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Quest Diagnostics / illegal balance billing

1 Teterboro, NJ, United States Review updated:
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Be careful about paying bills from Quest Diagnostics. Both my husband and myself have been "balance billed" by Quest for labwork. Quest is a preferred provider for both our insurance companies. Our insurance companies secure deep discounts from Quest for services (ex. insurance pays $30 when Quest billed for $310). Quest is not happy about this despite the fact that they freely enter into these contracts with the insurance companies when they agree to be preferred providers.

My insurance company has a co-insurance amount for labwork. My husbands does not, so he owes labs nothing for services provided. Quest first sent me a bill for the total amount they billed to the insurance company, and noted on their invoice that I was to remit a copy of my insurance company "explanation of benefits" if it showed I owed a lesser amount. I included the payment I owed per the explanation of benefits, and remitted a copy to Quest patient billing. At that time I thought my business with Quest was done.

Two weeks later I receive another bill from Quest. This bill showed my payment credited to my account, and a balance due for the difference between the entire amount billed and my payment. I called Quest and spoke to an extraordinarily rude individual who advised me to "just pay it" and when I asked to be transferred to customer service, she hung up on me. I called back and spoke to someone else who gave me a fax number and told me to fax a copy of my explanation of benefits to her. I did as I was instructed. My balance was not resolved after two weeks, so I called my insurance company. My insurance company advised me that Quest engaged in "balance billing" and that, after reviewing my records, I did not owe Quest anything other than what was indicated on the insurance explanation of benefits. My insurance company said they would contact Quest about the matter. A week later I received a letter from my insurance company stating that they sent Quest a copy of my explanation of benefits, and that they informed Quest that I owed only the amount per the explanation of benefits.

Today (two weeks later) I receive a letter from Quest advising me that my account is past due and they are going to send it to a collection agency. Their letter also informed me that "based on the explanation of benefits received from [my] insurance company, this balance is [my] responsibility". Funny how MY insurance company told me it wasn't. Guess my insurance company is trying to ruin my credit, huh? More likely Quest is trying to shake me down for the money. I am in the process of writing letters to Quest, my attorney, my insurance company, several news media agencies, my state representatives at the state and federal level, the New York State Health Insurance Department, and the New York State Attorney General's office. Quest has run afoul of the New York State AG before - see http://www.oag.state.ny.us/media_center/2003/jun/jun25a_03.html.

I can only quess that Quest engages in this highly illegal practice as it is so profitable for them. I have the education and the resources to fight this injustice. Quest must find that there are many people who will just fork over the money to avoid a hassle or because they fear collection agencies. Quest has tried to victimize the wrong person this time.

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Comments

  • Va
      22nd of May, 2008
    0 Votes

    I wanted to alert anyone who uses Quest Diagnostics Labs to be VERY clear on what their co-payments might be. My bank account would be $313 lighter IF I had not dug deeper to uncover my true charges.

    My insurer, Aetna, has contacted with Quest to accept an agreed upon amount for specific tests. However, I received billing for $313, much more than my co-payment of $16.

    After several phone calls between Quest and Aetna, an alert Aetna employee identified the charges as "Balancing Billing" - a ploy Quest uses to attempt to get extra payment for their services.

    An example being a submitted charge of $139.25 for cholesterol blood work - BUT Quest has contactually agreed to accept $12.64 from Aetna, along with $4.21 as my share...BUT Quest sent me a bill for the remaining difference of $122.40...which is classified as "Balance Billing." This is ILLEGAL and they have been sued for this in the past, most recently in Florida.

    I shudder to think of how many unsuspecting folks have ended up paying them for services that should NOT be charged for in light of Quest's supposed agreement with health insurers. It took me over 2 hours being transferred from place to place but thank goodness, I was saved from being extorted $313.

    My initial calls to Quest left me totally frustrated, but after I finally connected with a Quest employee with a clue (Monique) she finally recognized that the proper discounts had not been entered into my file. Four prior calls to Quest, did NOT meet with ANY resolution other than "Sorry but that is what you owe."

    Don't accept one person's word for it - keep calling till you are 100 percent sure you are being told the correct info.

