Dr Kaelee Brockway is a professor of education and physical therapy who has built a series of AI based “patients” for her PT students to train on. Kaelee is a pioneer in using these tools for training. She showed me the personas that she has built with LLMs that are now being used by her students to figure out how to train their soft skills–a huge part of any training. This a great demo and discussion about how clinical professionals are going to use LLMs in their training and their work–Matthew Holt
Owen Tripp, Included Health, talks AI
“So far AI in health care is being used to drive existing profits on workflows and increase revenue per event that patients in the end have to pay for. That’s not a win for anyone long term!” Included Health’s CEO Owen Tripp dives into the present and future use of AI, LLMs, patient self-triage and self treatment and all that. Another interesting conversation on where patient facing AI will end up — Matthew Holt
BTW here’s my Conversation with Ami Parekh & Ankoor Shah
Here’s Owen Tripp discussing Included Health.
Here’s Owen’s piece on AI, What’s in your chatbot?
How come I owe Labcorp $34.94? (Part 3)
By MATTHEW HOLT
For those of you waiting for the Labcorp, Blue Shield of California, Brown & Toland Physicians Physicians update, the ball has been moved a couple of years down the field.
If you want to catch up here is part 1, part 2 and part 3)
You’ll recall we left it with a mystery $34.94 bill which didn’t either fit the official $50 copay amount I have, nor the $0 patient responsibility in my EOB. I got a call from Rhea Fleming, an experienced customer rep at Labcorp, on whose virtual desk this has been dumped. We had a lovely conversation in which we agreed that the co-pay should either have been $50 or $0 but that it’s possible that the co-pay is the lower of $50 or the amount Labcorp was trying to collect.
She had previously called the Blue Shield of California provider line to try to figure this out. Blue Shield had indeed kicked this claim from Labcorp to Brown and Toland the IPA I am assigned to in the HMO product I bought. The charges from Labcorp were $322.28 and the response from B&T was that the contractual price (i.e. what they agreed to pay Labcorp for those tests) was $34.94, hence the “adjustment” of $287.34. However in Labcorp’s system the algorithm interpreted B&T’s response as saying 1) the agreed payment is the $34.94 according to the contract and 2) they were not going to pay so the patient owes the difference. When Rhea Fleming asked Blue Shield’s rep why the patient owed payment on this, the Blue Shield rep said that the procedure code and diagnosis code from my PCP (One Medical) did not count as preventative care. In other words Labcorp has not got paid at all for running these tests so far, because they are according to B&T “not preventative”. Although IMHO, CMS says that they are. And of course as it says my copay is $0 I’m interpreting Blue Shield of California’s EOB as saying that to me!
Hence Labcorp generated the bill for the $34.94 and sent it to me. Which started this whole telenovela.
BTW Rhea’s conclusion was that as none of the tests were “preventative,” Labcorp billed me the $34.94 as that was the total it was contractually owed rather than the $50 copay I am supposed to pay for lab work. I actually checked back in my Labcorp account and found that last year I did in fact pay $50 so perhaps last year I had different tests or somehow they have changed the algorithm. I checked the EOB for that 2024 bill and the total charge was $445.20 of which Blue Shield paid $28.07. No I couldn’t find the Labcorp bill on their system, presumably because I have paid it! Given that I paid $50 for services from Labcorp on that date (yes, it took me 7 months to pay up!), it’s likely that the agreed payment was $78.07 ($50+$28.07) of which I unthinkingly paid the $50 copay. And yes that should have been preventative too. (Perhaps I should ask for that $50 back!!)
BRIEF UPDATE: Rhea from Labcorp looked into this 2024 bill and that is exactly what happened
Then, I had another thought.
It turns out that the lab results this year generated a further concern in my doctor’s mind. (Bear in mind I had the lab tests before the office visit so that we could discuss the results). It seems that my iron levels were a little low, so while I was in the doctor’s office he ordered some more tests specifically about that. As One Medical has techs on site they drew my blood then and there and shipped it to Labcorp.
