We have Anthem Healthkeepers medical insurance. Back in June I got routine bloodwork completed at an in-network lab (Labcorp) using a primary care physician provided lab order. Lab is in network, so is physician and bloodwork is fully covered as per benefits.
Insurance denied the claim in late June stating that “services were not covered because the ordering physician is out of network and licensed in California, and not Virginia.” This is utterly wrong as the ordering Physician is in VA and only licensed in VA. The labcorp location is 2 miles from our home and also in-network. Upon initial investigation it appeared that labcorp was entering the wrong physician ID. After a 1 hour long call between the Anthem agent, physician office and labcorp, Anthem agent told me that labcorp will re-submit a corrected claim and the claim will be processed as in-network. Mid July claim rejects again (same reason as before). I call back Anthem and they tell me that the new labcorp claim still has wrong physician ID (for CA instead of VA). Another 45 minute call with the insurance agent and labcorp and a new corrected claim is submitted for adjustment in mid August. Anthem agent and labcorp assure me all is correct this time and will go through as in-network.
Fast forward to September, claim is denied again (3rd time). I call the agent and she tells me to file and appeal for “adjustment at in- network rate” as it’s my last resort. This is absolutely ridiculous. Why should I file an appeal if I went to an in-network lab and in-network physician and my lab work is fully covered under benefits. Has anyone run into this situation? Should I be filing an appeal or should I push insurance/labcorp to submit a new claim with the right physician info, knowing that it’s failed twice before? I am concerned that they will simply deny the appeal and then I will have no option but to pay this ridiculous bill. This is so wrong. Any info appreciated.
FYI, this is the last reply from Anthem when the claim was denied for the third time:
“The request has been denied, stating that the coverage only allows for out of area emergency services/urgent care, which is no different than out of network. The next route would be to file an appeal with our appeals team.”