Protection for difference "Amount Billed"-"Allowed Amount" after max benefit is reached?

Question

I had my yearly physical a couple of weeks ago. From this my health insurance received two invoices, one from my doctor, one from the lab. The Allowed Amount for the doctors visit was $176.86. My insurance paid $150 according my plan ($150 maximum benefit), I have to pay $26.86. No problem there.

The invoice for the lab (received by the insurance 2 days later, Amount Billed $603.89, Allowed Amount $75.96) is now completely denied by the insurance, due to the fact that the maximum benefit was already reached with my doctors invoice (same billing reason). I understand that my insurance will not cover more than those $150.
I am told now by my insurance that I will be billed and have to pay out of pocket the full $604 to the lab, not the $76, since I will not get the discounted rates my insurance does.
My quesiton now: is there insurance in FL available that extends the discounted rates somehow to its members, so they get the services to the same price as the company would?

Answer 1

Even if you get supplemental medical insurance, you are still liable for the $600 lab charge.

Contact your plan representative, not customer service, to determine why they have not considered the lab bill. I know that you mentioned that the "max" ($150.00) had been paid to the doctor, but sometimes the carrier will extend some consideration, especially where the procedure is "preventative".

Next contact the lab for a detailed statement of charges (get the name of the person you talked to). Once you have that information, contact your doctor to verify whether or not he authorized the tests, and if, in his opinion, the charges are "reasonable and customary".

Then contact the lab person you previously talked with. If the charges were not authorized, challange them and ask for another, corrected statement. If they are reasonable, try to negotiate a discount (start at 70%, with a "walk away point" at 90%) failing that, inform the lab of your payment plan - $ XX.00 weekly, bi-weekly, monthly, etc.

As long as you make "good faith" payments, I believe that there is little/nothing the lab can do.

Remember, it's your money, why give it up so easily?