According to my EOB, Labcorp’s charge for those new tests was $60.79 of which Blue Shield or rather Brown and Toland again paid $0 and created an EOB which again said my patient responsibility was $0. I asked Rhea to check that bill in her system and it turns out that I do NOT owe Labcorp anything on that set of tests. Maybe they were coded as preventative? I tried to find the bill on my patient portal at Labcorp but because I don’t owe anything I haven’t been sent an invoice and without an invoice number you cannot check the bill!
When Rhea ended the call with me, her next move was going to enquire of Blue Shield and Brown and Toland what the reason was for me owing $0 on that bill!
Meanwhile I await the result of the official Blue Shield investigation with interest. Of course this might just have come down to Amazon One Medical coding the tests incorrectly. But it’s all fun and games if you have unlimited patience in American health care.
And of course, this still isn’t over!
Adventures in how screwed up health care is, number 436
By MATTHEW HOLT
(I copied this here from Linked in where it 65+ comments just so I can find it when the story continues) Too painful to write up fully but I am on my 4th transfer in one phone call to MarinHealth trying to get an echocardiogram (EDIT-not an EKG as I originally wrote). They have lost the referral from One Medical twice. I had to download the referral and email it to them (Lucky it’s on the One Medical system). Every person has asked for my DOB and phone number. The guy who got the email, read the referral and transferred me. The latest guy appears very puzzled & wants me to fax him the referral. Eventually he gets me to his supervisor who says that radiology & cardiology are separate and they can’t receive an email because it’s a HIPAA violation. (I claimed to be Lucia Savage & laughed at him). Now I have to figure out how to fax it to them and the supervisor promised to call me back. He had to ask for my phone number….
Oh and I can’t book a echocardiogram on MyChart, but I can book a mammogram.
I’ll follow up in the comments. BTW that phone call was 19 minutes
UPDATE: OK, so I faxed them via a dodgy efax company whose “free trial” I need to remember to cancel. The supervisor did call me back, but for some reason my phone didn’t ring! He left a message and booked an appointment for me. But not in their Marin facility. In the next county over! (And Sonoma is very lovely). A 45 min drive rather than a 10 min drive from my house. I can SEE the appointment in the UCSF MyChart, and I can cancel it. but I cannot request a change or see when I could book one closer to me (presumably at a later date). So I guess I will call back on Monday….
UPDATE: So I called back today and got the appointment changed to the closer location. I had to wait one more day… I know you are all on tenterhooks so I will tell you if my heart works in 2 weeks!
UPDATE to the Update. A human called me and cancelled my appointment. Apparently the tech was out sick. Still no word on whether I have a heart or just a black pit inside my chest
UPDATE: I finally got in and had the Echocardiogram. Marin Health had an iPad based fast check in (well done). I didn’t recognize whose software it was. The echocardiogram took 45 minutes and was a bit like having somone stick their finger in your chest the whole time. Yes I do have a heart! More to come
Rosemarie Day & Me invite you to see Atul Gawande
My friend Rosemarie Day joins me to talk about the Healthcare Leaders for Democracy session coming up on September 4 (Thursday) at 8pm ET 5pm PT. It’s a one hour session with Atul Gawande as the keynote speaker, joined by Don Berwick and John McDonough. It’ll be a fascinating discussion and it’s a fundraiser for Movement Voter Project, but it’s free to sign up.
Rosemarie and I talked about how we work on getting grassroots mobilization for the mid-terms and beyond, and we hope people will come and join.
Hunting down my $34.94 lab test. An journey into the bowels of insurance billing
By MATTHEW HOLT
So I am back dealing with Labcorp & Blue Shield of California over the mysterious $34.94 copay. If you want to catch up go here
Over the weekend Labcorp sent me a final due notice on my bill…. the one that they couldn’t tell me about without asking for all the information they already had.
I call Labcorp customer service in the Philipinnes. The friendly rep says that they have had a message saying that “the insurance company requires that Labcorp provides documentation from the ordering physician”. What documentation, I ask? A letter that tells them what the updated codes are. Given that the Brown & Toland Physicians rep told me those codes and they must have been sent them by Labcorp when Labcorp sent in the claim, that seems to make no sense. I’m not yet prepared to ask my doctor’s office to get involved in this! (Better look out though, Andrew Diamond!). So I’ll let that go for a moment.
