Quest Diagnostics Refusing to Refund Overpayment Due to Insurance Reassessment

Submitted by Kintsukuroi85 t3_z8of6v in personalfinance

Basically this. I gave birth late last year and due to the way my midwives billed my insurance, it triggered a reassessment in spring of this year of how my deductible was applied. They wound up covering much more of a claim than they did initially, and paid Quest.

I already paid Quest in autumn of last year when the labs first came due. My insurance has proof of their payment and agrees that I am due a refund. Quest has been doing everything in their power to avoid me and my insurance, including refusing to email back, putting us on hold indefinitely (over an hour once), and agents hanging up on us. What do I need to do? It’s very cut and dry and my insurance is as fed up as I am.

I finally got somebody at Quest who sent it up the chain, but now they are telling me they need a copy of the check my insurance sent. My insurance sent an e-check in the exact amount of the refund I am due, gave me the date it was cashed by Quest, and the check number. Quest says that isn’t good enough, they want a copy.

I have a call into one particular senior insurance rep who pulled for me moreso than others, whom I think must be on holiday from Thanksgiving. But, on the whole this has been weeks of runaround. If she doesn’t call back, I don’t know what to do. Quest has told me they don’t have the corrected EOB, although I found a rep who said they did and didn’t know why it wasn’t processed (but then didn’t correct it, naturally). I emailed them both the original and updated EOBs from my records, and again that still isn’t enough. Is there a state board or something I can complain to? All in all Quest has been holding my money since March of this year. I would like options because I’ll be back at square one if this rep doesn’t call back.

Edit: You guys are helping me fight fire with fire, and I really appreciate it! I’m learning a lot. Thank you!

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7dayweekendgirl t1_iycgmkz wrote

I used to work for Quest. You need to get a lawyer to send a certified letter. That will get their attention.

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Kintsukuroi85 OP t1_iych88b wrote

Replying to 7dayweekendgirl (#800,721)

They won’t give me an address to mail anything to. They also won’t give me the names of any of their “upper management”. I emailed the EOBs to the grunt on the other end of the phone and she said she’ll forward it up, but will not tell me who she is forwarding it up to. She said they don’t give out that information.

She also claims to not have a direct number and says she can’t make calls out, only receive calls. It’s so frustrating.

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thinkcarefuly t1_iychsz0 wrote

I’m having the same issue. Their invoices had a larger out of pocket balance than my insurance EOB. I was told to email the EOB but no one replied. I had to have my insurance call over to them to fix the balance. I asked for a refund and the representative transferred me to a supervisor who themselves have to send a request to a refund supervisor. When I checked back in 4-7 weeks the refund is still on hold. I did get the contact info for one of their supervisors (who apparently works for a separate company) and they too promised a refund in 4-7 weeks. Which has not arrived either. I’m thinking of doing a credit card chargeback. Does that have a 60 day limit?

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Kintsukuroi85 OP t1_iyci53w wrote

Replying to thinkcarefuly (#800,983)

Well first I just want to say I’m sorry you’re going through this, but also in an unfortunate way it’s nice to know I’m not alone. Yes, everything you said is exactly in line with my experience. They told me the refund was in the mail in September and when it never arrived, I called back and it’s been this garbage ever since.

You can call your credit card company and ask. I’m sure different ones have different terms. Mine was from my checking and obviously was paid over a year ago, so I’m pretty sure I wouldn’t have any recourse on that.

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Kintsukuroi85 OP t1_iyco4zl wrote

Replying to lastingfreedom (#802,579)

I have a friend who is a lawyer I could ask, but I don’t know how she would just “know”. Is it a specific kind of lawyer I would need? I’ve never hired one before.

Alternatively, is there a consumer board I could go through?

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FVMAzalea t1_iycpumk wrote

Replying to Kintsukuroi85 (#802,646)

Your lawyer friend can probably refer you to a lawyer that can help, if she can’t. Most lawyers will happily refer you to other lawyers who can solve the problem if they aren’t qualified to do it themselves.

