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May 19, 2016Revdex.com of Southern Arizona5151 E. Broadway Blvd #100Tucson, AZ 85711Attn:  Valerie Ramos RE: Complaint ID #[redacted]- [redacted]Dear Dispute Resolution Consultant:Thank you for your correspondence and for providing us an opportunity to investigate and...

respond to Ms. [redacted].  Ms. [redacted] communicated in her dispute letter that genetic testing she did not specifically request was performed as a result of her visit to our patient service center on February 1, 2016; however, our records indicate that Ms. [redacted]’s provider signed a letter of attestation indicating that they take responsibility for obtaining  informed consent prior to her testing being ordered.  As an ancillary provider, Sonora Quest Laboratories proceeded with performing the testing that was specifically requested by Ms. [redacted]’s provider.The claim for the testing ordered by Ms. [redacted]’s provider was submitted to her insurance plan Blue Cross Blue Shield on 02/12/2016 and on 03/03/2016, Ms. [redacted]’s insurance provider denied the testing, stating the service is not covered under Ms. [redacted]’s benefit plan.  The Sonora Quest Laboratories billing team takes every measure possible to assist our patients with coordinating their insurance coverage for all ordered services, in fact, our call records confirm that two separate members of the Sonora Quest Laboratories customer service team communicated with Ms. [redacted] on 03/24/2016 and 04/04/2016 and provided Ms. [redacted] guidance on the information that would be required for our reimbursements team to file an appeal to Ms. [redacted]’s insurance provider.  Updated diagnosis codes were provided by Ms. [redacted]’s provider on 04/14/2016 and an appeal was filed on Ms. [redacted]’s behalf on 04/30/2016; unfortunately, Blue Cross denied the appeal request on 05/17/2016, reaffirming their original determination that the patient’s health plan does not cover this test.  As a courtesy and to assist Ms. [redacted] with resolving her account balance, we can extend a 30% discount to Ms. [redacted] and we can also offer her a five payment plan to help mitigate the financial impact of this unforeseen outcome.  To take advantage of this offer, please contact our customer service department at ###-###-#### between the hours of 7am and 5pm, Monday through Friday.Sincerely,Anthony G[redacted]Anthony G[redacted]Billing Customer Service SupervisorSonora Quest Laboratories

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.I spoke with the Doctors office and they told me that they supplied the information that was requested of them originally.  They did not receive any other requests for additional information.   I am relying on what the Doctor's office is telling me on this, but I am inclined to believe them because I myself was never made aware that there was still an issue.   I can guarantee that I did not receive another billing, nor did I receive a single telephone call from Sonora Quest informing that there was still an issue.   Sonora Quest told me that they would of called me at least 3 times, but they didn't.  If they would like to tell me when they did call,  I would be very happy to pull phone records to verify it.    The first I knew that there was a problem was when the collections agency contacted me.   This is still a big issue that lies on Sonora Quest's  Shoulder.   I do not like how they try to pass the blame when they are truly at fault.  This should never have gone to collections and Sonora Quest needs to dig into this deeper and come up with a better response.Once I was made aware I immediately worked on getting it resolved, however trying to deal with Sonora Quest was a night mare even getting them to return phone calls.  I have now had a call back from Sonora Quest informing me that they have received the additional information they needed from [redacted].   I am under the belief that this call back from Sonora Quest was in response to this complaint    I will be calling [redacted], the collection company on Monday August 24th to verify if Sonora Quest has contacted them to drop their collections as stated.   I will inform you of the results.
 Regards,
[redacted]

