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
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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 15 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.
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