Monday, July 21, 2014

Quest Diagnostics and United HealthCare

- the story of how lab tests for an Annual Wellness exam resulted in a $1,832.64 bill from Quest - 

I was inspired to write my story, because of a similar story I found when looking for information on how to address my problem with Quest Diagnostics:

Let’s get this out of the way first: I am a healthy adult woman.  I have no fundamental illnesses and never have.  I eat healthy, exercise regularly, my weight is proportional to my height (120lbs, 5’3”), I take no medications on a regular basis.

Now, here’s my story. 

I moved to a new town (Naples, FL) and went to a new doctor, Dr. Lindita Hobdari as a new patient and for an annual wellness exam (aka ‘annual physical’). At the time of this exam, I had health care coverage with United Health Care through my husband’s employer.  Of later irony, subsequent to his retirement we switched healthcare coverage to Blue Cross/Blue Shield of Michigan; more on this later!

As part of the annual wellness exam, Dr. Hobdari ordered an extensive set of lab tests; this is apparently routine for her office for new patients.  About the same time, my husband went to the same doctor for the same annual wellness exam and was ordered a very similar full set of blood tests.

When I left Dr. Hobdari’s office, the front-desk staff asked me if I had a personal Lab preference.  I said I did not given I was new to the area, so I asked who they would recommend that was nearby. I was handed a brochure for Quest Diagnostics.  Parenthetically – and unbeknownst to me given our appointments were not coinciding – my husband was asked the same question and because he was more familiar with the surrounding area and had an online record with LabCorp, he said that is where he would go.  My husband went and had his tests done first, total bill to the insurance company was $2,087, plan discounts $1,551.97, United Healthcare paid $481.55, out of pocket cost to us: $53.48

I didn’t think for a second about him going to LabCorp vs. me going to Quest Diagnostics, because over the years I’ve gone to Quest Diagnostics for a routine lab here and there, though not recently.  I found a Quest Diagnostics lab close to home, and off I went.  I handed my insurance card at the front office, they smiled, processed it, invited me in, I got all the tests done.  

My bill comes from Quest Diagnostics and guess what?!  Total bill to the insurance company was $3,277.36, plan discounts $0.  Yup!  ZERO!  Because as it turns out United Healthcare doesn’t have a contract with Quest Diagnostics.  When I called Dr. Hobdari’s office almost in tears, I was told “everybody knows United Healthcare doesn’t have a contract with Quest Diagnostics!”  When I suggested that given this statement it was odd that the Hobdari office staff would – knowing I was with United Healthcare – offer me a choice and give me a pamphlet for Quest Diagnostics, I was then told: “You are an educated person.  You should have checked to make sure it was covered.”   When I then called Quest Diagnostics and asked why they would take me in for the tests after I showed them my United Healthcare insurance card which they would have “known” was not accepted by their company … well they didn’t have a better response either nor did they have a solution.  Essentially they did not accept responsibility for giving me care knowing all along I would not have coverage! 

And now the plot starts to thicken.   UnitedHealthcare paid Quest Diagnostics – as an “out of network service”  $1,444.72 of the$3,277.36, leaving my share $1,832.64.

Really?!   So let’s look at this.  Virtually identical set of lab tests, same insurance company, husband goes to LabCorp (in network), I go to Quest (out of network):

LabCorp (Husband):
Total Bill = $2,087.00; UHC Plan Discounts = $1,551.97;  UHC Plan Paid = $481.55
We paid = $53.48
TOTAL RECEIVED BY LabCorp for tests:  $535.03

Quest Diagnostics (me):
Total Bill = $3,277.36; UHC Plan Discounts = $0;  UHC Plan Paid = $1,444.72
TOTAL RECEIVED BY QuestDiagnostics for tests so far:  $1,444.72

And yet Quest Diagnostics still wants another $1,832.64!  Does this make sense?  I didn’t think so.  They already received nearly $900 more than LabCorp for the same panel of tests! 

I understand that ‘caveat emptor’ applies, but how can two entities that as part of their business KNEW that Quest Diagonstics would not be ‘in network’ for my insurance: a) send me to Quest Diagnostics (Hobdari Family Health); and b) accept me at the door without comment (Quest Diagnostics Inc.)?

Further, Quest Diagnostics has already received significantly more in payment for a battery of tests than their competitor, LabCorp.  The ‘Out-of-Network’ issue worked in their favor to the tune of $900+ but they still want more! 

I have since been in touch with Quest Diagnostics.  I went through customer service and was eventually routed to a Billing Office Supervisor (Tina) – who told me “she would take care of it.”  Well, apparently how she took care of it was to try to get United Healthcare to reconsider paying Quest Diagnostics more of the $1,832.64 balance!  When that didn’t work … well, now Quest Diagnostics sent me another bill for that balance. 

Now for further irony.  A few weeks ago, now covered by BCBS-Michigan under a new plan following my husband’s retirement and our switch to my employers carrier, I went back to the same lab for a couple of tests (vitamin B12, vitamin D) and handed the person at the front desk my insurance card.  I asked her if they can tell if my insurance covers the tests.  She said:  “No.  But we can see the patient share of the bill so can ensure we charge you at the time of the service.”  I almost lost it, but of course there was no point in taking it out on the person who checked me in, who was not the same person as the one who checked me in several months ago.  I wanted to ask her: “When you see a patient balance due of “1,832.64” you don’t feel compelled to let the patient know that?”   Apparently not, because like most people, had I known a set of routine labs would saddle me up with a $1,800 bill, I would have left the lab immediately with all my blood still in my body!

As for my next step (July 2014), I will try to reach an executive at Quest Diagnostics to get their help.  I understand I bear some responsibility here.  But so should my healthcare provider (Hobdari Family Health) and the lab itself (Quest Diagnostics).  I do not understand why I – and UnitedHealthcare of course – should be asked to bear the full burden of this “misunderstanding.”

If anyone has any suggestions I’d love to hear them.  Please comment below!