  • Fe
      7th of Oct, 2008
    -1 Votes

    It is extremely important for all customers/patients to be aware of their insurance coverage(s) and what all medical providers are allowed to bill. I have found that billing problems occur with many medical providers across the board (not just Quest Diagnostics). Another improper practice many medical providers tend to do occurs when there are TWO medical insurance carriers (both a primary and secondary coverage) and when the provider is an IN-network, contracted provider for BOTH plans. When the secondary carrier happens to have a LOWER negotiated contract fee with the provider for a given service than does the primary carrier (and hence determines a lower amount of patient responsibility than does the primary), most providers believe they have an automatic right to balance bill the patient according to what the primary carrier has deemed patient responsibility. They will do this even though the amount being balance billed is MORE than what their agreement with the secondary carrier allows them to do. What many people do not realize is that unless the provider has some written contractual arrangement allowing them to do otherwise, providers have a lawful obligation to follow the negotiated fees of ALL contracts they sign on to, regardless of primary or secondary status. The patient should not be billed in excess of the negotiated fees of EITHER the primary or secondary plan. This all falls under the rules of contract law. (I have actually spoken with a senior analyst at the State Board of Insurance in my own home state and had this confirmed.) Patients -- know your coverage and don't let any medical provider take advantage of what they believe the patient does not know.

  • Fe
      10th of Feb, 2009
    0 Votes

    Based upon my own personal experience with Quest Diagnostics and their balance billing tactics, I completely concur that letters should be written to any and all regulatory authorities in addition to all parties named in Krankee Yankee's posted complaint. It may also draw attention to write a letter to the doctor(s) who are utilizing Quest informing them that you no longer want your lab work sent to Quest WITH a copy of ALL said correspondence to the following individual: Surya N. Mohapatra, M.D., Chairman of the Board, President, and CEO of Quest Diagnostics Corporate Office, 1290 Wall Street W., Lyndhurst, NJ, 07071.

    Quest is not honoring their contractual obligation with these insurance companies. Be aware also that even when there are multiple insurance companies involved (a primary and a secondary), Quest is STILL obligated to honor EACH contract they have entered into, regardless of primary or secondary status. A contract IS a contract!

    If the negotiated rates or co-payment amounts differ between contracted insurance companies, medical providers should not be billing the customer more than what EITHER contract allows. If the contract terms of each insurance company require the medical provider to file claim on behalf of the patient, then Quest should file with EACH insurance company BEFORE automatically attempting to extort funds directly from the patient. It all depends on the contract terms. But -- Quest does not get to pick and choose which portions (or which contracts) they choose to honor and those they do not.

    It is also a very safe assumption that Quest is relying on the ignorance of the average patient who often does NOT understand his insurance coverage and who will often just pay up rather than take the time and trouble to stand against what is going on. Quest (and others like them) will continue these unlawful practices as long as customers allow them to get away with it. Unfortunately such practices are common among businesses as such is the world we live in. (I have found medical providers to be among the worst abusers.)

    Don't let them get you.

  • Mo
      10th of Apr, 2009
    0 Votes

    I wish I could simply find some help online about negotiating with these ###. I am pregnant and have no maternity benefits with my insurance. My doctor negotiated a lower rate to help me out. The hospital negotiates a lower rate to help me. Yet Quest claims they have no such thing and that I must pay in full unless I make under 40K per year for a family of 4! Of course my family of 4 makes more than that as most do.
    This is for $1400 in lab work charges that I KNOW they would accept 10-20% in a negotiated rate from an insurance company. But they won't negotiate a single penny for an individual.
    They are gouging the "little guy" so bad and I have no idea where to turn to get them to take down this rate!
    Does anyone have advice?
    This is a nightmare with QUEST!

  • Jr
      28th of Jul, 2009
    +1 Votes

    Can I ask what the resolution was on your situation? I have just received a 5th bill notice from Quest after my insurance company told me they had already paid.
    I am filing a report with the BBB and NYS.

  • Wi
      30th of Jul, 2009
    0 Votes

    As a former employee of Quest Diagnostics, NRSC in Pa, I can assure you that this is not done intentionally. The bills that are received by Quest are generated by their billing system. A problem that should be fixed by now. The problem was everytime a payment was entered on a patient account a bill would generate causing an influx of bills being generated. If the employee is new or has not ventured through the company in different departments, then they may ill advise the caller.

