General Category > General Questions

Procedure done before insurance termed, lab done after.

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PMRNC:
Hmm but patient has no control over "facility" used.. the services are still related to the global billing period.. certainly if the patient could control where and when the specimen was tested it would be different?

Merry:
Agree with Karen. Global period relates to procedure.. not the lab done at an outside facility. If the physician did the TC then it would be covered. And many small procedures don't even have a global period.
 

PMRNC:
Read this again:


--- Quote ---A patient had a procedure to slice something off of their skin two days before their insurance terminated, so the procedure was covered.  But the specimen that was sent to the lab was not tested until the day after the patient's insurance terminated, so it wasn't covered.  The lab billed it with the date they did the testing as the date of service on the claim.  The patient called me upset.  Can the lab testing be re-billed with the date of service of the procedure on the claim instead of the date of the testing?  What is the protocol for this?
--- End quote ---

Answer is NO lab can't and shouldn't change dates of service. Something forgotten and not asked is why is patient calling YOU upset? wouldn't they appeal this with the lab? YOUR date of service is day the specimen was collected.

KarenH:
Agreed lab can't change the date of service the date of service can only be for the date the service was actually done. This is what I would do as a patient- contact your insurance company both the old and new carriers appeal to them. I would keep the doctor's office out of it because there is nothing they can do it's a different facility.

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