- the story of how lab tests for an Annual Wellness exam resulted in a $1,832.64 bill from Quest -
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!
Did you get this resolved? I'm in a similar situation.
ReplyDeleteYes I did. Multiple phone calls were not successful. I ended up putting my story in writing and sent certified mail copies via USPS to the Billing Supervisor (VP) at Quest Diagnostics, an executive at Quest, my doctor's office here in town, and the Quest lab here in town. Shortly after Quest received my letter, I was called by the billing supervisor and they waived the balance. My doctor's billing office also called and they were very willing to try to help, though I don't know how successful they would have been.
ReplyDeleteThanks for responding. So glad to hear you got it resolved! Did you find the mailing addresses for the billing supervisor and/or Quest executive on Quest's website, or did you have to track it down another way?
DeleteNo, I was not able to find any useful names/mailing addresses on the website. I called the number on my bill and asked to speak with the billing supervisor. After several weeks of calls and fruitless waiting, I finally asked her for her mailing address and for the physical mailing address of her VP. She was very gracious and helpful.
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Great post.
ReplyDeleteInteresting and valuable information.
Thanks for sharing with us.
Insurance Naples FL
Thanks for posting. We have United Healthcare and my doctors office had told me to go to a Quest lab for labwork. just got my bill of $1,000. My doctor told me that Quest should have billed it through Solstas since Quest and Solstas are now together. Have not tried calling yet, but hope they can try to bill through Solstas.
ReplyDeleteGood Luck! Hope it gets solved quickly.
DeleteI own a small lab in Irvine and we can never get into contract. We want to serve the patient and do our
ReplyDeletework. Insurance has complicated the system and lab consolidation destroyed competition. We are trying to launch a affordable unlimited plan. We are not hoping to launch until later but our thought is a modest subscription plan for unlimited testing. Any insight or thoughts would be much appreciated. https://m.youtube.com/watch?feature=youtu.be&v=zwKV681pGs8
I work in the qualified retirement plan industry for a large nationwide recordkeeper (that's what companies who manage and/or invest contributions and distributions from an employer's retirement plan are called) and after reading your article I have relative experience I thought might be of interest. This type of situation, although mind bogglingly illogical to the consumer/end user/individual (whatever synonym you want to use for you and me), is unfortunately symptomatic of how business is done in a lot of large industries today. It's most obvious in healthcare, but also affects my industry as well. So this makes sense, here’s some background on the employer retirement plan world. All qualified retirement plans are called that because they have received qualification from the IRS. They are set up by the plan sponsor (employer) who drafts submits a plan document to the IRS stating how all of the myriad provisions of internal revenue code and ERISA and Department of Labor regulations are going to apply to the plan when it is approved. This is reviewed by the IRS, and if good, they issue a letter of qualification. The employer then contacts a plan advisor to assist from there. The advisor (usually a large finance company such as Merrill Lynch) make recommendations on the investments the plan should offer in relation to their suitability. They recommend a Third Party Administrator (TPA), which is a benefits consulting firm that is in charge of certain aspects such as processing contributions and distributions from the plan. Then, the plan sponsor (the employer), usually on the advice of the advisor and/or the TPA, chooses a recordkeeper. For larger plans like for corporations, the company that recordkeeps the plan (big names are Fidelity, TIAA, Empower, Vanguard, etc.) act as the advisor, the TPA, and the recordkeeper. For smaller plans (typically less than $50 million in the plan), the advisor, TPA, and recordkeeper are usually all different companies, but the recordkeeper is the "face" of the plan to the end employee. I basically deal with similar situations to what you described above on a daily basis. The end user, the employee, tends to think of their retirement plan as a bank account, and the recordkeeper as the bank. But there is so much more complexity, and for something that seems simple (like taking money out of the account when you need to pay for unexpected expenses, or moving money from one place to another when you change jobs), there can be significant amounts of back and forth between when the employee calls or goes online and states what they want (ie starts the request), and when it is actually finished. To break it down sequentially, the employee is given the correct (almost incomprehensible to the average person) form for what they want, must fill it out, it gets sent back to the recordkeeper, the recordkeeper contacts the TPA for approval, the TPA contacts the plan sponsor (employer) for approval, the authorized person at the plan sponsor reviews and approves it, it goes back to the TPA, and it ultimately ends up back where it began with the recordkeeper to process and send out the payment. As you can imagine, this creates considerable room for error. The fact that everything is ultimately governed by internal revenue code, which was written with the intention of creating a retirement "blanket" outside of social security for workers and was then modified over and over and over again with the intention of using fiscal policy to shift the responsibility for paying for retirement from the employer to the employee. What should be a simple system for people to save for retirement has grown into an almost monstrous cacophony of different companies with different functions, contractual obligations to each other, and no best practices built in.
ReplyDelete