By Matthew Holt
Labcorp I have in a search in a search to try to understand why Labcorp charges me $ 34.95 for some laboratory tests that I think should be free from the statutes of Aca prevention care, and for which my insurer Blue Shield of Californian Hac was issued.
It is a bone microcosm of the chaos of American medical care so far, if you want to catch up, here it is Part 1” Part 2” Part 3 and Part 4
You can remember that I had paid a CO payment of $ 50 for the laboratory tests related to my preventive visit of annual well -being in 2024 (and I did not pay attention), but that when I obtained a charge of $ 34.94 of LabCorp in 2025 and discovered that Blue Shield said that my Topay was $ 0, I decided to investigate.
I have received a lot of help from RHEA, a senior customer service representative in Labcorp who I think is having both fun with this and me. She told me that the LabCorp copayment tries to charge is the lowest of $ 50 or whatever the total invoice. For the 5 tests I had, the LabCorp agreement rate with the doctors of Brown and Toland (the IPA owned by Blue Shield that hires its HMO, or that I am a member) was $ 34.94. So that is the answer regarding that position.
But no more questions answer.
- Why was it a subordinate laboratory test that I had as follow -up also shown by Blue Shield as a co -payment of $ 0 in EOB?
- Why wasn’t I the laboratory tests that I had considered preventive under the ACA and, therefore, also free?
Rhea’s assumption for the first answer is that LabCorp receives a captain amount for Blue Shield or Brown and Toland laboratory tests, and that the second test was somehow covered by that. Maybe, but why wasn’t it the first?
The second question takes me below in a rabbit burrow. Rhea brought a doctor’s order to Labcorp. You can see below that the CPT codes are in it (what are the real tests) and also what are the relationship diagnosis codes.
Of course, I asked ChatgPT what were those diagnostic codes and the answer is
E78.5 = hyperlipidemia (that is, high cholesterol)
R73.03 = Prediabetes
E66.811 = class 1 obesity
M10.9 = drop
As you can suspect as a fairly typical American of more than 60 years, the bill fits for all these diagnoses. The CPT encodes the tests that had complete blood count, metabolic panel, hemoglobin (A1C), lipid panel and uric acid (which causes drop).
Presumable, all those, with the possible exception of the drop/uric acid, could be seen preventive. After all The CMS website explains That preventive The exam is free for “Welfare visits annual and physical examsfor example with a primary care doctor and Health exams For blood pressure, cholesterol, blood sugar for diabetes and the fun of cancer detection, such as colonoscopies and mammograms. ”
So why is this not for me? Rhea de Labcorp suggests that Blue Shield Initial issued a $ 0 Copay EOB, but then should have reprocessed that when she received the Labcorp bill, and told me to pay the $ 39.94. He also discovered that, in addition to the suggestion of CMS, which should be called preventive, Blue Shield or CA have a very long document with what he Think it is preventive attention. You can see and download it here.
I asked ChatgPP to read it for me and after a bit of looking, we (that is me and chatgpt) concluded that E78.5 is on the list of ICD-10 diagnostic codes applicable for annual visits to the Apraisal Health, which are a covered (free) covered service. So my high cholesterol must be projected for free.
On the other hand, there is a complete section on page 28 of the document that discusses diabetes prior education, but does not explicitly say that an A1C test is covered by the annual well -being visit. And if you go down a lot, to page 116, there is a table that suggests that last year a review of Blue Shield eliminated several of the diabetes codes, including R73.03.
Now I am not going to pretend that I understand what the hell is happening in this document, and why (or if) Blue Shield can change what CMS should do, if that is what is happening in fact. But it seems strange.
And again, because there are no real costs through the LabCorp test (there are charges for proof, but they are inclined and discounts on the invoice), it is impossible to know what the cost hired for each test was, and there is free (I think your Hereth Herth Heth Hyth Heth Hyth HERTH HYTH HERTH HYTH HERTH HYTH HERTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HYTH HERTH HYTH HYTH HYTH HERTH HYTH HERTH HYTH HYTH HYTH HYTH HYTH HERTH HYTH HERTH HERTH HYTH HERTH HY HERTH HY HERTH FOR.
Finally, I was very excited when Blue Shield sent me a message tonight that I had an attached file that I think is an answer to the complaint that was somehow presented by someone from their executive offices in part 2. But the attack formatted. So I don’t know what he says!
No less to see in this adventure.
But we hope we are close to discovering who is charging who why and why!
UPDATE. I called the Blue Shield complaint line and a good customer service representative read me the letter that I could not see online. Essentially, Blue Shield has asked Brown and Toland to explain what happened. That complaint will take another 30 days! The representative was able to send it to me on my portal, but I could receive an email (it will be one of the insured who are very upset to open). She told me that she was sent while talking on the phone, but 30 minutes later, she is not here!
Matthew Holt is the founder and editor of THCB
