ComplaintsforDiagnostic Solutions Laboratory

• Initial Complaint

  05/14/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I used one of their tests that I have previously used in the past year twice. So this was my third time using the same test. The first two times there were no issues with the billing portion of it. This year the company claims they changed their policies as far as billing is concerned. So when they called to collect my deposit of $218 they failed to mention their policy changes when billing insurance. So they billed my insurance and didn't apply it towards my total bill because they don't think the insurance "paid enough" for the test. Yet they then turn around and charge me the full cash price for the test of $453. So they keep the money the insurance gave them PLUS require I pay the test in full!! How is this ethical? When I called they say it's a policy change and they don't have any responsibility to let their customers know of this policy change because they are not a credit card company. I didnt need them to submit a claim on my behalf. I could have done that myself. It takes less than 5 minutes to do. So I would have gotten the $152.89 the insurance paid out and just had to pay $298 for the test instead of $453. They apologized but weren't willing to lower the bill. I will not be using their services again in the future. Their customer service rep people were very unprofessional and I had to explain to them I wasn't attacking them personally but I was complaining about the company's billing practiced and policies which I know they personally didn't implement. They were not helpful at all just apologetic in the end. And said they would take my concerns to the company. Which means nothing because they aren't going to change just because I complained to them.

  Business response

  05/15/2024

  This patient has taken two previous tests with Diagnostic Solutions Lab, which were both processed differently from the current test. The insurance covered the previous testing in full and the patient was only responsible for the co-insurance amounts. DSL has not changed its policy on filing claims to the insurance, a deposit is paid upfront and applied to any denied or non-covered lines that were determined after the insurance processes the claim. This order was received marked to "bill to the patient's insurance" which is why a claim was submitted on the patient's behalf. The patient does have the option to file the claim to their insurance on their own once the discounted cash rate is paid in full, an itemized receipt could have been given, if that was the case the official order form should have been marked "patent cash" which allows DSL to provide an itemized receipt for self-submission. The insurance paid $152.89 towards a test that is listed at $761.00 out of the allowable of $218.38 based on a contracted providers rate, which DSL is not. There is a co-insurance of ***** and $441 of charges that were denied on the claim for a total of $506.49. DSL applied the payment of $152.89 to all covered lines, the deposit of $218 was applied towards some denied lines and the patient has a balance of $235 which will cover the additional non-covered services. As an Out of Network lab, we could charge the patient up to the listed rate, however the test was discounted down to the discounted rate, so the patient does not pay more out of pocket then the discounted rate which has always been the policy.

  Customer response

  05/15/2024

   
  Complaint: 21710370
  
  I am rejecting this response because: you just admitted in your response that your customer service representative didn't communicate honestly with me when asked why I was being charged this amount this time. They stated a policy change this year. More than once and more than one representative. Why are they saying there was a policy change if there wasn't? They apologized and said that the person who called to collect payment from me should have explained to me how the insurance billing worked which she didn't. I understand you CAN charge more but it doesn't make it ethical to do so. It's the same exact test. Yet the price billed to the insurance vs. The one given to the patient as a cash price are different. So instead of offering to bill the insurance for the patient, you should just offer me the cash price and not keep the reimbursement given to you by my insurance. You are charging me the cash price AND keeping what the insurance gave you. That is not right. I could have billed the insurance myself if I had been told that was what you were going to do. You COULD reimburse me the $152.89 and JUST charge me the cash price but you are CHOOSING not to. That makes you an unethical business.
  
  Sincerely,
  
  ***********************

  Business response

  05/16/2024

  As an Out of Network provider, DSL reserves the right to change its billing policies, which includes the listed cost of the test. Our most current and up to date billing policies are available on our website. In this case the insurance processed the claim differently than the two test in the past providing less coverage for this test. The price between what is billed to the insurance and what is billed to the patient is different because we offer patients a discount as we do not expect them to pay the same as the insurance company. It is not unethical to charge a fee for services that were provided, since the insurance denied some of the testing codes, which they had not done before. As we are only the laboratory providing the services, we would expect for all billing options to be discussed with the patient prior to the test being ordered. DSL processed the form as it was received with the request to bill to the insurance, there were no inquiries about any additional billing options, we proceeded with the order as it was received. As a courtesy we filed the claim unaware of how it will be processed. Since there was less coverage on this test the patient has more of a responsibility. As an Out of Network Lab, we do not practice unethical tactics as it is a priority to provide the patients the results they need to improve their condition. On the order form the patient acknowledged that she would be "responsible for payment if the insurance company denies the payment for any reason." We understand that it can be frustrating when claims are not processed the same as previous claims. DSL does not determine claim coverage, and we are not contracted. 

