Author Topic: In-Network Providers utilizing one or two out of network providers  (Read 646 times)


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This is probably easy for most of you - but this hasn't come up for us before.

We have a patient and we are in-net w/ their insurance.  They requested a genetic test kit which has to be sent out to a reference lab which is out of network.  The patient is insisting that our doctor should have billed the insurance company - and not the performing lab.  Even though all we did was collect the specimen (blood draw) and mail it out - we did not perform the analysis.  Are we wrong to tell the patient that it is not our place to bill the insurance company as we are not performing the test?

Thank you for your help.

BTW - first time here - what a great resource!


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Re: In-Network Providers utilizing one or two out of network providers
« Reply #1 on: August 12, 2017, 09:26:54 PM »
Since you did not perform the service of the actual testing you CANNOT bill the insurance for that.  It would be illegal.  Also, the provider probably isn't set up with the insurance to be reimbursed for those codes anyway.  I understand the patient's frustration if they didn't know the lab was out of network, but what they are asking is not possible.  Your doctor billed for exactly what services he provided which is correct.  The patient cannot tell the doctor how to bill.  Good luck explaining that to the patient!

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