Medicare, Medicaid, Life and Health Insurance/Labs & Referals


I have an HMO plan and had the hardest time finding an OBGYN that would take it but we finally found one to take care of me for my prenatal cAre. Supposedly the doctor's office confirmed all of our insurance info, said they had worked with them before and gave us the amount we had to pay and the due date. We have paid the amount we agreed to and then we started getting bills from the lab saying the insurance denied them. We called the insurance and they said that lab wasn't in the network with them and that we needed a referral. I asked the doctors office and they said that they didn't do referrals and they did not understand because the insurance did not mention this when they called. I'm not sure what to do here because no one told us anything about referrals until these bills started appearing and no one wants to take responsibility. I shouldn't have to pay these bills if they told me they were going to be covered.
Thanks for the help and time for reading my question.

Hi Natalie,

I am so sorry this has happened to you. This actually happens quite often. There may not be a resolution for this. You could try to file an appeal to your insurance company to see if they would reconsider paying for the labs. However,  I suggest you find a lab that accepts your insurance for the future. Have your doctor write you an order for your lab work and go there yourself to get your tests. Unfortunately it is ultimately the patient's responsibility to verify this information. It would be ideal for the doctor's office to do it but they don't always take the extra time for their patients.

Good luck

Medicare, Medicaid, Life and Health Insurance

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Joy B. Hicks, MBA, CPM


As a Medical Office Expert, I can answer any question related to the medical office from the prospective of hospital and physician office staff and patients.


I have been in the medical office field for 12 years and also have a blog that provides advice, information, and tips about the medical office.


Certified Practice Manager
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