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Incorrect information slows down lab payment

Q: Here is my tale of woe: In October 2005, I had my yearly gynecological exam; the lab work was sent to Quest Diagnostics. Shortly after, I received a bill for $45.

I called Quest on Feb. 9, 2006, to tell it the test was covered by Medicare and my supplemental insurance. A representative told me the "ICD-9" code was wrong, so I took the invoice to my doctor and she changed the code. I forwarded it to Quest.

Another bill arrived.

In March, I talked to Quest again and was told that my doctor's office needed to call with the correction, which it did.

I received another bill in August. This time when I phoned Quest, I was told it had no record of my doctor's office calling to correct the ICD-9 code and, in addition, the CPT coding was invalid. I called the doctor's office again and, while an office worker assured me Quest had been called previously, the office agreed to call again with both corrections.

In November, I got another bill and a letter from Quest stating that my supplemental insurance had not received an explanation of benefits statement from Medicare, so it wasn't paying the bill.

I have called the insurance company and Quest throughout December and am no closer to having this resolved.

Janetlee Clore

A: "We understand how confusing health insurance issues can be," said Maegan Mabry, regional customer care representative with Quest Diagnostics. "As a one-time courtesy to Ms. Clore, we've adjusted the balance of this account to zero."

From Mabry's explanation of events, it appears that your problems started when your doctor's office entered the incorrect diagnostic code on your bill. This problem wasn't solved in a timely manner because the Quest representative you spoke with didn't tell you that the information had to be received directly from the physician. In addition, Quest's first correspondence addressing the problem was incomplete. It listed five possible reasons the billing department couldn't process your claim, none of which were checked. A couple of phone calls later you had the doctor's office contact Quest and make the correction.

That didn't resolve your bill, however. Quest billed your supplemental insurance provider because Medicare had denied the claim, based on the incorrect diagnostic code. The insurance company couldn't process the claim without a copy of your EOB from Medicare. Medicare responds electronically, Mabry said, so Quest didn't have this information. When you called on Nov. 1, according to their records, a Quest representative asked that you send a copy of the EOB to your secondary insurance yourself. It followed up Nov. 28, with a letter requesting the same thing.

The claim has been in a holding pattern since then, but with Quest's clearing of your account, you should be able to put the matter to rest.

Please end the e-mails

Q: Pottery Barn refuses to take my name off its e-mail list. I have done everything it has asked, including writing a letter to the direct marketing department. It has been more than six months.

It's not a major problem, just a nuisance, but I wondered if you had time to help.

Jim Herro

A: Opting out of direct marketing through e-mail can be a real challenge, but consumers shouldn't have to jump through hoops to do it.

I sent your complaint to Howard Lester, CEO of Williams- Sonoma, Pottery Barn's parent company. Thanks for letting me know Pottery Barn contacted you by snail mail and has agreed to stop you sending you e-mails.

Action solves problems and gets answers for you. If you have a question, or your own attempts to resolve a consumer complaint have failed, write Times Action, P.O. Box 1121, St. Petersburg, FL 33731, or call your Action number, (727) 893-8171, or, outside of Pinellas, toll-free 1-800-333-7505, ext. 8171, to leave a recorded request. Requests will be accepted only by mail or voice mail; calls cannot be returned. We will not be responsible for personal documents, so please send only photocopies.

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