By MATTHEW HOLT

For these of you ready for the Labcorp, Blue Defend of California, Brown & Toland Physicians Physicians replace, the ball has been moved a few years down the sphere.

If you wish to catch up right here is half 1, half 2 and half 3)

You’ll recall we left it with a thriller $34.94 invoice which didn’t both match the official $50 copay quantity I’ve, nor the $0 affected person accountability in my EOB. I obtained a name from Rhea Fleming, an skilled buyer rep at Labcorp, on whose digital desk this has been dumped. We had a beautiful dialog during which we agreed that the co-pay ought to both have been $50 or $0 however that it’s doable that the co-pay is the decrease of $50 or the quantity Labcorp was attempting to gather.

She had beforehand known as the Blue Defend of California supplier line to attempt to determine this out. Blue Defend had certainly kicked this declare from Labcorp to Brown and Toland the IPA I’m assigned to within the HMO product I purchased. The fees from Labcorp had been $322.28 and the response from B&T was that the contractual worth (i.e. what they agreed to pay Labcorp for these checks) was $34.94, therefore the “adjustment” of $287.34. Nonetheless in Labcorp’s system the algorithm interpreted B&T’s response as saying 1) the agreed cost is the $34.94 in keeping with the contract and a pair of) they weren’t going to pay so the affected person owes the distinction. When Rhea Fleming requested Blue Defend’s rep why the affected person owed cost on this, the Blue Defend rep mentioned that the process code and prognosis code from my PCP (One Medical) didn’t rely as preventative care. In different phrases Labcorp has not obtained paid in any respect for operating these checks to this point, as a result of they’re in keeping with B&T “not preventative”. Though IMHO, CMS says that they’re. And naturally because it says my copay is $0 I’m decoding Blue Defend of California’s EOB as saying that to me!

Therefore Labcorp generated the invoice for the $34.94 and despatched it to me. Which began this entire telenovela.

BTW Rhea’s conclusion was that as not one of the checks had been “preventative,” Labcorp billed me the $34.94 as that was the overall it was contractually owed slightly than the $50 copay I’m speculated to pay for lab work. I truly checked again in my Labcorp account and located that final yr I did in truth pay $50 so maybe final yr I had completely different checks or one way or the other they’ve modified the algorithm. I checked the EOB for that 2024 invoice and the overall cost was $445.20 of which Blue Defend paid $28.07. No I couldn’t discover the Labcorp invoice on their system, presumably as a result of I’ve paid it! On condition that I paid $50 for companies from Labcorp on that date (sure, it took me 7 months to pay up!), it’s possible that the agreed cost was $78.07 ($50+$28.07) of which I unthinkingly paid the $50 copay. And sure that ought to have been preventative too. (Maybe I ought to ask for that $50 again!!)

BRIEF UPDATE: Rhea from Labcorp regarded into this 2024 invoice and that’s precisely what occurred

Then, I had one other thought.

It seems that the lab outcomes this yr generated an additional concern in my physician’s thoughts. (Keep in mind I had the lab checks earlier than the workplace go to in order that we might focus on the outcomes). Plainly my iron ranges had been just a little low, so whereas I used to be within the physician’s workplace he ordered some extra checks particularly about that. As One Medical has techs on website they drew my blood then and there and shipped it to Labcorp.

In response to my EOB, Labcorp’s cost for these new checks was $60.79 of which Blue Defend or slightly Brown and Toland once more paid $0 and created an EOB which once more mentioned my affected person accountability was $0. I requested Rhea to test that invoice in her system and it seems that I do NOT owe Labcorp something on that set of checks. Perhaps they had been coded as preventative? I attempted to search out the invoice on my affected person portal at Labcorp however as a result of I don’t owe something I haven’t been despatched an bill and with out an bill quantity you can not test the invoice!

When Rhea ended the decision with me, her subsequent transfer was going to investigate of Blue Defend and Brown and Toland what the explanation was for me owing $0 on that invoice! 

In the meantime I await the results of the official Blue Defend investigation with curiosity. After all this may simply have come all the way down to Amazon One Medical coding the checks incorrectly. However it’s all enjoyable and video games if in case you have limitless endurance in American well being care.

And naturally, this nonetheless isn’t over!