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Quest Diagnostics

Quest Diagnostics review: illegal balance billing 46

K
Author of the review
5:34 pm EST
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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.

Resolved

The complaint has been investigated and resolved to the customer’s satisfaction.

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46 comments
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fedup consumer
San Antonio, US
Oct 07, 2008 1:14 pm EDT

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.

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