However, Labcorp says that they received an EOB from Blue Shield of California PPO–it had my correct member number even though I am an HMO not PPO member. No the EOB did not come from the IPA Brown & Toland Physicians, and yes I asked very precisely. The EOB says the co-pay is $34.94. Labcorp can’t ascribe it to any one of the 5 individual lab tests (which all look preventative under the ACA to me but maybe one isn’t). So the $34.94 is the copay from the EOB that Blue Shield of California sent to Labcorp.
They asked me for my copy of the EOB. I sent one 5 days ago, but sent it again just to be sure.
Next up, asking Blue Shield of California what precisely they sent to Labcorp saying my co-pay is $34.94 when the one they sent me (well have on their website) says $0. Oh and by the way, the standard copay for labs on my plan is $50, not $34.94!
On my Blue Shield of California member portal there’s a message with a letter. Apparently they opened a customer grievance for me! I called the customer grievance number in the letter. According the answering IVR message there is a chat option for providers with grievances, but not one for consumers. My hold time is estimated at 20 minutes. A nice rep called Susie comes on in only 15 mins.
After verifying that she knows who I am she says there are 2 different grievances! One is an appeal for the lab test & one is a complaint about the process, both opened August 12. I suspect they were initiated by the nice man from the Executive office who called me on that day. Rep Susie is limited to telling me that appeal status. But she tells me that an appeal coordinator is looking into the complaint and will be back in touch within 30 days. AND she gives me an email to reach said coordinator at! So I sent that person an email….lets see what happens!
Matthew Holt is the founder and publisher of THCB
When is Preventative Care not Preventative? Let’s get Labcorp to join in! (with UPDATE)
By MATTHEW HOLT
To join in the fun I am having with Blue Shield of California & Brown & Toland Physicians IPA being unable to tell me why I have a $34.94 bill for lab work (see image) that should either be covered as preventable under the ACA, or have co-pay of $50 (see image of the BS of CA screenshot for the $50), I called Labcorp.
After 6 minutes I got a very confused person. BTW there is NO way to communicate with Labcorp on the website, and if you put your invoice number into their IVR system there is NO way to get a human. The only way to do that is to hang up and start again, NOT put in your invoice number and hit 0. Then wait on hold with muzak to get a human. They then ask your DOB and phone number. The call center is in the Philippines BTW.
I explained that I wanted information on which test was not covered under the ACA. Brown and Toland/Blue Shield’s EOB says I have a $0 co-pay (see image).
The Labcorp rep told me that of the 5 tests done (with CPT code and price), 3 were not covered. The Lipid (85027 $107.10), the A1C (80061 – $81.90) Uric Acid (84550 $43.05). 2 of those 3 clearly are covered under the ACA. The Uric Acid one may not be according to my reading of the CMS site. Labcorp submitted that bill to Blue Shield. The rep consistently told me the claim was sent to Blue Cross Blue Shield of CA, which doesn’t exist.
At that point — 15 minutes in — the call dropped. I don’t know if they just hung up but they had asked for my phone number. They didn’t call me back.
But I am a pain in the ass, and I called them back. After roughly 4 mins on hold, I got another rep. She told me ALL of the CPT codes/lab tests were subject to copay. She told me that Blue Shield (NOT Brown & Toland Physicians) has bundled all of these codes and there is a co pay for all of them. Which is what the bill says.
So the only thing I can do is to send an email with the screenshot of the EOB, which is from the IPA not Blue Shield. So I did that and may get a response in 3-5 business days.
I know you are on tenterhooks. Let’s see what happens next but the complete absence of anything resembling consumer transparency or access to the relevant information makes a mockery of everything Paul Markovich says on stage.
UPDATE. Labcorp both emailed me back AND asked me to contact them on Linkedin. See what they asked for! Yes even though they have sent me a bill and I sent them the invoice number, they want every detail possible about the claim they ALREADY have!