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ruidh t1_iycq4ss wrote

Replying to Kintsukuroi85 (#802,646)

The lawyer knows how to find the legal representative for the corporation in your state. It's the same way a lawyer knows how to serve a corporation with a lawsuit. Any licensed attorney is able to draft a demand for payment letter.

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planetarylaw t1_iycqr4z wrote

I had the exact same thing happen except not with Quest but a hospital. They jerked me around for two whole years about needing this thing then that thing (same BS about checks and copies blah blah blah). The power tripping billing manager even insisted I refer to him strictly as MISTER Barnes each and every interaction I had with him. I finally got in touch with the hospital's patient advocate and she got the entire issue corrected for me by the next day. Amazing. Unfortunately I'm guessing Quest doesn't have something like a patient advocate. I do know there's a state board or commission you can contact though, as that was going to be my next step if the patient advocate route didn't work.

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dcdave3605 t1_iycrqkd wrote

What can be done?

Your insurance company can withhold future payments made for any of their beneficiaries to quest, to balance everything out and then issue you a direct reimbursement.

I would go that route if you have better communication with your insurance.

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Kintsukuroi85 OP t1_iycs86e wrote

Replying to dcdave3605 (#803,688)

Honestly, I will call and ask them about that. We have really good insurance and they’ve been very helpful overall. I’m hoping this one rep will continue to be good and get back to me, but I’ve both emailed and called her and heard nothing back. I’m blaming the holiday, thinking she probably has a backlog and she will get to me in time. But it’s nerve-wracking because this has been such a runaround.

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Qbr12 t1_iyctzk5 wrote

In the past I have had success getting my insurer and the health care provider on a three way call.

Call your insurer first, explain the problem to them, and then ask them to initiate a three way call via their contact number for the provider. (Insurers often have their own separate contact number for providers). Getting all responsible parties in the same room helps to prevent finger pointing and he-said-she-said.

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Kintsukuroi85 OP t1_iycw2kz wrote

Replying to Qbr12 (#804,425)

Yes, that’s what I did. When we got through to Quest, my insurance rep explained the situation and I confirmed it was my account, etc.. Then the person on the other end told us to hold and left us there for over an hour. We started to assume that they kicked us back into the queue, but then nobody ever picked back up. We wound up terminating the call.

The same insurance rep from that day is the one who said she would make sure this gets resolved for me, but whether because of the holiday or for other reasons I’m not hearing back from her. She gave me her email and phone and I’ve tried both, but I don’t know if she’s taking additional time off or what.

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meamemg t1_iyczx0z wrote

Replying to Kintsukuroi85 (#803,586)

Yes. Your friend should be able to send a letter on fancy letter head that says pay up or else. Hopefully that gets their attention and resolves it. Anything beyond that you probably want to switch to a lawyer who specializes in this stuff.

Alternatively, you might be able to convince the insurance company to pay you directly and take it out of their next payment to Quest. The insurance companies contact with Quest should allow for that.

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curveball21 t1_iyd5ws0 wrote

Replying to Kintsukuroi85 (#802,529)

Every company registered in a state has a filing with the state auditor. It's usually available on the state auditor's website when you look up the business. They have the agent's name in the registration and that's where you send letters/lawsuits to.

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Dukeofdorchester t1_iyd6ljy wrote

I used to work there. Ask to be transferred to your local customer SOLUTIONS department. It’s different than customer service, they’re higher-level problem solvers and will likely get it done. Cases are tracked so they’ll get it done or at least let you know what to do.

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TripleBs t1_iyd6p7o wrote

Replying to Kintsukuroi85 (#800,850)

Every company that does business in your state has an address on file with the Secretary of State - the address that lawsuits / attorney correspondence can be served at.

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bros402 t1_iydbyet wrote

Replying to Kintsukuroi85 (#810,032)

It works - we did it when Verizon said we were outside of their service area for FiOS even though our next door neighbors were all getting it. Two weeks later we got a call from the assistant for the dude who ran thing for our region, explaining that Verizon hired a third party company to map areas for service - and the third party company placed us in a town 5 miles away. It was fixed right then and there, and we got a good discount on our service for 2 years.