    I do agree, when certain entities of an insurance company have contractual agreements with labs or o ther providers it is the patients responsibility to know and understand their copayment, co-insurance, and deductible. Because the laboratory is nationwide there are a wide range of insurances that participate or are non-par with the lab.

    So I ask, please be patient as they try to iron out these kinks in their billing process.

  • Ma
      11th of Aug, 2009
    0 Votes

    It hasn't been 'fixed' in at least a year of its existence, and likely will not be unless more class action lawsuits are brought against them. You are right that there's no reason to take it out on the individuals on the other side of the phone, however while I work in software and know exactly how hard it is to design and manage complex systems, we bend over backwards to help customers in any way possible. I have not seen one example of Quest doing anything that could remotely be construed as such.

    https://www.complaintsboard.com/complaints/illegal-balance-billing-c161469.html

    http://www.businessweek.com/magazine/content/08_36/b4098040915634_page_2.htm

  • In
      12th of Sep, 2009
    +1 Votes

    I had a different but related experience. Actually there are two issues that I have observed: 1, Quest routinely bills outrageous charges (anywhere from four to seven times the "usual&customary" charge for their services); and 2, they sometimes make up their own diagnosis codes instead of using the codes supplied by the requesting physician, as a result of which insurance companies deny claims on the basis of "invalid codes." In my own case, Quest deliberately put an incorrect (invalid) code on the paperwork they sent to BCBS, so of course BCBS denied the claim and Quest repeatedly billed me the entire $626.80 for labwork worth less than $100 on the grounds that "my insurance company denied the claim" and that therefore I owed the "full amount." The labwork was done on 17 September 2008. I went round and round with them, begging them to re-submit using the doctor's codes (and they would repeatedly follow through by resubmitting with their own wrong code instead, generating more denials of the claim). I finally brought my requesting physician into the picture -- her office contacted QUEST multipletimes regarding the correct code that was originally sent to Quest, and also filed appeals to BCBS -- twice! -- and finally, on 29 July 2009, BCBS paid the claim in my favor -- they allowed $98.11, of which BCBS paid $88.31 and informed me that my responsibility (co-pay) was $9.78 !! So now it is mid-September 2009, and Quest has not yet billed me for the revised amount. I distrust Quest enough so that I sent them a check for $9.78, together with a photocopy of the BCBS explanation of benefits, because I can imagine them deliberately charging me a fraudulent "late fee."

    By the way -- I very recently had a Pap smear, and the labwork was again done by Quest (I had no idea the doctor would send the speciment to Quest, so I didn't have the opportunity to ask her not to do so). They "billed" $195. to BCBS, and as per the BCBS explanation of benefits sheet, the allowed ("usual and customary") amount was $44.29, of which my responsibility is supposed to be $0.00 -- all this took place within 15 calendar days of my Pap smear.

  • Qu
      8th of Feb, 2010
    +2 Votes

    Quest is ridiculous. I have been battling them for over 2 years for a lab bill. They had the wrong information even though I called them and corrected them 3 different times. It has been a nightmare that I don't have time for and the customer service department sis extremely unprofessional and even a little combative. I think they should be investigated and put out of business.

  • Un
      4th of Aug, 2010
    +2 Votes

    I contacted Quest billing today. I am outraged at the unauthorized billing that they did towards me as well. I am dealing with the emotional rollercoaster of infertility treatments and bills already. I sent in a payment coupon to Quest for one of their lab bills, authorizing a payment of $50 from my debit card. Quest ignored the amount I clearly wrote down on the payment coupon, and charged me for the full lab balance due, which was several hundred dollars. I was outraged! I faced an overdraft fee from my bank, and when I contacted Quest billing dept., the man I spoke with was offensive and very unhelpful, stating this was the "first time" he had ever heard of this happening in the entire time he had worked at Quest. He should look on this complaint board - and see that this seems to happen often! I am paying with a paper check next time and maybe copies for my records for sure. The billing division of this company appears to conduct business fraudulantly in my opinion, and I will be speaking to my clinic about them as well!

