Insurance Thinks I Paid 5K Out of Pocket, But Bill Was Reduced

I took a genetic test for mental health medication (Genesight from Myriad Genetics.)

I received an EOB from Horizon Blue Cross Blue Shield stating that the testing company billed them $5,650. HBCBS sent me a check for $436.11 and said I am responsible for the rest of the payment to Genesight.

First, why did HBCBS send me a check? They have never done this before, they have always paid the provider directly.

Second, Genesight has a promise that customers will never have to pay more than $330 out of pocket. So they adjusted my invoice from $5,650 to $766.61 ($436.11 from my provider + $330.50 from me, I guess.) Fine, I was prepared to pay $330 because I have High Deductible insurance.

However – My insurance company has applied $1,551.73 to my deductible for this claim. I don't know where they got this number from. It seems like they think I have to pay the full 5k but they will only allow part of it to go towards my deductible.

This amount caused me to exceed my deductible for the year, so now they are covering all claims after this one. It took a few months for me to get all this information, so they have covered several claims at this point that normally I would have had to pay.

I called Genesight to confirm the amount on their invoice. I asked them if they would be sending an updated invoice to HBCBS and they said no.

So am I responsible for calling my insurance company and telling them how much I actually paid for this service? And then what will happen – am I going to be retroactively billed for the services they covered in the meantime? I assume I am, but how does that work, since they have already paid my providers?

submitted by /u/Helpful-Pickle-Jar
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