By Matthew Holt
I know you all care, so I’ll give you a sixth soap opera update about me Laboratory Corp Bill for $34.95.
The TL:DR summary of where we are so far is that in May 2025 I had a lab test to go along with the free preventive visit that the ACA guarantees, but they charged me for the lab tests and I was trying to figure out why, because according to CMS I shouldn’t have done it.
For those of you who have missed it so far, the full 5-part series is underway. The healthcare blog (1, 2, 3, 4 & 5). Feel free to go back and read.
When we left the scene on September 9, California Blue Shield They had finished their 30-day investigation and their representative read me the letter they sent me (which I couldn’t open because their secure email wasn’t working). The letter told me that Brown and Toland Physiciansthe API that manages my HMO, I was going to investigate. Today I received a text message from Blue Shield alerting me to a secure email and I was very excited, but it had nothing to do with this. And, of course, I should have heard from Brown and Toland in October or November.
So I decide to take it all over again and called. Brown and Toland Physicians or actually Altais which is the holding company that owns them and Blue Shield. I went through the phone tree and finally got “leave your number and I’ll call you back,” which actually happened not long after.
The very kind representative tried to resolve my case and told me this:
On August 14, 2025, Mike from Blue Shield called Brown and Toland and asked that the original claim (1430201) be reviewed. I’m pretty sure Mike is the nice guy from Blue Shield’s executive management office that we met in part 2 (or was it part 3?).
On August 29, 2025, Brown and Toland’s benefits department completed its review and reported that the original laboratory test was not coded as preventive laboratory services by one doctorso the copay was $34.95 correct. ($34.95 was the agreed-upon total payment for all tests, charged to a total of $322.28. And since it was less than my $50 copay, LabCorp only charges the patient the total, not the $50!)
Meanwhile, that 30-day Blue Shield investigation was still continuing. In the end they asked Brown and Toland to investigate. Presumably as a direct result of that, on 9/9/2025 Kelly from Blue Shield called Brown and Toland and sent them the $34.94 claim asking them to review it. (Again, turns out they had just reviewed it on 08/29/2025).
“So what happened?” I asked today.
My representative told me that whoever spoke to Kelly at Brown and Toland on 9/9/2025 did not obtain or correctly enter the claim reference number, so when they passed it to the adjuster in the benefits department it could not be worked on, so nothing has happened since. That’s it for your 30-day investigation!
However, my nice representative today told me the results of the 08/29/2025 benefit analysis which, as mentioned above, was that when Labcorp filed this claim, it was NOT coded as preventive. So the solution is that One Medical needs to change the diagnosis or CPT codes and resubmit the correct order to Labcorp so that Labcorp can bill Brown and Toland for these preventive services and presumably get their $34.95 directly from them. For now, that’s all.
Of course, I am gearing up and preparing to ask One Medical to resubmit that lab claim with the preventive codes.
In the meantime, I mentioned to my friendly representative that I had two subsequent tests for which I was not billed. One was a fit test where One Medical sent me home with a kit to collect my stool. This definitely seems to be preventative, as it was for colon cancer testing. The other was a series of low iron tests that I was ordered during my preventive care visit because my iron levels seemed a little low. I guess that doesn’t fit into the preventative category and I should have paid for it.
You may remember that the iron test was billed at $0 and neither I nor the Labcorp representative who was working with me on the case understood why.
It turns out that Brown and Toland think I should have paid a co-pay for both tests. Fit test billed on 05/18/25 was $15.60 (1537124). By the way, Brown and Toland are getting a good deal as The cash price Labcorp charges consumers is approximately $90.! The iron test was billed at $60.79.
You’ll remember that my lab copay is $50, so Labcorp should have been charged the lesser of the copay or the actual total. Which is $15.60 for the fit test and $50 for the iron test.
They didn’t charge me for either.
By the way, I would like to show you the Blue Shield EOB, but if I canceled and reinstated my insurance last month.Your online site has deleted all my EOBs!
So I agreed with the Brown and Toland rep when he suggested they look into the $15.60 bill for the proficiency test to see if there should be a co-pay, and I may hear from you in 30-45 business days.
And just to square the circle I will (probably) ask One Medical to resubmit the claim!
And yes, this is all totally ridiculous and all points to why healthcare is so complex and why no consumer can understand what is going on.
CODA: Meanwhile, a journalist contacted me to ask about the use of ChatGPT to classify and protest medical bills. then i I also went down that rabbit hole a bit..
Matthew Holt is the founder and editor of THCB
