Wiki Horizon BCBS NJX reimbursement for out of network laboratory services

[nataliiam]

We are out of network independent laboratory, our services used to be paid by NJX plans of Horizon BCBS but this year they are denied due to no out of network benefits. Does anyone know how to deal with these denials in order to get reimbursed?

 

[andersona1229]

Fellow independent lab biller here. To put it bluntly, you've got to eat the denial and follow the EOB. If it's an adjustment, then you adjust. Full balance to patient responsibility, bill the patient. Patients can appeal these denials if they didn't know their specimen was being sent to an OON lab and the ordering provider is in-network. We deal with this frequently as we're OON with some plans in high volume states for us so we have to bite the bullet on it.

Pray they don't start sending the checks & EOBs to the patients; I can't tell you how many patients call in about their bill and find out those checks from Anthem were for their lab work and not for personal use.