Rhia had previously contacted Blue Shield’s provider line for clarification. It turned out that Blue Shield had redirected this claim from Labcorp to Brown & toland—the Independent Practice Association (IPA) associated with my HMO plan. The charges submitted by Labcorp totaled $322.28; though,brown & Toland responded stating their contractual obligation was only $34.94—resulting in an adjustment of $287.34 on their end.

this discrepancy arose because Labcorp’s system interpreted B&T’s response as indicating two things: first, they agreed upon a payment amount of $34.94 per contract terms; second, they would not cover any additional costs—leaving me responsible for the difference owed. When Rhia asked why I was being billed this amount during her discussion with Blue Shield’s representative,she learned that my primary care physician’s procedure code did not qualify as preventative care according to their standards—meaning Labcorp has yet to receive payment for these tests since they were deemed “non-preventative.” Interestingly enough, I believe CMS guidelines classify them otherwise—and given that my EOB states a copay responsibility of zero dollars—I interpret this as meaning no payment is due from me!

A Shift in Billing Practices?

This led Labcorp to issue me a bill for the puzzling sum of $34.94—a scenario reminiscent of an ongoing drama series!

I also revisited my records on the Labcorp platform and discovered I had indeed paid a copay fee of $50 last year under different circumstances—perhaps due to variations in testing or changes within their billing algorithms? Upon reviewing last year’s EOB related to those services—which totaled approximately $445.20—I noted blue Shield covered only about $28 while I contributed another unthinking payment towards what might have been an agreed total closer toward around $78 for those lab services rendered (which should also have qualified as preventative). Should I consider requesting reimbursement for that previous charge?

A New Set Of Tests Brings More Questions