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nivek_c t1_iydip9r wrote

Reach out to your state insurance commissioner if you are not on federal insurance. Explain the situation and provide all written documentation and contact numbers from both quest and your insurer. Give it about 2 weeks and watch quest send you an apology email with a refund attached.

The state insurance commissioner can revoke or suspend a medical providers panel coverage, which would severely hamper Quest's business since they would be considered out of network by every insurer in the state afterwards

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Kintsukuroi85 OP t1_iydjmh1 wrote

Replying to Dukeofdorchester (#812,512)

I appreciate that immensely, thank you. Means a lot. This is stuck in my craw and it’s such a stupid reason to get a canker sore, but it’s so bafflingly simple, my brain—I swear, is all haha. I’m gonna do every one of these suggestions until I get results.

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nivek_c t1_iydkye3 wrote

Replying to Kintsukuroi85 (#812,624)

Tbh, I need pretty regular health care visits and my SO is a healthcare provider. I learned this from watching her send the commissioner after insurers when they failed to pay her claims in a timely manner.

Then one day I went to see a new primary. He told me the office phlebotomist was in network, and she was not. I had to get the insurance commissioner involved twice in that case. The first time to have them inform the provider that surprise out of network charges are illegal in my state, and unless they have a signed release from me they and my insurance will have to pay the lab costs. Well my insurance agreed to... But only for the amount they would pay an in network provider. So then I had to get the commissioner involved a second time to have him inform the lab that balance billing me is also illegal and they will have to take that up with the provider and my insurance.....

Yea I never went back to that primary again after that shit show.

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GordaoPreguicoso t1_iydlqje wrote

Quest is a bunch of shady groups tied together where no one can help because they can’t see it in their system. My wife has been fighting them because she was sent to collections for a bill that the insurance paid. They say they need her explanation of benefits which she emailed in March and never heard anything back until the collection letter. So we called back again and since it’s gone to collections she needs to speak to this other person. That person says we need to fax the eob which she does. She calls back a week later and no update on her account and no one can tell her who she actually faxed because their number is an 855 one. So after getting passed around, put in the “queue”, disconnected, and no help we have 0 hope that the last person she talked to is actually going to do anything. When my wife asked what dept she should ask for when calling back the lady would just say she was billing. Which we know isn’t true because her fax was not the 855 one that billing swears is the only one.

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Kintsukuroi85 OP t1_iydlqpk wrote

Replying to nivek_c (#813,155)

Wow! That’s quite a lot! I’m glad you were able to get it sorted out, but hate to wonder what the headaches must have felt like. This option is pretty high on my list to chase now. Thank you so much. It’s relieving just to know there’s a chance!

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Kintsukuroi85 OP t1_iydm4pz wrote

Replying to GordaoPreguicoso (#813,379)

Such a mood, I completely and totally understand. This has been on and off for months. I don’t know how they sleep at night scamming people and treating others so poorly. Please refer your wife here, as people have made a lot of great suggestions!

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FatchRacall t1_iydnbyp wrote

Replying to planetarylaw (#803,389)

>patient advocate

This is my first request for a direct line any time I consider going to a hospital or a clinic associated with a hospital. And it's the first call I make when I have a problem that takes more than 15 minutes with anyone else at the hospital at this point. It's not worth my hundreds of hours being bounced from person to person. Maybe I'll spend the extra 20 minutes getting insurance on a 3 way call with them, but after that it's just requests for them to CC in their supervisors. Once I had a 40 email chain forwarded to the CEO of the hospital himself and, let me tell you, they don't want or need to be involved in a $2500 overpayment dispute.

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nivek_c t1_iydpbxt wrote

Replying to Kintsukuroi85 (#813,380)

To be honest, once you hand everything to the commissioner you are entirely hands off unless they need more info from you. It was only a headache while I was researching state laws to see if I had any recourse for the out of network charges and balance billing, other than that just an annoyance really

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larz_6446 t1_iydrcj4 wrote

There must be a state regulatory authority over medical billing where you live. Contact them with all of your info detailing everything, and they will definitely light a fire under someone's voluminous posterior.

