Category: Health Tech

7th and possibly final update on the $39.94 lab test bill

Apr 9, 2026

By MATTHEW HOLT

I know you all care, so I am giving a 7th update on the telenovela about my Labcorp bill for $34.95.

The very TL:DR summary of where we are so far is that in May 2025 I had a lab test to go with the free preventative visit that the ACA guarantees, but I was charged for the lab tests and I was trying to find out why, because according to CMS I should not have been.

For those of you who have missed it so far the entire now 7 part series is on The Health Care Blog (1, 2, 3, 4, 5 & 6). Feel free to back and read up.

Where we left it last, Brown and Toland (the IPA between my plan Blue Shield of California and Labcorp) told me that on 8/29/2025 their benefits department had finished their review and reported that the original lab test wasn’t coded as preventative lab services by One Medical, so that the co-pay of $34.95 was correct. ($34.95 was the total agreed payment for all the tests, charged at a total of $322.28. And as it was less than my $50 copay, LabCorp only charges the patient for the total, not the $50!). That call was on December 18 and resulted in update 6.

I next (well about a week later later because life, etc) requested One Medical to resubmit the bill coding it as preventative. That happened on Dec 24, 2025 and someone called Alexis working for One Medical, while exhibiting terrible life skills, replied on Dec 25 and sent it on to their billing department asking them to recode it. I followed up on Jan 15 and Alexis at One Medical confirmed that the billing department had faxed the updated codes to Labcorp. I presumed that Labcorp would resubmit the claim to Brown and Toland and I would eventually get a $0 bill from them.

However, today (4/9/26) I called Brown and Toland about a different telenova — a coinsurance I had received for a dermatology office visit. While I had the rep on the phone, I asked about the Labcorp bill from May 2025. She told me that the benefits team at Brown and Toland had decided on December 18 — that’s right, before I contacted One Medical to ask them to resubmit the claim — that the codes should have been classified as preventative and that I don’t owe the $39.94. Of course Dec 18 was the last time I called Brown and Toland when they said that I had to have One Medical resubmit the claim to Labcorp. Sounds a little coincidental that very same day their benefits team re-reviewed the claim and decided that it should change to being preventative. But who am I to complain or raise a fuss!

Just to add to the complication, on Dec 29 someone within Brown and Toland (customer service?) received that message from the Benefits team and sent it over to the “Epic team” which I assume deals with outliers, with a request to reprocess it. As of today (April 9, 2026), that reprocessing had not happened.

As it happens they may not bother. Labcorp way back when agreed not to send me to collections, and I don’t know if they care enough to go after Brown and Toland for the $39.94, or have just given up on it. More likely if the claim is reprocessed, it will probably be tossed into the capitated amount they already got paid. Which is why the “payment” for my two subsequent lab tests was $0.

So I think we may be at the end of this series. (OK, if you read part 6 there are a couple of other tests Brown and Toland think I should be paying for but no one has sent me a bill for those yet and I may just let sleeping dogs lie).

But don’t worry, there’s always more stupidity in the way Americans deliver and pay for health care, so I’ll keep talking about it. Until we blow up the system and build one that works.

Mathew Holt is the Founder & Publisher of THCB

Tom Kelly, Heidi Health

Apr 6, 2026

Tom Kelly is the CEO of Heidi Health, another of the many ambient AI scribes that is spreading its wings to other roles, including bringing its own AI Open Evidence competitor! He calls it an AI care partner. Heidi started in Australia, and quickly moved to the UK and Canada, but now are in over one hundred countries. More recently they have come to the US and have now four major health systems and a lot of other mid market users. Tom think’s Heidi will soon do all the “work around the work”, and he doesn’t think it has to be deeply integrated with the EMR. He sees that as a superpower as doctors don’t want to be in the record. Is he right? Are scribes and ambient AI going to be separate? Does the scribe have to be a medical device, as it does in the UK? Will patients use it? Lots of questions about the future and Tom has lots of answers. Some might even be right!–Matthew Holt

Today’s April Fool is me in 2011

Apr 1, 2026

I randomly found this interview I had completely forgotten about on Youtube from 2011. I was younger and thinner then, even though I didn’t have much hair. And I was very optimistic that tech was going to change health care in 10 years……and that it was going to take a long time. Guess we are still waiting!

