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A year-and-a-half after he gave them his blood, Glen Thibedeau still owes $100 to Quest Diagnostics Inc.
In April 2017, the 59-year-old mechanic saw his doctor in Las Vegas for an annual checkup. His blood pressure was high, so the physician ordered basic blood work. A couple weeks after visiting a Quest clinic, Thibedeau got a bill in the mail for more than $1,000.
Thankfully for Thibedeau, the Quest facility was covered under his insurance plan. He paid $130 of the $230 for which he was responsible, keeping the rest to make a statement.
"I thought that was ridiculous," he said. "Basic blood work for over $1,000? I haven't paid them $100, and I'm doing that out of spite.''
As health plans with high deductibles become more prevalent, labs are increasingly being forced to seek payments from patients, rather than insurance companies. The cost-shifting is leading to unpleasant surprises. Four in 10 insured adults under age 64 said they received an unexpected medical bill in the past year, according to a poll by the Kaiser Family Foundation. Most respondents listed surprise invoices as a bigger financial concern than living expenses, prescription-drug prices and food.
Sometimes customers are unaware that an outside company is doing their testing, not their doctor.
Lab companies have invested in tools that make the payment process more clear for patients who use their standalone facilities, but many samples are collected remotely. A majority of Quest customers don't have any contact with the firm until they're billed, according to Chief Financial Officer Mark Guinan. When blood is drawn at a doctor's office, for instance, a physician might not mention that the testing is contracted out to a diagnostic firm.
"A lot of times the reaction we might get is, 'Who's Quest? I never went to Quest,"' Guinan said in an interview.
"There's no formal training for some of this stuff. Patients do not have navigators."
Sometimes customers learn about their tests, take all the appropriate precautions and still end up getting an unexpected bill.
Allison Ritchie, 43, found a lump under her jaw earlier this year. An ears, nose and throat specialist near her home in Muscatine, Iowa, told her she needed a biopsy performed at a hospital to test for cancer. Ritchie got everything preapproved by her insurance company, but her tissue samples were sent to an out-of-network lab.
"I didn't ask where they were sending tumor samples to," said Ritchie. "It wasn't a question that was at the forefront of my mind."
