Plan refusing to pay doctor ordered lab tests at in-network lab
I had an Advanced Lipid Panel done (ordered by my doctor) due to history of high cholesterol. The test was done at an in-network lab. However my EOB indicates the following "Your plan pays for charges we find to be reasonable and appropriate based on professional standards of safety and effectiveness for diagnosis, care or treatment. This service does not meet that requirement. [789]" for all the lipoprotein related testing done and refuses to cover it or apply it towards my deductible. Yet my EOB still suggests I owe this amount to the provider. What is even more confusing is that the EOB shows the cost for the testing AND the plan discount yet tells me I owe the FULL amount before the plan discount.
I'm confused because I thought if insurance can't figure out charges with in-network providers, I wouldn't be responsible. This test didn't need pre-auth either. Why am I responsible for the full amount. Why is it not applying towards my deductible?
Can someone help me understand what is going on here? I will call the insurance directly as well, but wanted to understand what might be happening here so that I don't get the run around from my insurance.
Insurance: Aetna
Location: PA
submitted by /u/pililies
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