Kevin Wang, Suki

Apr 1, 2026

Suki is one of the original Ambient scribing, now Ambient intelligence, companies. They’re selling both to providers and to other partners using their tech in their tools and services (think telehealth, other EHR providers like Athena, and more). Kevin Wang is the Chief Medical Officer, and he told me about the evolution of ambient documentation, how it makes doctors happy, and how it’s now moving into improving coding (and billing) but will soon be moving into improving clinical decision support. We haggled a little about the ROI from Ambient and where that comes from (remembering codes), and discussed how the EMR v Ambient plays out. And we talked a little about what the impact of ambient and AI will be on medicine…–Matthew Holt

Adventures in health care billing. My $51.96 zit co-insurance

Mar 30, 2026

By MATTHEW HOLT

I know my many fans love me delving into the world of why we get seemingly incorrect trivial bills in health care, and what they all mean. The long telenovella of the $39.94 bill from Labcorp is as yet stalled with One Medical apparently resubmitting the original claim with the new preventative codes on it. But even though I am continuing and expanding my role as a difficult patient this year, there are still some blasts from the past that won’t quite leave.

This particular one concerns some rather unpleasant dermatology issues. For many years I had an nasty small sore/lesion on my leg that never quite healed. Then I started getting a few more that started as zits and never quite left. My wise PCP Andrew Diamond at One Medical told me to use some antibiotic wash and referred me to a dermatologist. Unfortunately the one I was referred to was out of network for the Blue Shield HMO I was in, but one request back to One Medical and I was both sent to a dermatologist in my network and got a pre-auth in the mail from Blue Shield to go see him!

Dr Cristian Gonzalez took a quick look at my leg, decided what the problem was, and proceeded to inject, freeze and attack my various lesions. He then prescribed a cheap topical steroid for me to use, and basically after 4 visits over the summer and Fall, my legs went back to resembling a baby’s bottom–well more or less.

For each specialty visit Blue Shield had a co-pay of $85 per visit, which I handed over using my HSA card. One time the front desk said I had a balance, but when I asked them what it was for they told me it was a mistake. Until this week.

Some 4 months after my last visit I got a bill in the mail for $51.96

Given that I had made a co-pay of $85 each time, this seemed a little odd. So I took a look at my Blue Shield EOBs. (BTW they are back online, you may recall they vanished when Blue Shield cancelled and then changed my plan but the Internet never forgets….)

There a curious anomaly began to play out. Each visit generated three identical claims and three more or less identical EOBs.

Ian Shakil, Commure

Mar 26, 2026

Ian Shakil is the Chief Strategy Officer of Commure, the AI platform being used by HCA, Tenet and others. He came to Commure via its acquisition of Ambient AI vendor Augmedix, and there are a lot other other new acquisitions within Commure (Athelas, PatientKeeper, Memora Health, Rx Health etc). We dived in not only about what Commure does but the big question of how does a client like HCA or Tenet decide what Commure does, vs what Meditech does, vs what Google does vs what they do internally. We also (sorta) looked into the various criticisms (basically all from Sergei Polevikov!) of what Commure and its main funder General Catalyst are up to and what is happening at Summa Health the hospital in Ohio that GC bought. He also says the good experience from AI will come to help patients this year, and I’ll be holding him to that!–Matthew Holt

Function Health has a 23andMe problem

Mar 25, 2026

By DEEKSHA HEGDE

I had an itch to draw parallels between the two. The structural facts kept lining up in ways I couldn’t dismiss, and by the end, I stopped trying.

Function’s product is an app: you pay $365 a year, go to a Quest Diagnostics location, get 160+ biomarkers tested twice a year, and receive clinician-written notes interpreting your results. The lab testing is fully outsourced. Function is the layer on top: panel design, member experience, clinician note generation, longitudinal tracking.

