Brown and Toland weigh in on the $34.94 Labcorp test. (Part 6) – The Healthcare Blog

By MATTHEW HOLT

I know you all care, so I’m doing a 6th update on the telenovela regarding my $34.95 Labcorp bill.

The very TL:DR summary of our situation so far is that in May 2025, I took a lab test to accompany the free preventive visit guaranteed by the ACA, but I was billed for the lab tests and was trying to find out why, because according to CMS I shouldn’t have been.

For those of you who have missed it so far, the entire 5-part series can be found on the Health Care Blog (1, 2, 3, 4 and 5). Feel free to go back and read.

When we left the premises on September 9, Blue Shield of California had completed its 30-day investigation and their representative read me the letter they had sent me (which I was unable to open because their secure email was not working). The letter informed me that Brown & Toland Physicians, the IPA that manages my HMO, was going to investigate. Today I received a text message from Blue Shield alerting me to a secure email and I was excited, but it had nothing to do with it. And of course, I should have heard from Brown and Toland in October or November.

So I decided to start over and called Brown & 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 get a call back” which happened shortly after.

The very friendly representative tried to understand my case and told me this:

On 08/14/2025, Mike from Blue Shield called Brown and Toland and requested that the original claim be reviewed (1430201). I’m pretty sure Mike is the nice guy from the Blue Shield Executive Administration Office that we met in Part 2 (or was it Part 3?).

On 08/29/2025, the Brown and Toland Benefits Department completed its review and reported that the original laboratory test was not coded as preventative laboratory services by One Medical, so the $34.95 copay was correct. ($34.95 was the agreed upon total payment for all tests, billed a total of $322.28. And since that was less than my $50 co-pay, LabCorp only charges the patient the total, not the $50!)

Meanwhile, the 30-day Blue Shield investigation was still ongoing. They ended up asking Brown and Toland to investigate. Presumably as a direct result of this, on 9/9/2025, Kelly from Blue Shield called Brown and Toland and sent them the $34.94 claim asking them to look into it. (Again, turns out they had just reviewed it on 08/29/2025).

“So what happened?” I asked today.

My rep told me that the person at Brown and Toland who spoke to Kelly on 9/9/2025 did not obtain or enter the claim reference number correctly, and so when she passed it to the benefits department adjuster, it could not be worked on, and so nothing has happened since. That’s it for their 30-day investigation!

However, my friendly representative informed me today of the results of the 08/29/2025 benefits analysis which, as previously mentioned, was that when Labcorp received this claim it was NOT coded as preventative. So the solution is that One Medical needs to change the diagnosis or CPT codes and resubmit the corrected order to Labcorp so that Labcorp can bill Brown and Toland for these preventative services and likely get their $34.95 directly from them. For now, that’s it.

I am of course preparing to ask One Medical to resubmit this lab claim with the preventative codes.

During this time, I mentioned to my friendly representative that I had two subsequent tests that I was not billed for. One of them was a fit test where One Medical sent me home with a kit to pick up my poop. This definitely seems to be preventative, as was the case with colon cancer screening. The other was a series of low iron tests ordered during my preventative care visit because my iron levels seemed a little low. I guess this doesn’t fall into the preventative category and I should have paid for it.

You may remember that the iron test was charged $0 and neither I nor the Labcorp representative who worked on the case with me had a good understanding of why.

It turns out that Brown and Toland think I should have paid a co-pay for both of these tests. Fit test billed on 5/18/25 was $15.60 (1537124). By the way, Brown and Toland are getting a good deal since the spot price Labcorp charges consumers is around $90! The iron test was charged $60.79.

You will remember that my lab copay is $50, so Labcorp should have charged me the lower of the copay or the actual total. That’s $15.60 for the fit test and $50 for the iron test.

I had no charge for either.

By the way, I would like to show you Blue Shield’s EOB, but since they canceled and reinstated my insurance last month, their online site erased all my EOBs!

So I agreed with the Brown and Toland rep when she suggested investigating the $15.60 bill for the fit test to see if there should be a co-pay, and I could hear back from them 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 completely ridiculous and all of this points to why healthcare is so complex and why no consumer can understand what is going on.

CODA: During this time, I was contacted by a reporter who asked if ChatGPT was used to triage and protest medical bills. So I went down that rabbit hole a little bit too.

Matthew Holt is the founder and editor of THCB