"This is a textbook case of passing the buck when health care companies make errors and expect patients to clean up the mess. Quest Diagnostics should have submitted your claim correctly the first time with the proper diagnostic codes. When that failed due to unspecified laterality diagnosis code (a fancy way of saying they didn't specify which side of your body was being treated), Quest should have immediately corrected and resubmitted the claim before the deadline."
"Parenthetically, our health care system is so messed up. I've experienced other health care systems around the world where claims errors like this are almost impossible to make. Everything is handled quickly and efficiently. For example, I just picked up a refill for prescription medication in Seoul, and the entire process from getting the prescription to walking out of the pharmacy with the medication took less than 10 minutes. But this 18-month odyssey with Quest? Not so efficient."
Routine blood tests were performed and the insurer sent an explanation of benefits showing patient responsibility $0. Later, a collections agency demanded $562 despite an earlier zero-responsibility EOB. A second EOB, not previously received, also showed zero patient responsibility. The claim was ultimately denied for expired timely filing because the provider failed to submit the claim properly, apparently using an unspecified laterality diagnosis code. Providers typically have 90 to 365 days to file claims. The provider should have corrected and resubmitted the claim before the deadline. The patient maintains a good credit history and should not bear the full retail charge caused by provider error.
Read at www.mercurynews.com
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