By MATTHEW HOLT
For these of you ready for the Labcorp, Blue Shield of California, Brown & Toland Physicians Physicians replace, the ball has been moved a few years down the sector.
If you wish to catch up right here is part 1, part 2 and part 3)
You’ll recall we left it with a thriller $34.94 invoice which didn’t both match the official $50 copay quantity I’ve, nor the $0 affected person duty in my EOB. I received a name from Rhia Fleming, an skilled buyer rep at Labcorp, on whose digital desk this has been dumped. We had a stunning dialog through which we agreed that the co-pay ought to both have been $50 or $0 however that it’s potential that the co-pay is the decrease of $50 or the quantity Labcorp was making an attempt to gather.
She had beforehand known as the Blue Protect of California supplier line to attempt to determine this out. Blue Protect had certainly kicked this declare from Labcorp to Brown and Toland the IPA I’m assigned to within the HMO product I purchased. The costs from Labcorp had been $322.28 and the response from B&T was that the contractual worth (i.e. what they agreed to pay Labcorp for these assessments) was $34.94, therefore the “adjustment” of $287.34. Nevertheless in Labcorp’s system the algorithm interpreted B&T’s response as saying 1) the agreed fee is the $34.94 in keeping with the contract and a couple of) they weren’t going to pay so the affected person owes the distinction. When Rhia Fleming requested Blue Protect’s rep why the affected person owed fee on this, the Blue Protect rep mentioned that the process code and analysis code from my PCP (One Medical) didn’t rely as preventative care. In different phrases Labcorp has not received paid in any respect for working these assessments thus far, as a result of they’re in keeping with B&T “not preventative”. Though IMHO, CMS says that they’re. And naturally because it says my copay is $0 I’m decoding Blue Protect of California’s EOB as saying that to me!
Therefore Labcorp generated the invoice for the $34.94 and despatched it to me. Which began this entire telenovela.
BTW Rhia’s conclusion was that as not one of the assessments had been “preventative,” Labcorp billed me the $34.94 as that was the whole it was contractually owed quite than the $50 copay I’m presupposed to pay for lab work. I truly checked again in my Labcorp account and located that final yr I did in truth pay $50 so maybe final yr I had completely different assessments or in some way they’ve modified the algorithm. I checked the EOB for that 2024 invoice and the whole cost was $445.20 of which Blue Protect paid $28.07. No I couldn’t discover the Labcorp invoice on their system, presumably as a result of I’ve paid it! On condition that I paid $50 for companies from Labcorp on that date (sure, it took me 7 months to pay up!)(, it’s seemingly that the agreed fee was $78.07 ($50+$28.07) of which I unthinkingly paid the $50 copay. And sure that ought to have been preventative too. (Maybe I ought to ask for that $50 again!!)
Then, I had one other thought.
It seems that the lab outcomes this yr generated an extra concern in my physician’s thoughts. (Keep in mind I had the lab assessments earlier than the workplace go to in order that we might focus on the outcomes). Evidently my iron ranges had been somewhat low, so whereas I used to be within the physician’s workplace he ordered some extra assessments particularly about that. As One Medical has techs on website they drew my blood then and there and shipped it to Labcorp.
Based on my EOB, Labcorp’s cost for these new assessments was $60.79 of which Blue Protect or quite Brown and Toland once more paid $0 and created an EOB which once more mentioned my affected person duty was $0. I requested Rhia to examine that invoice in her system and it seems that I do NOT owe Labcorp something on that set of assessments. Perhaps they had been coded as preventative? I attempted to search out the invoice on my affected person portal at Labcorp however as a result of I don’t owe something I haven’t been despatched an bill and with out an bill quantity you can’t examine the invoice!
When Rhia ended the decision with me, her subsequent transfer was going to investigate of Blue Protect and Brown and Toland what the explanation was for me owing $0 on that invoice!
In the meantime I await the results of the official Blue Protect investigation with curiosity. In fact this would possibly simply have come right down to Amazon One Medical coding the assessments incorrectly. However it’s all enjoyable and video games you probably have limitless endurance in American well being care.
And naturally, this nonetheless isn’t over!
