Labcorp, Blue Shield and My $34.95 Co Pay (Part 5) – Healthcare Blog
Matthew Holt
I've been looking to understand why Labcorp charges me $34.95 for some lab tests, and I think I think it should be free under the ACA preventive care regulations, and my California insurance company issued EOB for me and offered $0 co-payment.
So far, this has been a microcosm of health care chaos in the United States, and if you want to catch up here is Part 1, Part 2, Part 3 and Part 4
You may remember that I paid $50 for the CO for the preventive annual health visit in 2024 (I didn't notice), but when I received $34.94 in 2025, I found that Blue Shield said my Copay was $0 and I decided to investigate.
My senior customer service representative at Labcorp got a lot of help and I think like me, he had almost the same fun as me. She told me that the co-paid Labcorp tried to collect was $50 or total bills. For the 5 tests I did, the agreed interest rate for Labcorp with Brown and Toland Dr. (the IPA owned by Blue Shield of the HMO contract (I am a member) contract) was $34.94. So, that's the answer to the allegation.
But this still doesn't answer more questions.
- Why do I also show Blue Shield as $0 Copay on EOB as follow-up?
- Why do I think that preventive lab tests are not free under the ACA?
Rhea's guess for the first answer is that Labcorp received the vote amount for Blue Shield or Brown and Toland's lab tests, and the second test was somewhat covered. Maybe, but then why not the first one?
The second question took me to the rabbit hole. Rhea digs out orders from a medical to Labcorp. Below you can see the CPT code in it (what the test is actually) and what the related diagnostic code is.
Of course I asked chatgpt what these diagnostic codes are, the answer is
E78.5 = Hyperlipidemia (i.e., high cholesterol)
R73.03 = Diabetes
E66.811 = Obesity Category 1
M10.9 = gout
You might suspect that you are a very typical American over 60s and I'm suitable for all these diagnoses. The CPT codes I conducted for the test were full blood count, metabolic panel, hemoglobin (A1C), lipid panel and uric acid (which causes gout).
Probably all of this can be seen as preventive except for gout/uric acid. After all, the CMS website explains that preventive screening is free.Annual Health Visits and Physical Examinationsfor example with a primary care physician Health Screening For blood pressure, cholesterol, blood sugar used for diabetes, and various cancer screenings such as colonoscopy and mammograms”.
Then why is this not free for me? Labcorp's Rhea shows that Blue Shield initially issued a $0 Copay EOB to me, but it should be reprocessed later when it gets the bill from Labcorp and tells me to pay $39.94. She also found that in addition to the hint that should be called preventive CMS, CA's Blue Shield has a long file it Considered to be preventive care. You can view and download it here.
I asked Chatgpt to read it for me and after a while we concluded that E78.5 is on the list of applicable ICD-10 diagnostics for annual health assessment visits, a service (free) covered. Therefore, my high cholesterol should be screened for free.
On the other hand, there is an entire section on page 28 of the document discussing diabetes education, but it does not explicitly say that the A1C test is covered in the annual health visit. And, if you go down to page 116, there is a table that shows last year Blue Shield Review removed several diabetes codes including R73.03.
Now, I'm not going to pretend that I understand what's going on in this document and why (or whether) Blue Shield is able to change what CMS says should do – if something is actually happening. But this seems strange.
Again, since LabCorp doesn't have the actual fee per test (per test is charged, but bundled and discounted on the bill), it's impossible to say what the contract fee per test is, so if I get some for free (I should think I should have) and what I actually charge.
Finally, I was very excited because Blue Shield sent me a message tonight, which I thought was a response to a complaint made by someone in the Part 2 Administrative Office for me. However, the format of the attachment is not correct. So I don't know what it is talking about!
No less than what I expected of this adventure.
But hopefully we can find who is charging who is who and why!
Matthew Holt is the founder and publisher of THCB