  Customer response

  05/16/2024

   
  Complaint: 21710370
  
  I am rejecting this response because:

  As an OON lab I get that you can do whatever you want. That's the point I'm making you COULD let the customer know "We will keep whatever your insurance pays us and still make you pay the cash price or the difference in the price we choose to bill if they don't pay what we think is appropriate. We recommend you bill your insurance yourself as we can provide you with an invoice and receipt at your request." You COULD offer that to your customers but you choose not to. You could be more transparent but choose not to be. You could offer a one time pardon for misunderstandings and miscommunication (made on your part by your cs rep) but you are CHOOSING not to. You might not call that unethical but it doesn't leave a positive impression of your company or desire to use your services again. So call it whatever you want but it's not good business practice at all. You are okay with losing a repeat customer rather than giving me back what my insurance company paid you.

  
  Sincerely,
  
  ***********************

• Initial Complaint

  04/24/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My doctor recommended this test they cost 559 dollars. She said if its not covered by my insurance we can go another route. I treat a chronic illness and its very expensive. I have to be careful. I called this company twice the week I sent in my sample to make sure that they would process my insurance. I had altered the requisition and put in exactly what they said. The rep said if anything was wrong they would call me. No calls. I can prove this with my phone records if needed. The test was done and charged to the doctors office who I have to pay. This seems unethical They were not honest to me And if someone made a mistake, own up to it and make it right. Dont tell a client they can use insurance if they cant due a doctor not being registered. As I said , there were options other than you I could have used that were covered under other doctors.

  Business response

  04/30/2024

  Diagnostic Solutions Lab received an altered order form from the patient. Forms that are completed by the provider office should not be altered in any way, because it is an official order form. A email which is attached was sent to the ordering providers office to confirm if this order should be processed through the insurance or if the patient was set to pay the provider. Per the email received from the providers office the patient was to pay the office directly. DSL proceeded with the order as confirmed by the ordering provider. The patient did not and has not paid DSL directly and they would need to follow up with the ordering provider regarding any payments made to the office. 

• Initial Complaint

  10/27/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  My naturopath, *************************************** ordered stool testing to better understand the complications of my SIBO diagnosis. On March 31, 2023, I began several conversations with Diagnostic Solutions, my naturopath and my insurance carrier, ************** Advantage plan through the ***********, for payment purposes. Several conversations over the next 3 days where my insurance company said they would cover but Diagnostic Solutions (DS) would not bill them because I am not in a strictly ******** plan. My medical MD also offered to use her name as the naturopath might not be accepted but DS also turned that down. I was finally told by DS that I should pay the $453 for the test and I could then submit my bill to *****. ***** worked with me and asked to have someone from DS call them to straighten this out but DS would not call *****. Since my stool sample was time limited, I agreed to pay the $453 out of pocket with the understanding that I would be reimbursed. That did not happen. I submitted my claim to ***** showing what had been paid. This summer I found out that Aetna paid $92.90 to DS to cover the ******** accepted amount. DS is sending me a check for the amount ($92.90) that they received from the insurance *** I am most unhappy that DS will not refund my money since they had received the ******** amount from my insurance *** and I have told them I will be filing this claim with BBB. Any help you can give me to retrieve the balance of the money would be most appreciated, thank you, ***************************

  Business response

  05/15/2024

  Per the complaint the provider who originally ordered this test was Naturopathic provider which is not a degree that is covered by ********* In addition to having a non-covered provider order this testing the patient also has a ******** Advantage Policy which DSL does not except for claims filing to the insurance. The patient was notified that she could cancel the sample if she did not want to proceed with this elective test for the discounted cash rate. It is stated on DSL's website that we do not file claims to select ******** advantage plans and we also provider receipts for records only and not for submission to the insurance. As an out of network non-contracted independent lab, we work with insurance in a limited compacity. Although, this patient was advised that her receipt was for records only, she proceeded to submit the records only receipt to the insurance and it was processed bases on Aetna ******** reimbursement rate for contracted providers. DSL does not owe this patient any refund as she elected to continue testing for this elective, cash only test with no option to file with the insurance. DSL only accepts orders from Providers who are registered with DSL to order lab testing, any provider not registered is prohibited from ordering this test. 

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