Good luck.

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nivek_c t1_iye554w wrote

Replying to Nemesis651 (#816,534)

the insurance commissioner in my state was clear he has zero say over anything regarding a federal insurance policy or the billing related to it. If it is the same in OP's state then they will probably politely direct OP to a better resource. so definitely worth reaching out regardless, but a complaint to them may be a waste of time

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merithynos t1_iye66wt wrote

CEO - Jim Davis

Corporate Headquarters

Quest Diagnostics

500 Plaza Drive

Secaucus, NJ 07094

​

Send a certified letter with your documentation, including the timeline of your communications with Quest. Let him know that if the matter is not resolved to your satisfaction within 30 days:

  • You will contact your state's attorney general and regulators to report Quest for medical billing fraud.
  • If it is less than your state's maximum for small claims court (for instance Ohio is 6k) you will be filing a claim in your local small claims court OR (if more than the small claims limit) you will be retaining an attorney to pursue the reimbursement and reasonable compensation for the time you spent.
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bluto69 t1_iyeayv9 wrote

I also have a billing nightmare with Quest.

I have used them in the past for labs with no problems. I received a statement for $261.45 for routine tests ordered by my doctor and performed on May 18 of this year. Typically my insurance covers 100% of these tests.

My insurance company provide me with an Explanation of Benefits that showed the 3 tests (and billing codes) and the amounts they paid; no out of pocket due according to them. When I sent this to Quest, they said the billing codes don’t match. After months of back and forth, promises to investigate and get back to me (which only resulted in repeated additional statements being mailed to me), and repeated requests for the same information I already provided (yes, every email exchange was a different representative that seemed to be starting at square one each time), I finally contacted the insurance company who said that Quest must have submitted the wrong billing codes (which, again had been paid) and that they should revise them and resubmit them.

I informed Quest about this but they kept insisting I have the insurance company contact them. I passed this on to the insurance company but as far as they were concerned the claim had been filed and paid. I also doubt this will work as contacting either part (to initiate a three-way call) takes up to and sometime over an hour to get out of the queue.

Whenever I asked Quest to explain where the funds that the insurance company HAD paid them went (and why not credited to my account) they could not explain other than to say the codes don’t match (the codes THEY filed with the insurance company) and I still owed the amount.

This has been a never ending horror cycle with no end in sight. I plan on switching insurance companies next year due to costs, and I’m sure once that happens a whole new complexity will be introduced.

I considered contacting a lawyer but I assume they will charge more than the $261.45 that Quest is trying to get from me.

I am just continuing to push back and insist they contact the insurance company, reverse the old codes (and I guess send that money back) and then resubmit with the codes they claim are correct; or credit me with the funds they already received (where did those funds go?) and quit harassing me.

I will never use Quest again and have informed my doctor about this. They have an in-house Quest presence and those reps are great. Their billing and customer service are the worst.

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Kintsukuroi85 OP t1_iyebs03 wrote

Replying to bluto69 (#821,408)

Please look at some of the suggestions people have on here! Don’t give up! They are, they are complete nightmare to work with. I understand everything you said, as it’s been pretty much my experience as well. I’m so sorry you’re going through it. Sounds like they do this to a lot of people!

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DemDave t1_iyek46t wrote

Replying to bluto69 (#821,408)

You shouldn't need a lawyer for this. File a complaint with your state insurance commissioner. They exist to settle disputes like this and can be an advocate on your behalf.

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bluto69 t1_iyf87ve wrote

Replying to DemDave (#824,620)

Thanks DemDave. I will give Monica Toney a bit to see if she can remedy this. If not then I'll escalate. I'm just glad to see other options now that I've suffered for too long with this headache. Granted, my situation isn't as challenging (or probably as costly) as others here, but it's definitely still frustrating.

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DBCOOPER888 t1_iyfd1ro wrote

Replying to Kintsukuroi85 (#802,646)

It's not that they just know the address, it's that they know how to find the address based on their experience and knowledge of the law and legal system. You're paying them to navigate this process for you.

Like, what exactly do you think lawyers do all day?

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