Function Health raised $298 million at a $2.5 billion valuation in November 2025. At 25x revenue, the market clearly isn’t buying a lab reseller. It’s buying the data flywheel: longitudinal biomarker histories that compound in clinical value over time, aggregated across hundreds of thousands of members into a dataset that health plans, pharma companies, and AI developers can’t build any other way. A member with four years of data can’t switch to a cheaper competitor without losing the trend. The unit economics work if the interpretation layer scales without proportionally scaling headcount, which is what the Medical Intelligence Lab, their generative AI model launched in November 2025, is built to do. Function is also building toward a B2B enterprise channel, positioning the product as a way to keep employees “healthy, focused, and ready to perform.”

It satisfies a burning need for specific personas: the worried well, the health optimizers, the people who saw their loved ones get diagnosed a little too late, the people who aren’t waiting for a diagnosis before they start paying attention. These are people the rest of the industry has mostly left alone. I wrote earlier this year, in a piece on Hinge Health, about the prevention paradox: the employer ROI model is structurally blind to the member who benefits most from early intervention. Function skips the employer ROI story entirely, charges the member directly, and doesn’t try to prove a CFO case it can’t make. Yet.

Jason Prestinario, Particle Health

Mar 25, 2026

Jason Prestinario is CEO of Particle Health. The company is best known for its current lawsuit against Epic, but behind that there is a real company delivering a set of products as on ramp for clients wanting to access health data. Particle was cut off from access to Carequality & Epic a couple of years back but is now both delivering services to its customers and separately suing Epic for being an abusive monopoly regarding its payer platform. I had written about this a couple of years ago but I used this chance to catch up with Jason, to see what the sate of play was. He explained that Carequality said that Particle was right in the original dispute, and why they were right and Epic was wrong. The court case continues. But it’s interesting to hear from someone in the middle of the new disputes about data. — Matthew Holt

Mario Danek, QNovia

Mar 24, 2026

Mario Danek is CEO of QNovia, a behavior change platform focusing on smoking cessation product. Essentially the problem with smoking cessation nicotine products is that they don’t deliver the “hit” of a cigarette as quickly as a cigarette or a vape. Mario’s new vape-like product delivers a nicotine replacement therapy (think like Nicorette gum) just as quickly as the form factor it’s replacing. He is hoping that the device/drug/and forthcoming mental health support will be the engine to reduce the current smoking rate from the stubborn level it’s got stuck at. He told me about its likely time to commercialization–Matthew Holt

Beyond Generative AI

Mar 23, 2026

By BENJAMIN EASTON

Healthcare’s administrative burden is not a documentation problem. It is a workflow problem. Healthcare’s next leap depends on agentic systems that can actually do the work

Over the past year, healthcare organizations have widely adopted generative AI for an array of documentation-related activities such as drafting appeal letters, producing patient-friendly summaries, and even assisting with administrative writing. While these tools have improved how information is created, healthcare’s administrative bottlenecks (e.g., prior authorizations, benefit verification, denial management, clinical trial enrollment), are not caused by a lack of text. They are caused by fragmented systems, manual tracking, payer variability, and workflow handoffs that require continuous monitoring and intervention.

If generative AI helps write the email, agentic systems send it, track it, escalate it, reconcile the response, and close the loop.

That distinction is healthcare’s next inflection point.

From Content Generation to Workflow Execution

An agentic system is not just a chatbot layered onto healthcare workflows. It is a coordinated set of AI-driven agents designed to:

Pull structured and unstructured data from EHRs, payer portals, labs, and internal systems
Apply payer-specific policy logic
Validate documentation requirements
Submit transactions through the appropriate channel
Monitor status changes
Trigger follow-up actions
Escalate exceptions to humans
Log every action for audit and compliance

Behind the scenes, these systems rely on rule engines, structured clinical mappings, secure API integrations, and event-driven automation frameworks. They continuously re-evaluate state changes (e.g., a new lab result, a status update from a payer portal, or a missing documentation flag) and dynamically adjust next steps.

This is not robotic process automation replaying keystrokes. It is intelligent orchestration across disconnected systems.