[Need advice] $800 Labcorp bill not paid by insurance
I live in NorCal and I'm on Anthem Blue Cross PPO. A few months ago I needed some blood work for antibody/immunity tests (for immigration purposes). For simplicity and to avoid a field trip to a doctor's office, I did a virtual visit with an online physician for 10 minutes so he could place some lab orders for me. I found the doctor in Anthem's Sydney Health phone App, via "LiveHealth Online". So far so good, I paid the $10 copay for the online visit (provider billed $80 and the plan paid $70), then I went to a Labcorp location near me (in the San Jose area) and had my blood draws. Since Labcorp is considered in-network by Anthem, I thought that would be the end of it. A few weeks later however, I got a bill from Labcorp saying the claim was processed as out-of-network, the plan didn't pay much and and I still owe them ~$800. I logged onto my online account at Anthem, seeing the latest claim was indeed processed as "out of network".
Trying to figure out what's gone wrong, I called Labcorp to explain the situation, and they offered to put a 1-month temporary hold on the bill and kicked me to Anthem. So I called Anthem too, their online agent was nice with empathy, but nothing they could do except to suggest me filing an appeal. I took the advice and filed the appeal to Anthem, only to get a denial in the mail a few days later. The letter explained that, lab testing is considered "ancillary service" and related claims must be submitted to the Blue Cross Blue Shield(BCBS) state where the ordering physician is from. And based on the physician's National Provider Identifier (NPI) submitted on the claim, he was based in Florida, and as a result the claim was sent to Blue Cross and Blue Shield of Florida. And Labcorp San Antonio is contracted with BCBS of Texas but is not contracted with BCBS of Florida. That's how my last claim was handled as "out of network".
Now, a few things seem odd:
1) I did the blood draw in a Labcorp location in San Jose California, but the claim was saying "Labcorp San Antonio". What's possibly going on here? Maybe a clerical error on Labcorp's behalf? Does that matter?
2) I saw the doctor online (via LiveHealth online in Anthem's own app), and the visit was billed in-network, with a Boston-based clinician: ONLINE CARE NETWORK (NPI 1336582550). But on the Labcorp order rendered from the virtual visit, the physician column used the doctor's real name and a Florida-based NPI (instead of the Boston-based organizational name and NPI). Did the doctor mess up here? Should he have used the Boston-based NPI instead?
3) Massachusetts or Florida, they're not my residence state California. You'd wonder the same "out of network" argument would stands for both, but they were treated differently by Anthem. How should I interpret this?
4) Once I had the lab order, the blood work claims was between the lab and Anthem (or at least I assumed), why the doctor's NPI location still matter? Not quite understanding this TBH.
Now, I have the option to appeal the second time with Anthem. What could be my best course of action here? I'm still new to US health care systems, any advice is appreciated. Thank you all!
submitted by /u/RealRefrigerator6014
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