January 5, 2016Revdex.com 4428 N. 12th StreetPhoenix, AZ 85014RE: Complaint ID [redacted]Dear: Dispute Resolution SpecialistTo assist with bringing resolution to Ms. [redacted] concerns, a member of our billing team contacted Ms. [redacted] insurance company by phone on 01/04/2016 to confirm that the claim which was denied on 12/23/15 had been properly adjudicated.   Per the representative that our billing team member spoke with, the diagnosis code provided was not a supportive code for the specific test ordered by Ms. [redacted] provider and as a result, the recent determination on 12/23/15 accurately reflects Ms. [redacted] patient responsibility.  In addition, a member of our staff contacted the ordering provider to confirm that Sonora Quest has the correct diagnosis codes on file; a representative from the physician’s office did confirm the diagnosis information we show on record is correct and as a result, their office will not provide us with any further updates or revisions to the diagnosis codes for this order.  It is always the intent of our billing department to thoroughly resolve concerns on behalf of our patients.  The insurance company’s claim determination does validate that Sonora Quest Laboratories billed Ms. [redacted] appropriately; however, I recognize that this outcome does not meet the expectations of our patient.  For that reason and as a gesture of goodwill, I have authorized the full adjustment of Ms. [redacted] account.  Going forward, it is imperative that if Ms. [redacted] has any questions regarding what tests will be covered by her health plan, that she reach out to her insurance company to discuss any potential patient responsibility in advance.  Thank you for your correspondence and for providing us with an opportunity to investigate this dispute.  I sincerely hope that the proposed resolution addresses Ms. [redacted] concerns.Sincerely,Nichole K[redacted]Billing ManagerSonora Quest Laboratories

RE: Complain ID #[redacted]- [redacted]Dear Dispute resolution consultant:Upon review of Mr. [redacted] account, his insurance adjudicated the claim and left a balance as patient responsibility for his deductible. Sonora Quest Laboratories is an ancillary provider and bills with the information...

provided by the physician on the original order.  Mr. [redacted] physician’s office provided additional diagnosis information in March, however Mr. [redacted] insurance requires diagnosis to be listed on physician office letterhead with patient chart notes. Sonora Quest has attempted 3 times to obtain the required information and never received a response from the ordering provider’s office and Mr. [redacted] account continued through the billing cycle.   Based on the original adjudication of the claim, Mr. [redacted] is responsible for $69.51.  Mr. [redacted] account will be pulled from collections upon receipt of missing documents. We apologize the representative Mr. [redacted] was dealing with did not keep him informed while she was attempting to get the information needed to submit an appeal.   We hope this explanation provides insight on why this claim was not yet resubmitted to insurance. . Unfortunately as an ancillary provider, Sonora Quest must rely on the ordering physician’s office to provide all necessary information to resubmit the claim.  Sincerely, [redacted]Billing Customer Service Assistant Supervisor

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted] and find that this resolution would be satisfactory to me, however will the negative information that the collection agency has been reporting about me be removed from my...

credit report and repaired.  Thank you again for your assistance in this matter.  
Regards,
[redacted]

Revdex.com 4428 N. 12th StreetPhoenix, AZ 85014RE: Complaint ID #[redacted]Dear Dispute Resolution Specialist: We appreciate the opportunity to review this matter and research Mrs. [redacted]’s concern. “Sonora Quest Laboratories believes every patient comes first in everything...

we do, our passion is to provide every patient and every customer with services and products of uncompromising quality”. Sonora Quest has confirmed testing was completed and results sent to ordering physician. Mrs. [redacted]’s complaint; it was determined that the collection process was not followed resulting in contamination of the specimen, has been thoroughly reviewed by our Quality team. Sonora Quest Laboratories staff was not involved in collection of this sample and there is no visible indication of “contamination” prior to the testing being performed. The test was performed and the charges for such were assessed to Mrs. [redacted] per the Explanation of Benefits.  Sonora Quest Laboratories is committed to reaching a mutually agreeable solution to Mrs. [redacted]’s concern, to further demonstrate this, we’ve credited this charge in full and Mrs. [redacted] will be sent an itemized statement confirming zero responsibility.   We hope that this proposed resolution is satisfactory to Mrs. [redacted], if she has additional questions she may contact our customer service department at (800) 853-4288 (M-F 7am-5pm). Sincerely,[redacted], Billing Customer Services SupervisorSonora Quest Laboratories