In-Network Provider didn’t get pre-authorization before running a test.

My wife went to an Urgent Care to get tested for Mycoplasma Pneumonia, because the day before I was hospitalized for it. (I had it in my left lung and was prescribed antibiotics. The doctor at the hospital told me that the type of pneumonia I have doesn't pop up in normal tests and they had to also do a CT to see it in my lung.)

My wife had a cough and was worried she caught it so she went to an urgent care near our house and told them what type I had and that I was diagnosed. So the place did a test (sent it to a lab) and went ahead and prescribed her antibiotics since I was confirmed to have it. She thankfully tested negative and I recovered from it; however, we got a bill from the lab (Quest Diagnostics) with a bill for hundreds of dollars and a note on it saying that insurance denied it. I called my insurance (Aetna) to ask about it and they told me that they denied it due to not getting pre-authorization. The lady I talked to emailed me an appeal form but I'm confused because on my insurance's website it states that, "Network providers are responsible for submitting pre-certification requests to Aetna on your behalf, but you can avoid costly surprises by connecting with an Aetna Concierge…"

We had no idea because we didn't know some lab work required pre-authorization and I assumed because this place was In-Network that we would be fine. Am I stuck with this bill? Or do I have some sort of course or protection from this? I'm going to try and contact my job's HR about it to see if they have some insight but I'm trying to find a way to avoid this bill that I don't know if I could pay right now.

submitted by /u/WillieMunchright
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