Who is responsible for charges if a doctor uses a labthat is not accepted by a patient’s insurer?

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Who is responsible for charges if a doctor uses a labthat is not accepted by a patient’s insurer?

Last month my girlfriend went to her oncologist and they performed a BM aspiration and sent out the sample out to be analyzed. Instead of sending the sample to the usual laboratory, they sent it to a lab in different lab. Today we found out that there had been a $17,000 charge into my girlfriend’s insurance from the lab tests and they weren’t going to pay any of it stating “out of state physician”. Who is responsible for this charge? We had no idea the doctor would do this.

Asked on May 22, 2011 under Insurance Law, Florida

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

First, your girlfriend is "responsible" in the sense that she has to pay. Her sample, her test; the lab may look to her for payment, and take action (e.g. sue; report her to credit rating agencies) if she does not pay.

However, that said, if the doctor's office sent the sample to the wrong lab after having said that it would go to a different lab--or arguably, even without saying it explicitly, but after having created a reasonable expectation, based on past practice, as to where the sample would do and what it woudl cost--then your girlfriend may have a claim against the doctor's office for reimbursement. The main thing will be to show that they said it would go to lab A, not B; or that since it went to A every other time, your girlfiend was entitled to think it would go to lab A again--and that the office did not tell or warn her it was going to B.


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