and the rest your insurance pays for.

Out-Net= you can visit any M.D. outside ot the net but the coverage is much less.

Keep in mind that anytime you need to go outside you Net wether is Power Point or HMO always ask for a referral (do not go without one).

If you need to be hospitalized (even if emergency) you need to inform your primary within either 24 or 48 hours something like that. (read your benefits otherwise you are going to pay too much out of your pocket).

Insurance benefits are like contracts, you MUST read them and call a Service Representative if there is anything you do not understand. The only dumb question is the one you do not ask.

There are different HMO and different coverages, so you cannot go around this, you must read them.

Good Luck!