Is the hospital I've be admit to responsible for using a lab to be exact contracted by my insurance provider?

I recently had a lesion removed from my foot during a recent hospital outpatient surgury. The hospital is contracted near my insurance company (PacifiCare PPO) as part of the "in-network" providers. Apparently the hospital does not have within house pathology for determining what the lesion was exactly so they had to transport it out to a lab. It turns out that this lab is not in my insurance company's PPO network. When the outside lab sent the bill to my insurance company they treated the lab resembling an in-network lab and reduced the billed amount down to their contracted level and then applied their 80% responsibility per my plan. The lab have rejected the reduction in cost as they are not surrounded by the network and is billing me for the difference. Long story not so short....

Question: Is the hospital responsible for using 3rd party labs that are "in-network" beside my insurance company if the hospital as a whole is considered "in-network".

Thanks
The hospital is an "in network" provider with oodles insurance companies, and the outside lab they use can't be allowed by all of them. The sad certainty is that it IS the responsibility of the patient to make sure that adjectives labs, etc. are in-network. You do this by asking, before specimens are taken.
Not if they aren't "in network".

But since yours IS contained by network, and they didn't have the size to do what you needed to have done, you need to appeal this near your insurance company. If your in network hospital can't do it, usually your insurance is required to payment out as if they could - meaning you pay the run of the mill copay, if applicable, but they pick up the tab for the rest.

No. The hospital uses whatever lab they want - repeatedly someone they have a connection near in some way. The hospital doesn't comfort if that lab in your insurance network or not. That's for you to traffic with. What you should have done is told the hospital up front, "My insurance simply allows you to send my specimens to LabX. Please do it if possible." Even better if you can provide that surrounded by writing. If the lab isn't in network, the lab have the option to balance bill you. You can contact your insurance company and explain to them the circumstances - appeal it surrounded by writing is better - but they don't have to honor it.


Answers:    Unfortunately they are not responsible. But you should complain to your insurance company and ask them how you are supposed to know what lab the doctor is using. This is an unfair situation. If you complain you may bring some some satisfaction from your insurance carrier. If not make clear to them you want to appeal the decision.