Health Insurance Billing questions

[niccig]

I always get confused when a statement arrives from our Health Insurance Co. - Health Net PPO

So here's an eg and some questions, if someone could please explain I will be very grateful.

Billed Amount was $76.10
Non Allowed was $43.10
Allowed amount was $33 of that, Health Net paid $30 and said I might be billed for $3.
There was no co-pay, this was blood tests.

So, my question. Can the lab bill me for the non-allowed ($43.10) and my part of the allowed ($3)? If they do, do I have to pay the non-allowed amount, or can I argue that it's more than Health Net contracts - I do know I've signed those forms at Dr's office that say you will be responsible if your Health Insurance won't pay - do those forms mean you have to pay the non-allowed?

Thanks for any help. After 5 years of living here, you would think I've figured this out by now.
Nicci

[spunkybaby]

You don't have to pay the "non-allowed" amount; the bill is reduced because of Health Net's contract with the lab. If the lab bills you for the $3, you will have to pay that amount. But you should also check your insurance plan to see if you have to pay for in-network labwork. Sometimes the insurance company makes a mistake and charges you when the labwork should be free. If that's the case, call your insurance company and ask to have the claim reprocessed.

I know that if I go to my hospital's lab facility, I do not have to pay a cent. And if I get my blood drawn for labwork while at my doctor's office, I do not have to pay an extra copay because I've already paid a copay for the office visit. BUT if I go to my doctor's office just to get my blood drawn, my insurance charges me the office visit copay, and the doctor's office sends me a bill for that copay amount.

[ShanaMama]

It depends if the lab is contracted with HealthNet or not. If they are contracted, then they must accept HealthNet's assignment & can bill you only what HN determined is your responsibility ($3). If they are not contracted with HN they can bill you for the difference.
What lab was it? Not sure what labs are in your area, but I also have HN & around here they are contracted with Quest but not BioReference.
Also, did you go to the lab or did the doc draw your blood & send the blood there? The difference is if it was sent by your doc's office to a lab that doesn't participate with your insurance, you might not be responsible for the balance.
Hope that helped. Feel free to pm me with any other questions.

[niccig]

Thank you both.
The lab is part of USC Internal Health Center and Hospital. With our PPO we pay 10%, so the $3 is correct. Until this year, we only ever did check-ups, but with my surgery we've had more appointments, so more paperwork and I want to make sure they're aren't any mistakes. On the good news, it looks like the anesthesia bill will be totally covered, and that was much more than the lab work. Now waiting on the surgeon and the hospital room bill.

Nicci