BCBS won't cover lab work? (x-posted)

[Champ715 207]

Hi all,

I had gastric sleeve surgery last September 2015. In August 2015, I had the pre-op blood work done at Quest Diagnostics. Shortly after that visit, I got a $1113 lab bill from Quest and they told me that BCBS wouldn't cover the costs because the surgeon's office had coded it to "obesity". I don't understand why BCBS will cover weight loss surgery but not the associated lab/blood work. I called my surgeon's office to explain this to them and the nurse told me she would change the billing code and resubmit to Quest. Well, apparently she never did that. I thought she did because months went by and I never heard another word about it. This past Monday I got the same $1113 bill from Quest again for the August 2015 lab work. I had post op lab work done in March and Quest says BCBS won't cover that blood work either because it was also coded to "obesity". Quest refuses to negotiate with me on the cost but says I can pay $25 each month until the end of time if I want to.

What baffles me is that I know I'm not the first person to have BCBS insurance and my surgeon's office sends everyone to Quest diagnostics for lab work. This cannot be the first time this has come up. The insurance coordinator at my surgeon's office said to be verbatim "it will be covered" and the nurse already told me once she would fix it but never has.

Has this ever happened to anyone else? BCBS said I had 180 days to appeal the first bill from August 2015 so I'm screwed on that one. I'm just trying to figure out what to do to get the March 2016 bill covered or negotiated.

Any suggestions or ideas would be greatly appreciated.

(Cross posted in the post op forum)

[PayItForward 207]

You only need to post it once.

[Champ715 207]

You only need to post it once.

Not everyone looks at both forums, hence why I posted it in two different places.

[jane13 2,256]

@@CourtneyLouise - Did you get the name of who you spoke to and when? I would call them and provide that info, especially if you went months without a bill and then got one again.

I have BCBS fed and went to LabCorp and was fortunate enough to have that type of info and LabCorp wrote off the charges (over $1400). I specifically asked the woman did they take BCBS Fed and she said yes - I had her name and date/time I spoke to her. Apparently BCBS Fed goes back and forth every couple of year between taking LabCorp or not taking them. The OM said the check in person should have told me otherwise because they supposedly verified my coverage.

[KristenLe 5,979]

I would call your surgeon's office again and question them - as Quest may be the ones who didn't correct and refile. I work in the medical field and most often if labs aren't paid due to the diagnosis submitted - the lab contacts the ordering provider directly for corrected diagnosis. If you look online - many have similar complaints against Quest. I would not pay them.