Insurance denied Prior Authorization after Quest Performed testing now I’m being billed $3K
I had a bone marrow biopsy and after my doctor wanted additional testing done on the specimen. Quest submitted a prior authorization request to my insurance, which was approved and Quest then proceeded with the additional testing.
After the results came back and Quest billed my insurance, the claim was denied. My insurance told me the prior authorization wasn’t valid because the date the test was performed was after the date of the bone marrow biopsy/collection (The prior authorization letter stated the dates it was approved from which was after collection date).
When I called my insurance, they explained that because the bone marrow biopsy was performed on X date and the additional testing was performed on Y date, the authorization they approved was considered invalid. Apparently, the service date needed to be associated with the original specimen collection date (Which Quest was aware of as they explained the same to me, but still proceeded with the test).
I’ve contacted Quest numerous times over this because I don’t understand why I’m being held responsible for a $3,000 bill when Quest was the one that submitted the authorization, received the approval, and then proceeded with the testing. The authorization letter even listed approval dates beginning two days after the bone marrow biopsy. If the service date needed to be the specimen collection date, why did Quest proceed with the testing knowing the authorization dates didn’t match?
The frustrating part is that I didn’t even know this additional testing was being performed. I only found out by logging into my patient portal and reading the notes. I never personally requested or authorized this additional testing.
Quest has essentially told me to deal with the insurance issue, while insurance is saying to talk to Quest.
What can I do in this situation? I have filed an appeal with my insurance already and requested a formal review and submitted a complaint to the No Surprises Act which was denied because they're limited to non-emergency services that are out of network.
I’m really struggling to understand how I can be responsible for $3,000 when the testing and authorization process were handled between Quest and my insurance without my involvement.