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Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site and hosts the #THCBGang and #HealthInTwoPoint00 video shows/podcasts. He was co-founder of the Health 2.0 Conference and now also does advisory work mostly for health tech startups at his consulting firm SMACK.health.

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

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

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

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

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

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.

Continue reading…

Ian Shakil, Commure

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

Jason Prestinario, Particle Health

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

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

Preeti Bhargava, Arintra

Preeti Bhargava is CTO of Arintra. She is the living embodiment of my crack that the smartest people in the world spent the 2010s convincing people to click on ads and now spend their time figuring out how to bill payers more for providers doing the same work. Arintra is in the RCM business. It uses AI to read the medical chart and automatically generate claims using fewer human coders, and generating up to a 5% revenue uplift for one customer, Mercy Health. Of course those paying those claims may have noticed, so we had a chat about the emerging AI RCM arms race–Matthew Holt

Jesse Shoplock, Inbox Health

Jesse Shoplock is SVP of Business Development at Inbox Health. They are trying to help one of the messiest parts of American health care, figuring out both how much patients owe at the point of care and how to actually help the providers get paid. As of now 70% of patients don’t know what they owe, and in some cases those patients payments are 30% of total revenue and a bug chunk of that isn’t being collected. Jess told me how they are helping practices fix that. (And in the answer to my question Jesse didn’t know, they’ve raised some $55m so far)–Matthew Holt

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