  • Bl
      31st of Oct, 2010
    -8 Votes

    You guys get on my nerves ! Read your policy know what your getting before having services done. And you would not have this problem. I do insurance billing for a living for 19 years . ( Quest is crap ) your issue would have been corrected fast if your insuance company would have told you to call your dr office 1st because quest diagnostics does not make up code your dr office does you see that once your dr office got involve your issue was corrected ! It's up to your dr office to change which you call " invalid code" once your dr make those changes your claim get refile back to your insurance by the way you did not just have a pap smear you have more then a pap smear you guys lie so much. (mommyneedshelp ) did you read or find out what kind of insurance policy you were paying for ! Blame everyone but your self. Even if you have insurance here no GUARANTEE your going to get those saving if your paying for these type of benefits.

  • Ja
      4th of May, 2011
    +2 Votes

    Quest can not answer questions on the bills they send. This is garbage. You should have sensible front line representatives to answer the most basic of customers questions. Quest has not put this in place. If you have an option, tell your Dr. to use another Lab. Chalk mine up to another complaint about Quest.

  • Jt
      29th of Jun, 2011
    +1 Votes

    I got a bill from Quest for balance payment. What should i do? Please suggest.

  • No
      23rd of Jul, 2011
    +1 Votes

    I went to Quest Lab for bloodwork. I dont have insurance. I told them I would pay by credit card. They told me they could not do the lab work my Doctor IN SAME BUILDING ordered. I told them I would go get cash. They said NO.

    How can I be denied services due to no health insurance? Is that not discrimination?

  • Mi
      15th of Aug, 2011
    +2 Votes

    Quest Diagnostics practice illegal credit card billing, its just a fact. I had blood work done with them and paid a $25 co-pay during the visit. About a month later I received another bill for another $25 additional cost that I chose not to pay. About 3 months later, they charged my debit card without my authorization. I guess they kept in on file. Luckily it didn't cause any checks to bounce. Unethical practice!

  • Ac
      5th of Mar, 2013
    0 Votes

    SO U WANT TO KNOW WHY THIS COUNTRIES MEDICAL BILLS R OT OF SITE?

    QUEST IS A VERY GOOD EXAMPLE OF RIPPING OFF THE PUBLIC..
    EXAMPLE LAB BILL $ 400. AND QUEST ACCEPTS FULL PAYMNET OF $ 65.00 FROM INSURANCE COMPANY.
    THINK ABOUT THIS

    PEOPLE WHO HAVE NO INSURANCE MUST PAY THE $ 400. PEOPLE ALSO WHO MUST PAY ON AN 80 /20 % BASIS WILL BE PAYING MORE THAN $65. THAT QUEST ACCEPTS FOR FULL PAYMENT ($80.) PLUS THEY REC THE 80% PORTION FROM INSURANCE COMPANY ( OR WAHT EVER THE INSURANCE PAYS THEM)... WHAT A RIP OFF

    AND MR. OBAMA COULD CARE LESS ... NOTHING HA S BEEN DONE TO CORRECT THSES ISSUES NOT EVEN WITH THE NEW OBAMA CARE WHAT A JOKE
    THE PUBLIC NEEDS TO STAND UP AND SPEAK OUT AGAINST THSES CRAZY PRACTICES IN MEDICAL CARE FOR THE GOV IS NOT DOING ANYTHING ..
    WRITE SHOUT SCREAM LET THE GOV KNOW ABOUT THESE UNFAIR PRACTICES
    AS FOR OTHER MEDICAL BILLS THE SAME PREVAILS ( DOC VISITS; PROCEDURES ETC.)

    SPEAK UP WRITE YOUR CONGRESS MEN THE NEWS MEDIA ETC.

