Q: I had routine blood tests at Quest Diagnostics last year. My insurance company, Lucent Health, sent me an explanation of benefits stating “Patient Responsibility = $0.00.” I thought everything was settled.
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But now I’m told the claim was denied for “expired timely filing” – meaning Quest didn’t submit it properly.
I maintain an excellent credit score and always pay my bills. I don’t mind paying my fair share, but I shouldn’t have to pay the full retail price because of someone else’s mistakes. Can you help me get this resolved?
– Jan Burnett, Jacksonville, Fla.
A: 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.
Under most insurance contracts and state laws, providers have 90 to 365 days to submit claims. Quest apparently missed this deadline, which is entirely its fault, not yours.
You could have prevented some of this headache by closely monitoring your explanation of benefits. But honestly, patients shouldn’t have to be insurance claim detectives.
When companies like Quest make filing errors, you have recourse. You could have escalated this to Quest’s executive team. Executive escalation often cuts through the bureaucratic nonsense.
Your insurance company, Lucent Health, also bears responsibility here. It should have proactively communicated about the claim status and worked to resolve the filing issue rather than leaving you in the dark for months.
After reviewing your case, I contacted Lucent Health on your behalf. Within days, the company voided the denial and reprocessed your claim.
You were caught in a web of corporate incompetence, but persistence paid off. Your insurance is now covering the tests, as it should have from the beginning, and you won’t have to pay that outrageous $562 retail rate.
Christopher Elliott is the founder of Elliott Advocacy, a nonprofit organization that helps consumers solve their problems. Email him at [email protected] or get help by contacting him at the nonprofit’s site.
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