Hi everyone. Throwaway for privacy. I'm not from the US, and 2020 was the first year I had insurance in the country. I got insurance coverage through the Marketplace.
In January 2020, I was diagnosed with fibromyalgia after enduring months of incapacitating pain. Fibromyalgia is considered an illness of exclusion, and my doctors told me there were no tests to confirm it. Trying to better understand the condition, I found r/Fibromyalgia, where redditors were discussing a new genetic test for fibromyalgia. The discussion included whether the test was covered by insurance, and the consensus was that it depended on your insurance company and insurance plan.
After some research, I decided to take the test if my insurance would cover it. I had then the same insurance plan I have now, and since the website for the test displays the logo for my insurance company on its home page, I went ahead and filled out a form on the website. The information requested in the form included personal information, my primary care doctor's information, and insurance information, including insurance company, insurance phone, and ID/policy number. A while after filling out the form, I received a response (that I believe was automated) saying my insurance wouldn't cover the genetic test. I gave up on it and moved on.
A few days later, on March 16, I received an email from the genetic testing company's "Patient Services":
I contacted the number in the email and stated I would like to go ahead with the testing since it was covered by my insurance. A few months later (lockdown happened a week after receiving the email) I had blood drawn for the test at a lab, and received the results a few weeks later by mail.
To my surprise, on December 16 I received a call from someone at the genetic testing company's Billing department stating my insurance company was not going to cover the entirety of the amount of the test, and was going to charge me a significant amount of money for it if they didn't file an appeal. I was told I was going to receive some documents by mail, and that I needed to sign and return them so they could go ahead and file the appeal. I received the documents right before Christmas, scanned them, signed them, and sent them back to the requested address on December 30.
Yesterday I received a letter from my insurance company stating they reviewed the appeal and that they're upholding their original decision, and that I owe $8,500!
https://i.imgur.com/t5xRjvt.jpg
https://i.imgur.com/gsXc2Cl.jpg
After this, I went through my insurance account online and found my EOB for July 2020:
https://i.imgur.com/CrkEVcl.png
https://i.imgur.com/ZaOgEgG.png
I am LIVID. I have opened this letter last night, could barely sleep and can't stop shaking. I absolutely do not have this money, and my current situation couldn't be worse: I'm out of work, barely being able to take care of myself due to the progression of the fibromyalgia, I have no car, no partner, no family, and barely making rent. There is simply no way I'll be able to pay this bill without going homeless, even if I paid it in installments. I never owed this much money to anything or anyone in my entire 42 years of life!
I have no idea how to even begin turning this situation around. What can I legally do here? Is there any recourse for me besides suing the genetic testing company? All the proof I have are what I posted above, an email exchange to schedule the blood draw, and the test results. I'd rather not sue, but if suing is the best course of action, what kind of lawyer should I contact, and how do I go about finding one? Would I have to pay them upfront for their services?
Are there other subreddits or forums I can go for help?
My head is still spinning and it's hard for me to even think of what questions I should be asking here. Please help!
In January 2020, I was diagnosed with fibromyalgia after enduring months of incapacitating pain. Fibromyalgia is considered an illness of exclusion, and my doctors told me there were no tests to confirm it. Trying to better understand the condition, I found r/Fibromyalgia, where redditors were discussing a new genetic test for fibromyalgia. The discussion included whether the test was covered by insurance, and the consensus was that it depended on your insurance company and insurance plan.
After some research, I decided to take the test if my insurance would cover it. I had then the same insurance plan I have now, and since the website for the test displays the logo for my insurance company on its home page, I went ahead and filled out a form on the website. The information requested in the form included personal information, my primary care doctor's information, and insurance information, including insurance company, insurance phone, and ID/policy number. A while after filling out the form, I received a response (that I believe was automated) saying my insurance wouldn't cover the genetic test. I gave up on it and moved on.
A few days later, on March 16, I received an email from the genetic testing company's "Patient Services":
I contacted the number in the email and stated I would like to go ahead with the testing since it was covered by my insurance. A few months later (lockdown happened a week after receiving the email) I had blood drawn for the test at a lab, and received the results a few weeks later by mail.
To my surprise, on December 16 I received a call from someone at the genetic testing company's Billing department stating my insurance company was not going to cover the entirety of the amount of the test, and was going to charge me a significant amount of money for it if they didn't file an appeal. I was told I was going to receive some documents by mail, and that I needed to sign and return them so they could go ahead and file the appeal. I received the documents right before Christmas, scanned them, signed them, and sent them back to the requested address on December 30.
Yesterday I received a letter from my insurance company stating they reviewed the appeal and that they're upholding their original decision, and that I owe $8,500!
https://i.imgur.com/t5xRjvt.jpg
https://i.imgur.com/gsXc2Cl.jpg
After this, I went through my insurance account online and found my EOB for July 2020:
https://i.imgur.com/CrkEVcl.png
https://i.imgur.com/ZaOgEgG.png
I am LIVID. I have opened this letter last night, could barely sleep and can't stop shaking. I absolutely do not have this money, and my current situation couldn't be worse: I'm out of work, barely being able to take care of myself due to the progression of the fibromyalgia, I have no car, no partner, no family, and barely making rent. There is simply no way I'll be able to pay this bill without going homeless, even if I paid it in installments. I never owed this much money to anything or anyone in my entire 42 years of life!
I have no idea how to even begin turning this situation around. What can I legally do here? Is there any recourse for me besides suing the genetic testing company? All the proof I have are what I posted above, an email exchange to schedule the blood draw, and the test results. I'd rather not sue, but if suing is the best course of action, what kind of lawyer should I contact, and how do I go about finding one? Would I have to pay them upfront for their services?
Are there other subreddits or forums I can go for help?
My head is still spinning and it's hard for me to even think of what questions I should be asking here. Please help!
