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landedgentry | 1 year ago

This is what worked for me. (In my case the insurance company and provider were the same - Kaiser - so YMMV.)

Write a letter to your insurance company to dispute the explanation of benefits. Follow the instructions for the dispute process. Cite and attach relevant information, like what annual preventative labwork is mandated to be covered by insurance for people your age due to the affordable care act (I believe this is on healthcare.gov). Note that the labwork was preventative and NOT diagnostic. Then wait for them to process it.

Providers submit my explanation of benefits wrong (in their favor) almost every time I go into a clinic or hospital or lab. And it boils my blood to know they get away with it because 90% of the people just pay it.

Edit: if it's the provider's mistake, then you got to start with the provider.

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zug_zug|1 year ago

Yeah there needs to be a better solution to this. Either some sort of expedient arbitration by a 3rd party, or ability to get reimbursed for your time.