Matthew Holt
For those waiting for Labcorp, Blue Shield, Dr. Brown & Toland’s doctor update, the ball has been under the court for several years.
If you want to catch up here is Part 1, Part 2 and Part 3)
You will remember we left behind a mysterious $34.94 bill that didn't fit the official $50 payment I owned nor my EOB $0 patient responsibility. I received a call from Labcorp's experienced client representative Rhia Fleming, who has been abandoned on his virtual desk. We had a pleasant conversation and we agreed that the co-payment should be $50 or $0, but the co-payment could be a lower amount of $50, or the amount Labcorp is trying to charge.
She had previously called the California provider's Blue Shield series to try to solve the problem. Blue Shield did kick this Labcorp claim to Brown and allocated an IPA in the HMO product I purchased. Labcorp's fee is $322.28, and B&T's response is $34.94 for the contract price (i.e. they agreed to pay for LabCorp for these tests), so the “adjustment” is $287.34. However, in Labcorp's system, the algorithm interprets B&T's response as saying that 1) the agreed payment is based on $34.94 on the contract, while 2) they won't pay, so the patient owes the difference. When Rhia Fleming asked Blue Shield's representative why the patient owed this, Blue Shield Rep said that the program code and diagnostic code for my PCP (a medical treatment) did not count as preventive care. In other words, Labcorp has not received any reward for running these tests so far, as they are based on B&T's “unpreventive” nature. Though IMHO, CMS says they are. Of course, as I said, my communist is $0, and I'm explaining the Blue Shield of California EOB said to me!
So Labcorp generated that bill for $34.94 and sent it to me. This started the entire Telenovela.
By the way, Rhia concluded that since there was no “preventiveness” test, Labcorp paid me $34.94 because that was the total amount owed on the contract, not the $50 Copay I should have paid for the lab work. I actually checked it in my LabCorp account and found out that I actually paid $50 last year, so maybe last year I had different tests or somehow changed the algorithm. I checked the EOB for this 2024 bill, and the total cost was $445.20, of which Blue Shield paid $28.07. No, I can't find the Labcorp bill on their system, probably because I've paid it! Given that I paid $50 for Labcorp on that date (yes, it took me 7 months to pay!) (, the agreed payment could be $78.07 ($50+$28.07), I unconsciously paid $50 COPAY.
Then, I had another idea.
As it turns out, this year's lab results have attracted further attention in my doctor's mind. (Remember, I did a lab test before my office visit so we can discuss the results). It seems my iron level is a bit low, so when I was in the doctor's office he ordered more tests. When a medical field provides technology, they sucked my blood at any time and transported it to Labcorp.
According to my EOB, Labcorp costs $60.79 for these new tests, with Blue Shield or Brown and Toland paying $0 again and creating an EOB, which again says my patient responsibility is $0. I asked Rhia to check the bill in her system and it turns out I don't owe anything in this set of tests. Maybe they are coded as preventive? I'm trying to find the bill on my patient portal on Labcorp, but since I don't owe any invoices I haven't received, without the invoice number, you won't be able to check that bill!
When Rhia ends the call with me, her next move will ask why Blue Shield and Brown, Toland and Toland owe $0 on the bill!
At the same time, I am waiting for the results of the official Blue Shield investigation. Of course, this may just be attributed to Amazon's medical code that incorrectly encoded the test. But it's all fun if you have unlimited patience in healthcare in the United States.
Of course, this is not over yet!
