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.


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!


HealthCare.gov: I signed up.

So, I finally signed up for “ObamaCare.”  I was able to get a Bronze plan for $180/mo with approx. $6k deductible. No tax credit for me though.  My plan is set to start Dec, 31, 2013.  The website was a little laborious at times, but not much unlike applying for a job.

I did find it annoying that I had to keep logging back in to continue the process.  The first time, it will verify your email, then it sends you a letter with your plan eligibility and whether you can get tax credits, or Medicaid, etc.  Being that I’m in Alabama, the Medicaid was a long shot, but that was already impossible due to income restraints.  Medicaid is like the best insurance ever, but I digress.  According to sources, the Medicaid expansion in Alabama would enable some 300K citizens to become insured, with “the best insurance ever”  to quote myself.  I once worked in the state Medicaid realm, so I can definitely back up this claim.  Stay tuned, there is still one more month for the expansion to occur, before Jan 1st, when that provision of the Affordable Health Care Act (ObamaCare) kicks in;  Not sure how many “working days” are left for the Ala. legislature to consider it though.

Back to my Healthcare.gov adventure.  So I waited a week before I decided on a plan.  It wasn’t that difficult because of the “monopoly” Blue Cross Blue Shield has here in the State, I just went with them, especially to ensure I get my choice of providers (doctors). It was a pretty fast choice deciding, since the choices were limited.  It was either hamburgers or hot dogs…(The available selections of plans averaged seven in Alabama, compared the the national average of over 50. )

***The Healthcare.gov site just warned me that I would be logged out due to inactivity, or to refresh my session***.  This always happens on my online banking site.  I have been following the media concerns about security of personal info.  At this point, it’s more “wait and see.”

Please, Share your thoughts with me.

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!