Why I cancelled my Affordable Health Care Insurance Plan. Are you required to use a network of “preferred labs?”

Read the fine print. You hear it all the time. Be advised, your new insurance plan under the Affordable Health Care Act, may leave you up the creek without a paddle.

Case in point, I was excited to have my Bronze Saver plan through Blue Cross Blue Shield, and based on the brand of Blue Cross, I thought I had “good insurance.” Well, shortly after I used my plan for routine tests I received a nasty letter that read something like

You must review your benefits online before visiting your doctor to make sure those services are covered. Your recent lab services were not sent to in-network labs, and are not covered. It is your responsibility to review this information before you see your doctor.

Really?

Yes, my plan required me to use a series of “preferred labs.” This was indeed a little different for me, having a background in managed care, and health insurance, I found it extremely odd. Even the billing specialist at my Doctor’s office was unaware of the “preferred labs” requirement when she submitted my lab work, and “it wasn’t clear on the insurance card….they usually tell you…”

Even after all this, I stuck with my plan, and began the appeals process, which is actually one of the protections under ACA–a guaranteed right to appeal coverage determinations. This is what pushed me over the edge though–

At a visit to a primary care location I called my insurance plan Blue Cross Blue Shield, knowing my history of the rejected lab charges, and simply asked “What Doctor can I use in this area that will utilize the lab that you want me to use?” The agent directed me that the lab was Quest Diagnostics and that I would have to ask the doctor at my visit which lab they used.

WHAT??! Me: “So you are telling me you can’t give me or direct me to a list of providers that use your “preferred labs?”

Agent: No, I’m sorry. But you can go to an in network hospital…

Me: This is ridiculous, you can just cancel my plan right now!

And that’s how it happened. I just share this so that you can be aware of the fine print. Health insurance is a good thing but if you are not informed it can be a drag. Talk about drag. After my appeals were denied, I had to settle a bill for lab services in excess of $1300.

If you haven’t already, review your benefits plan online. They probably didn’t send you a real booklet. Another tactic that I feel is terribly unfair. But life is not fair, nor is the law of contracts. So if they directed you to review your plan online, Do it! Read everything before you use your plan. Don’t just assume because your insurance is a certain, or “trusted” name that you are good.

The idea of a “preferred lab” versus a preferred provider, is still very hard for me to accept.

I can understand your insurance plan being a HMO or restricting you to a certain group of MDs, but the idea that we should take the extra step to inquire where my MD is going to send my urine or blood sample after my visit to make sure it is a preferred lab is a little over the top.

What do you think?

Disclaimer: This blog is Commentary Only and nothing here is to be interpreted as legal advice, solicitation, or any claim that the quality of legal services offered by The Keli R. Edwards Law Office, LLC is greater than the quality of legal services performed by other lawyers. I welcome your feedback and comments!

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