Question:
Why am I getting a bill from champus for Labs?
HELP ALL YOU CHAMPUS PEOPLE..I HAVE TRIGON STANDARD..HUSBAND RET. USN. THEY SENT A LETTER STATING MY SURGERY WOULD BE COVERED...Now i'm receiving eob's stating that my labs and xrays are not covered ...900.00 $ worth. What should I do? Thanks Jacki — Jackiis (posted on January 9, 2002)
January 9, 2002
We don't have the same insurance but I too had the same thing happen to me.
In fact all my bills were being returned saying that weight loss not
covered etc etc. I called my insurance and found out that the people who
were reviewing claims didn't "bother" to check and see if I had
preapproval. They just assumed I didn't. The person I spoke to resubmitted
everything and it all got taken care of. I know what you mean about the
$900 one, I had a hospital bill for $22,500! Just about made me have a
heart attack! Good Luck hope this helps....
— kristen H.
January 9, 2002
A lot times the "link" that is needed in the claims department
tieing all of your claims to the one pre-approval or referral has not been
put in the system. Call your insurance company first and explain that there
is a referral as well as a pre-approval somewhere in their system - alot of
times when I call, they answer the question before I even have a chance to
tell them there is an approval on file, they just say they will resubmitt
the claim and get it paid. If that doesn't work, call the billing
department of the company that is billing you for your labs... sometimes
they don't have the insurance information correct on the paperwork and so
it doesn't get "linked" up when submitted. Good luck!
— Kellie Jo B.
January 9, 2002
I have Tricare Standard (Retired) also, and usually it is because someone
just put the wrong code or something. Call your regional office (the
number is usually on your eob) and ask to speak to a claims rep. Then
explain this was part of the hospital stay and then ask what they suggest
you do, or who should you contact to get it straightened out. They are
usually very cooperative and helpful. They will give you the specific
answer to the question of why it was not paid. Then you should call the
place that sent you the bill and tell them what you learned. Most of the
time all of this happens automatically, but sometimes it does get mixed
up--especially when you have major surgery and so many people are sending
in claims to Tricare!
Good luck!
— Susan B.
January 10, 2002
I don't have Champus, but another federal plan, Mailhandlers. I have had a
few problems with getting billed for the tests from time to time, but they
were all eventually straightened out & paid. Interestingly, while I was
receiving a bill, it was for just over $1000. I KNEW I was getting the
exact same tests as the others in my WLS support group & asked how much
their labs were running. I was told around $200! Well, since I was having a
problem with my lab PPO billing me, I had the tests done once at a hospital
instead & my bill was just over $200. QUITE a big difference. I called
& asked why this was & was told that since the PPO lab was paid
according to their contract what they actually billed had nothing to do
with what payment they received. weird. All I really understand is that it
all worked out OK, but now we have a new PPO lab & of course, there's
not one in my area at all so now I'll have to pay the $150 deductible right
off the top. Great! :(
— Kathy W.
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