Full email below just for giggles
Oh and when I went to DM them on Linkedin as they requested their account was not accepting DMs!
2nd UPDATE: A very nice man from the Blue Shield of California corporate office called me up. We discussed whether the care I got was preventative or not and why I was being charged the $34.94. Of course he didn’t know. He agreed with me that it was a shit show, and actually started to complain that sometime HE had been charged for preventative stuff he thought should have been free.. He didn’t have any solution other than calling Brown and Toland to cancel the charge, but I told him I didn’t want any special treatment (at least not yet!). I told him I wanted no special favors, but I wanted the claim reprocessed and an explanation.
And there’s a part 3!
Matthew Holt is the founder and publisher of THCB
How exactly is my lab test co-pay $34.94?
By MATTHEW HOLT
I moved over something I wrote on linkedin, so that it doesn’t vanish. I do this type of thing so you don’t have to & to make Brett Jansen happy I am writing in one line paragraphs.
My question, is how do LabCorp, Brown & Toland and Blue Shield Of California come up with this stuff?
1. I go for my free annual checkup
2. I get blood/lab tests which AFAICT are included in the ACA free checkup.
3. My pre-diabetes is still “pre”. My cholesterol is good!
4. Blue Shield of California puts the claim on its website. The EOB representation says
–total billed $322.28
–In network savings $271.37
(note difference is $50.91)
–Patient responsibility $0
5. Then it has 5 sub-charges for different tests (which I assume total to the $322.28). All have a different price. All say “in network savings” of the same amount. All say Patient Responsibility $0
6. Labcorp sends me a bill. For $322.28. “Adjustments” $287.34. Difference $34.94.
7. I call Blue Shield of California customer service. Its annoying as hell automated system reads me the claim EOB that I can see on the website.
8. After a few minutes of that I hit 0 and get a human eventually. After a loooong time she goes to call Brown and Toland, the IPA that is somehow involved in the lab billing. They tell her that I do indeed owe $35. (26 mins on the call)
9. I ask her why, given they are allegedly free under the ACA, I am being charged for these lab tests. She says that the medical group has sent her the CPT codes and she can tell me which of the 5 lab tests I owe for.
10. (On the Labcorp bill the charges are split up by test [no codes provided], but the “adjustment” is to the total, so there’s no way to tell what the adjustment per test is. Reminder that on the BS site, they all adjust to $0.)
11. But that information is not in whatever documentation the IPA gave her. She goes back to call them AGAIN. Because, yes I am difficult and I did ask her to. Minute 37 at this stage
12. Minute 45. The person from the IPA comes on line. She keeps asking if I want a service or a diagnosis code. But tells me they will review the claim. My guess is that one of these codes doesn’t count as preventative. Eventually she gave me the 5 CPT codes for the tests.
13. The BS rep is still on the call. She chimes in and the IPA rep (who I think is in India judging by accent and bad phone connection) agrees that my lab copay is $50. (BTW the BS rep is clearly American but her phone connection is dreadful too!)
14. After a lot of clarification (OK, me leading the witnesses) they both agree that if the co-pay is $50 but my bill is $34.94, then something is off, and maybe one of the codes has been classified as non-preventative, therefore not free under the ACA.
15 The IPA (Brown & Toland Physicians) rep is going to resubmit this to the claims team. I should get a new EOB. From whom I have no idea. I thank them both for their time and we hang up. 1 hour 4 minutes
I know that wasted more than $34.94 of my time, and certainly way more than that of Blue Shield of California & Brown & Toland Physicians money. But it’s just an indication of how screwed up internal billing and customer service is at these antique orgs!
If you want to follow along, there’s a part 2!
Matthew Holt is the founder, author and publisher of THCB
Ami Parekh & Ankoor Shah, Included Health
Ami Parekh is the Chief Health Officer & Ankoor Shah, is VP, Clinical Excellence at Included Health. I had a long conversation with them about the philosophy of how we are doing population health and how we fix the system that we have today. I’m arguing for more primary care, but Ami restated it and says, you need somone you trust who is an expert who can help you make decisions. And this might not be a human! How do we change the system, and how does telehealth work now and how will it change? Defining health from the person perspective, not the way the health system wants to define it! Matthew Holt
Are the MA(HT)GA crowd going to be proud of themselves?
