Appeal Rejected-Help with Interpretation
My rejected appeal stated –1. " ALL services performed outside the state of Michigan are subject to your out-of-network cost share, unless your provider is in the BCBSM PPO network. " and
2 "My ordering and performing provider is out of state and ordered lab services that were tested by Quest of Illinois. Therefore your claims correctly processed according to your plan benefit at out of network level".
Who is the provider? I thought the doctor was a provider and Quest Diagnostics is a provider. My doctor is non participating and out of state but I stayed in MIchigan and did my testing with Quest. I also have another out of network (non participating) doctor in MI but all my Quest Labs are billed in Network. What is the difference?
Quest left the state of MI and only has clinics where they draw blood in MI. Once drawn they send it to Illinois. So my out of state doctor (out of network) gets billed by Quest Illionois but my out of network MI doctor gets billed by Quest MI. All the blood is sent to Illinois. The doctor has no choice and is not involved with where it gets sent.
I'm trying to appeal to the Department of Insurance but I don't really know how to prove this as the EOB does not state the doctors name just Quest Diagnostics as the provider and I don't have all the Quest bills.
Plus all my drugs are paid in network by both doctors
submitted by /u/agreateday
[comments]
