By MATTHEW HOLT
the Labcorp Billing Dilemma Continues
If you’ve been keeping up with the developments surrounding Labcorp,Blue Shield of California, and Brown & Toland Physicians, it truly seems we are still in a state of uncertainty, as updates have been delayed for several years.
For those who need to get up to speed, here are links to earlier discussions:
Part One,
Part Two, and
Part three.
The last update left us scratching our heads over an unexpected $34.94 bill that didn’t match my anticipated $50 copay or the $0 patient responsibility stated in my Explanation of Benefits (EOB). I received a call from Rhea Fleming, a knowledgeable representative at Labcorp. During our discussion,we agreed that the co-pay should logically be either $50 or nothing; however,it appears Labcorp was trying to collect the lower amount between these two figures.
Rhea had previously reached out to Blue Shield’s provider line for clarification. It turned out Blue Shield had redirected this claim from Labcorp to Brown and Toland—the self-reliant Practice Association (IPA) linked with my HMO plan. The total charges from Labcorp amounted to $322.28, but Brown and Toland indicated they woudl only reimburse $34.94 based on their contractual agreement with Labcorp—resulting in an adjustment of $287.34. Unluckily, this led to confusion within Labcorp’s system where it interpreted B&TS response as indicating they wouldn’t cover any costs beyond what I owed as the patient.
This misunderstanding occurred because Blue Shield informed rhea that my primary care physician’s procedure code did not qualify as preventative care under their guidelines—meaning payment for these tests has yet to be received by Labcorp since they were classified as “non-preventative.” In contrast, I believe CMS categorizes them differently! Given that my EOB states a copay of zero dollars due from me, I interpret this as evidence that I shouldn’t owe anything!
This situation led Labcorp to issue me a bill for the aforementioned amount of $34.94—a development which initiated this entire saga.
A New Round Of Tests Raises Further Concerns
A quick update: Rhea confirmed what transpired regarding last year’s bill.
I then realized something concerning recent lab results which raised additional questions during my doctor’s visit (note: these tests were conducted prior so we could discuss findings). It appeared my iron levels were slightly low prompting him right then and there order further testing using onsite technicians who collected blood samples destined again for analysis at Laboratory Corporation.
The EOB indicated charges totaling around $60.79 for these new tests; however once more neither Blue Shield nor Brown & Toland contributed anything towards them resulting again in an EOB stating zero patient responsibility! When checking back with Rhea she confirmed no outstanding balance exists on those particular tests—possibly coded correctly this time? Attempting access through their portal yielded no results since invoices aren’t generated when balances are clear!
As our conversation concluded Rhea planned next steps involving inquiries directed toward both Blue Shield/Brown & Toland seeking clarity behind why no payment is required on such bills!