conversation: User (alrashid2): "Hi guys. Long story short, had a doctor's appointment for my doctor I see regularly who is in my network. He requested I get some routine blood work done and said he'd send the request to LabCorp and that they are in my network - he said I could choose whatever location. According to my benefits, tests like blood work are covered fully by my plan in network, while there is a deductible for out of network.\n\n\nThere are a bunch around so I just visited the one closest to my work. As I finish up they let me know I owe $55. This seems odd as I thought I had full coverage, but I was in a rush so instead of paying then and/or asking questions, I asked for the bill to be mailed and left. This seems strange though as they had my doctor's request for tests in their system.\n\nCalled my insurance customer service and they confirmed that if the lab was in network, it'd be fully covered. I asked if she could check if the lab I visited was in my network but she said I had to contact the lab...\n\nAnyway, just trying to figure out what's happening here. Is it normal for a doctor to send a request for work to a lab out of network? Is it possible some Labcorp labs are in my network but not all, and that this one isn't? \n\nI have a feeling that for whatever reason I am screwed here and that this lab is out of my network. If that is the case, can I negotiate the bill with Labcorp? On the receipt, it says $0 copay, $0 co-insurance, $55 deductible (out-of-pocket).\n\nI appreciate you guys' advice. This is my first year on my own insurance and I feel like it's so difficult to not get screwed as little things like this keep happening to me... I'd also appreciate any tips in the future as to what I can do to avoid these unnecessary charges. \n\n**UPDATE 1:** I called the insurance again and spoke with another representative. She didn't have that specific Labcorp listed on the in-network list, but said that any Labcorp in my referring doctor's area should be covered. She said I'll have to wait for the Labcorp location to submit my claim, and my insurance should correct it - she also mentioned something about a Summary of Remittance. She said this can take some time, up to 6 months, so I guess I'll just have to wait this one out and see what comes in the mail in the following weeks. Thanks everyone for your help so far!"
  Self: "I would call your insurance company back. They most certainly can check whether or not the lab is in- or out-of-network. Ask for a supervisor, as the basic CS people have such a high turn-over that I never trust them myself(I'm a medical biller). Also document everything and get call reference numbers in case you might need them for an appeal later. The way the lab would determine if you were in or out of network would be by calling your insurance company to check your benefits. They can give you the same information. \n\nAlso, out-of-pocket and out-of-network are two different things. If they are in fact out-of-network you may have grounds for an appeal to have it processed as in-network due to medical necessity since thats where your doctor sent you. If they end up being in-network they should be able to reprocess the claim because, yes, the insurance companies make mistakes and will usually hope no one notices. \n\nFinally, a good place to crosspost is in /r/codingandbilling as they can pick apart and explain some things a little better than I can. "
  User (alrashid2): "Thanks for your advice. I called them again and spoke with another representative. She didn't have that specific Labcorp listed on the in-network list, but said that any Labcorp in my referring doctor's area should be covered. She said I'll have to wait for the Labcorp location to submit my claim, and my insurance should correct it - she also mentioned something about a Summary of Remittance.\nThanks again!"
  Self: "Your welcome, and I am glad you got someone helpful. \n\nYou mentioned having to wait for Labcorp to submit your claim - I am now wondering where the $55 charge came from if the claim has not even been processed? \n\nThe Summary of Remittance (aka Explanation of Payment, Explanation of Benefits, Remittance Advice) is what you will receive from your insurance after the claim has been processed and finalized. It is not a bill. This outlines what was charged to your insurance, how it was processed (in or out of network), what was paid/what is owed to your provider, and how the charges were applied. "
  