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Doctor Messed Up, What Can I Do?

I'm having a major dilemma right now. Long story short, I went to my podiatrist to get medicine for foot fungus.

He took a culture of my feet and sent it to a lab that was not in my network (i'm Horizon).

They want 411 dollars from me for the lab services.

We sent in an appeal to no avail.

Is this his responisbility, since he did not do a pre-determination? He claims he never asks for a pre-determination for something like this.  He does not seem willing to bend to this and wants me to pay the bill myself. But he didn't tell me he was sending my culture to a lab that was not in network (he admits to the mistake). He said he just found the lab at a convention and I was the second person he sent there. My family has been going to this doctor for years with no issues.

What can I do? I do not want to pay 411 dollars for this service. Any information would be much appreciated.
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282113 tn?1388163349
Dear jbman84,

Health Insurance coverage & rules vary by plan, carrier and state. I am going to anticipate that by Horizon you are referring to Horizon Blue Cross Blue Shield which is a carrier in NJ and most of their members are on HMOs!

You should start out with calling your carrier and ask them to explain to you, who is responsible for what.

Often most providers require you to sign off on an agreement that holds you responsible for any & all bills should your insurance does not cover it for any reason. So you need to find out if you have signed off on one of those. If you have, then you are contractually responsible for those bills. In that case you need to leverage yours & your family’s relationship with the doctor & the fact that he admits to his mistake & suggest that you can’t afford to pay this bill & you would have not gone forward with it if you were made aware of this outcome. Ask your doctor to reach out to this lab & ask them to cut it down to at least half. The lab wouldn’t want to ruin their chances of getting more referrals from the doctor, so they are very likely to agree to it.

If this works out, pay the bill & take this as a $200 lesson that may save you thousands in future!  


Amir Mostafaie
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