Brown and Toland reviewed Labcorp's $34.94 test. (Part 6) – Healthcare Blog

Author: Matthew Holt

I know you're all concerned, so I'm providing my sixth update on my Labcorp $34.95 bill on TV.

TL:DR The summary of where we are so far is that in May of 2025 I had a lab test done to coincide with a free preventive visit guaranteed by the ACA, but I was charged for the lab test and I'm trying to figure out why because according to CMS I wasn't supposed to do it.

For those who have missed the entire 5-part series so far, please see the Healthcare Blog (1, 2, 3, 4, and 5). Please feel free to go back and read.

When we left the site on September 9th, Blue Shield of California had completed their 30 day investigation and their representative read me the letter they sent me (which I could not open due to their secure email not working). The letter told me that IPA Brown & Toland Physicians, who manage my HMO, would investigate. Today I received a text message from Blue Shield alerting me to a security email, which I was excited about but had nothing to do with. Of course, I should hear from Brown and Tolan in October or November.

So I decided to start over, and I called Brown & Toland Physicians, or actually Altais, which is the holding company that owns them and Blue Shield. I checked the phone tree and finally got “Leave your number and get a call back” which actually happened shortly after.

This very nice representative tried to figure out my situation and told me:

On August 14, 2025, Mike from Blue Shield called Brown and Toland requesting a review of the original claim (1430201). I'm pretty sure Mike is the nice guy from the Blue Shield Executive Office that we met in Part 2 (or was it Part 3?).

On August 29, 2025, Brown and Toland's Benefits Department completed a review and reported that One Medical's initial lab test was not coded as a preventive lab service, resulting in a $34.95 copay correct. ($34.95 is the total agreed upon payment for all tests, for a total of $322.28 charged. Since it is less than my $50 deductible, LabCorp only charges the patient the total, not $50!)

Meanwhile, the 30-day Blue Shield investigation remains ongoing. Eventually they asked Brown and Toland to investigate. Presumably as a direct result of this, on September 9, 2025, Blue Shield's Kelly called Brown and Toland and sent them a $34.94 claim request for review. (It turns out they just reviewed it on August 29, 2025).

“So what happened?” I asked today.

My rep told me that no one Kelly spoke to at Brown and Toland on September 9, 2025 had received or entered the claim reference number correctly, so when they passed it on to the adjuster at the benefits department, the number could not be processed, so nothing has happened since. That concludes their 30-day investigation!

However, today my good representative informed me of the results of the August 29, 2025 benefit analysis, and as mentioned earlier, when Labcorp submitted this statement, it was not coded as precautionary. So the solution is that One Medical needs to change the diagnosis or CPT code and resubmit the corrected order with Labcorp so that Labcorp can bill Brown and Toland for these preventive services and presumably get the $34.95 directly from them. So far, that's it.

Of course, I'm about to ask One Medical to resubmit the lab statement with a precautionary code.

In the meantime, I mentioned to my good rep that I was subsequently tested twice but I was not billed. One of them was a health test and One Medical sent me home with a tool to scoop up my poop. This seems absolutely as preventive as it is to test for colon cancer. The other was a set of low iron tests done during my preventive care visits because my iron levels looked a little low. My guess is that this doesn't fit into the prevention category and I should be paying for it.

As you may recall, the charge for iron testing was $0, and neither I nor the Labcorp representative I was working on the case quite understood why.

Turns out Brown and Toland thought I should pay out-of-pocket for both tests. The fee for fitness testing on May 18, 2025 is $15.60 (1537124). By the way, Brown and Toland have a great deal, Labcorp charges the consumer cash price of about $90! The cost of the iron test is $60.79.

You may recall that my lab co-pay was $50, so Labcorp should charge me the lower of the co-pay or the actual total. The fit test is US$15.60 and the iron test is US$50.

I didn't charge any fees either.

By the way, I wanted to show you Blue Shield's EOBs, but when they canceled and reinstated my insurance last month, their online site had wiped all my EOBs!

Therefore, I agree with Representatives Brown and Toland when she suggested that they look into the $15.60 health test bill to see if there should be a co-pay, and I will likely hear back from them within 30-45 business days.

To resolve this issue, I will (probably) ask One Medical to resubmit the claim!

Yes, this is completely ridiculous and it all goes to show why healthcare is so overly complicated and why no consumer can figure out what's going on.

CODA: At the same time, a reporter contacted me to ask if ChatGPT was being used to organize and protest medical bills. So I went down that rabbit hole too.

Matthew Holt is the founder and publisher of THCB