  • Ki
      23rd of Apr, 2013
    0 Votes

    I have also had multiple problems with Quest's billing and am (somewhat) amazed at how many others have complaints with them. A number of years ago, I started receiving bills from Quest after various medical tests. Initially, I paid what was not covered by insurance and was then double- and triple-billed for the same procedures (invoices showed the same lab codes and same test dates), with Quest saying that this was not covered by insurance. I saved all my invoices, credit card statements and bank statements showing what I had paid; called my doctor's office, called my insurance company, called and e-mailed Quest numerous times and faxed copies of invoices showing what had been paid and when, along with my EOBs. I finally threatened to report them to the Attorney General, BBB and my insurance company for insurance fraud. Miraculously, the invoices stopped coming. Regretfully, I did not follow-through with my actions. Now, several years later, I have been billed by Quest with the explanation that my (one and only) insurance carrier has informed Quest that they are not my primary insurance carrier. This alarmed me so I called my insurace provider (BCBS of MA) who was helpful in getting the matter solved - Quest had billed the work 2 times, but incorrectly. Unfortunately, when BCBS tried to call Quest to get the matter straighetened out, Quest was closed so I was informed to call Quest and have them call BCBS directly. When I called Quest, I was told that there's nothing they can do. I am reponsible for providing correct insurance info (which I did, and it has not changed since the last time Quest performed lab work for me and was actually billed correctly). When I asked them to call BCBS to get it straigtened out, I was informed that "they can't be calling insurance providers as they other patients to help." (So I don't matter.) I was livid, so I immediately called BCBS back, and they took care of it within minutes. Needless to say, I will be filing fraud reports with all appropraite authorities. I will also be speaking with my doctors to voice my complaints.
    I would suggest contacting your insurance carrier first when you have concerns regarding bills from Quest Diagnostics. Quest will give you the runaround and will bill you until they get as much money as they can from you - regardless of whether or not they are owed the money.

  • Na
      26th of Jun, 2013
    +2 Votes

    I was just notifed on a bill from 2.5 years ago that I never received prior to this call from a collections company. I am trying to contact someone from Quest Billing and no one is able to help or even knows of my account. Help!

  • Qu
      30th of Jun, 2013
    +1 Votes

    I too am fighting with Quest. Seems they are the only ones who don't know what the hell is going on. My doctor's office has resubmitted the "correct" codes they want. Mind you, these are the same diagnoses codes I have had for several years and the previous lab had no problem with. My insurance said that they NEVER received a claim from Quest to pay for these labs so that is why they were never paid, so request Quest to bill them. Well, here it is almost 2 years later and despite the physicians office (which I work at) calling them 5 times that I know of and my insurance company, which I switched off of over a year ago to a new plan, waiting to get a bill from Quest still so they can pay for it and all I have to show is a letter from a collection agency saying they are about to start proceedings to garnish my wages!!! really??? I have went through everything I know how to do. I initially started everything I've stated above. When I got the first letter from the collection agency I contacted them and told them I was not responsible for this bill and sent them copy of insurance payment for day of visit with diagnoses codes, orders, etc and the copies of my insurance saying that they never received a bill from Quest so that is why they didn't pay. Well, Quest never apparently responded to that and here I am... I am not paying them. That is why I pay health insurance premiums for coverage. I am not going to let some little piss-ant lab company who thinks they can screw people worse than we are all already getting screwed on a daily basis by our lovely government which loves to tax us to the last penny take me down. I am in the process of reporting this to every agency I can, seeing if I can report them to CLIA, medical board, Arkansas Dept of Health and also getting a lawyer involved to investigate this. I would rather pay a lawyer to do this than pay a crooked ### company that is only doing this out of pure, unadulterated greed. And to the "BILLER" above "blame everyone but yourself", if you really did work anywhere around healthcare, then you would know for a fact that this crap happens all the time and it isn't just people not knowing their policies!!! so, educate yourself a little more too hon and get out of the medical field if you do work in it because you are part of the problem. one of "those" people who don't give a crap and treat people like crap when all they want is a little understanding and explaination.

  • Je
      13th of Oct, 2013
    0 Votes

    I am going through the same exact thing right now. They are trying to balance bill me as well and my insurance company has told me that I owe nothing and they have even contacted Quest twice telling them that I owe nothing and that they are trying to balance bill. I will never use Quest again and am willing to get a lawyer to fight this and make them pay for the lawyer in the end. This is utterly ridiculous and this is really what is wrong with today's healthcare. When your EOB statement says that it is the provider's responsibility and not the member's, then Quest needs to really educate their employees what that actually means and stop trying to balance bill the patients!

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