I used to process claims for Medicare Part B and after that for other types of medical insurance.Providers who accept Medicare's allowable charge as full payment know that was what they will receive. If you see a physician who does not participate in Medicare you can be billed the full amount, and any coverage by insurance will be sent directly to the patient.)
Medicare or any other insurance does not bill anything back to the patient, but the provider does. Even if the doctor's office bills you, if the insurance person knows it's wrong they are contesting it and if htey get an adjustment you will get a refund from the doctor. You get an explanation of benefits from Medicare which shows how the claim is broken down but that is not a bill in fact it clearly states that.
For a contracted provider, if bill is $300 with an allowable charge of $200, the provider receives 80% of $200. The provider may then bill the patient 20% of $200 and that other $100 is written off. The providers know their allowable charges they are part of their contract. This is how labs generally work with insurances in general. If the particular service is not in the provider's contracted services then it would be denied and the provider can bill for the whole amount. If the provider is not a participating provider then they can bill you for more than 20% of the adjusted amount. But you won't get a bill from the insurance company for the amount they didn't cover.
The physician ordering the labs should know which of the big labs are participating providers and that is where one should go. First rule of medical insurance: never go to a non participating provider.
The error could have been made by the doctor in the written order, the lab in submitting the claim or the claims processing at the Medicare office. Somewhere along the way it can be corrected. If a lab charge is denied, go to the doctor who ordered it to start the review. You have to let them know because they are not going to see the payment info from the lab
I suspect that doctor's office called to double check the code and ask for the claim to be refiled with a correction if it was coded in error. If the doctor's office put an incorrect diagnosis or code on the lab order that is sent over, then the doctor's office will make the correction, resend the order and the lab will refile. The lab wants to be paid too. Normally when a claim is rejected by insurance, the provider gets right on it .
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