By MATTHEW HOLT
I have been trying hard to suppress this line of thought but when I woke up in the middle of the night with this piece basically fully formed in my head I couldn’t not write it. Yes I might lose some friends, but someone in health tech has to say this.
Last week a bunch of health tech companies, providers, plans and others went to the White House to an event remarkably called “Make American Health Technology Great Again”. The main organizer Amy Gleason is someone I consider an industry friend. No one can doubt her credentials in wanting to help patients, especially given her daughter Morgan’s medical condition and her awful experience in the health system. The initiatives spelled out–while they are voluntary and based on actions and regulations that are already on the books–will be net net good for American health care, and good for patients.
Now, almost everything proposed is happening anyway. Anyone in health tech knows that it’s much easier to get health data and to run AI on it than it was in 2020, and it was way easier to get health data in 2020 than it was in 2016. Yes, of course it should be better and easier than it currently is. Yes, it should have happened quicker. Yes, the big provider systems and their main EMR Epic have not exactly bent over backwards to make data access more convenient for patients and innovators. Yes, of course there are too many demands to “send us a fax”. I personally had great fun with a UCSF-affiliated hospital last week, speaking to 5 different people and ending up both emailing and faxing them a referral to get an appointment. I’m pretty sure I’ll be doing the same thing in 2028.
You can read tons more about the plans, the event and the voluntary agreement from luminaries like Lisa Bari and new dad Brendan Keeler.
But none of that is what is troubling me. What is deeply disturbing is the normalization of the people allegedly in charge of the nation’s health and health tech and the nonchalance and even knee-bending of those who went to the event last week.
Now I wasn’t there, even if several industry friends and clients were. I was at several similar events back in the Obama administration, but what we have seen from this Trump administration is a radical and toxic departure from America’s leadership in health and democracy, and it is not acceptable.
This is encapsulated by the people on the dias, and the actions they have taken.
Trump and his administration have committed so many egregious authoritarian acts that there’s no way to list them all. Just because people voted for him and the Congress and Judiciary is neutered does not obviate the fact that he was – deep breath – convicted of rape and separately found to be lying about mortgages in a civil court; convicted of 34 felonies for essentially tampering with the 2016 election; and impeached twice–once for politicizing America’s foreign policy and once for starting a violent coup. Don’t forget that at the time of the 2024 election he was being–another deep breath–prosecuted for stealing (and presumably selling) state secrets; being prosecuted for vote tampering in Georgia; and being prosecuted for planning the coup on Jan 6. It’s worth pointing out that two countries that have recent experience of dictatorships (Korea and Brazil) have both prosecuted and banned from office the leaders who attempted similar crimes there. (Incidentally I highly recommend you watch I’m Still Here, the Oscar-winning story of one family whose father was “disappeared” under Brazil’s military dictatorship in the 1970s).
Since his return to office, Trump has overseen the greatest direct political corruption ever in this country – you can bribe him directly via his memecoin. He has also overseen the transformation of ICE into an American-style Gestapo. Masked unidentified ICE agents are now snatching people, including both citizens and legal immigrants, off the streets and burying them in concentration camps here and abroad. Don’t forget that many immigrants or first generation immigrants are heading up those health tech companies at the meeting last week, not to mention how many poor, and perhaps undocumented, immigrants are working in our health care system.
I haven’t even mentioned the impending cuts to Medicaid, the program for the poorest Americans, which will be the result of Trump’s “One Big Beautiful Bill Act”. That is sure to have a terrible effect on patients and on much of the health system, including many health tech companies trying to support Medicaid patients.
I didn’t even mention Epstein! And this is the guy America’s health care community wants to go and politely applaud just because he reads a speech about interoperability?
And it doesn’t stop there.
Continue reading…
