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Provider billing labs

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midwifebiller:
A provider draws blood in the office, then sends it to the lab for processing.  The lab refuses to submit claims to the patient's insurance company and bills the provider instead. Can the provider submit a claim to the insurance company for the lab (in addition to the blood draw)?  Is a modifer needed?

Thank you,
Kelli

medauthor:
Kelli,

I am confused ???  Why is the lab refusing to bill the pt's ins company?  Was the patient required to go to a specific lab per her ins co and this is not the lab that the provider sent the blood to?

Michele:
I was wondering the same thing.  Did the provider know prior to the services that the lab was going to bill him directly? 

Michele

midwifebiller:
Many labs will not contract with a midwife for whatever reason: practice is too small, they are not physicians, they are out of network with the insurance companies, etc., etc.  It's very common.

So the midwife gets stuck with the lab bill and her clients want her to submit it to their insurance company.  Can she?  I have heard (vehemently) both yes and no and am trying to get direction.

Thanks!
~Kelli

medauthor:
Kelli,

I've never done your type of billing, so I don't want to sound dumb....but if a patient chooses to use the services of a midwife versus an OB, and the patient is aware that the midwife is not contracted with the labs for insurance carriers, why can't the patient be responsible to pay for the labs and then the patients submit the bill themselves to see if any reimbursment is sent to them for out-of-network benefits?? ???

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