Prometheus Laboratories Inc

Review: Was told I do not qualify financial assistance and I do meet the criteria.Desired Settlement: I should have a zero balance.

Business

Response:

This letter is provided to you in response to the consumer complaint submitted on

11122/2013 ID # [redacted]. This complaint involves diagnostic services performed

by Prometheus Laboratories Inc. ("Prometheus") pursuant to two (2) test

requisitions from Ms. [redacted] physician.

Specifically, we received two specimens for this consumer and corresponding test

requisitions on August 10, 2012 and April 17, 2013. Ms. [redacted] insurance carrier

was billed $690.00 for the first specimen and paid a total of $436.30; thus leaving a

remaining balance of $253.70. Prometheus also billed the insurance carrier for the

second specimen with total charges $337.00. Ms. [redacted] carrier paid $70.20

leaving a remaining balance of $266.80. The consumer's total balance for both

specimens' is $520.50.

On May 16, 2013, Ms. [redacted] 2012 balance of $253.70 was sent to an outside

collection agency after multiple attempts to collect from her through phone calls

and letters from Prometheus billing staff. After the account was sent to collections,

Ms. [redacted] contacted the Prometheus billing department to inquire about any

financial hardship programs. At that time, the Prometheus billing staff reviewed

Ms. [redacted] account for financial assistance. The billing staff has had several

conversations with Ms. [redacted] since she initially contacted Prometheus regarding

the financial hardship program. Ultimately, it was determined that Ms. [redacted] did

not qualify for the program per the program guidelines; her stated income on the

2012 tax returns exceeded the income parameters of the program. The 20 13

account for $266.80 remains with Prometheus and is due and owing. Our

Prometheus billing staff and third party collection service is willing to structure a

payment plan for the consumer.

Thank you for the opportunity to respond to this complaint. Please call or email if we

can be of any assistance to you, or if you have further questions. I may be reached at [redacted]

Executive Director, Legal Affairs & Compliance

Prometheus Laboratories Inc.

Consumer

Response:

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 qualify for 100 percent financial assistance as I am unemployed and my income

Is less than a 1000 a month. I never was made aware that my labs would be sent to another

Here's the letter I sent to Prometheus:

I am writing to express my dissatisfaction with your services and to request that you withdraw your bill.

Our physician, Dr. [redacted] of Mass General Hospital, provided your test to our son to see if he had developed the antibody to Remicade, the TNF-blocker. Our son had used Remicade to control a flare of his Crohn’s Disease about 5 years ago, and then had stopped.

Your test showed that he had not developed the antibody, and that it would be appropriate to administer another dose. This finding turned out to be wrong. About halfway through his infusion, he had a severe and quite scary allergic reaction that had to be addressed with a strong dose of steroids and antihistamines.

I am dissatisfied on three counts:

1. The test proved wrong, and we're being billed for both your test and the expensive infusion of Remicade that your test should have told us to avoid had it provided accurate results.

2. Your test is inappropriately expensive, for the apparently uncertain results it provides.

3. Your test/lab is not in the Blue Cross formulary, and they have rejected the claim. At this point, we are facing a $2,500 out of pocket expense.

I hereby request that you withdraw your bill for this test. I have made our care team at Mass General aware of this matter and will be reporting back to them on your decision. Thank you for your consideration.

Prometheus reduced their charge to $250, still inappropriate given that it failed to do what it was supposed to. Caveat emptor, steer clear!

Based on my personal experience, this place seems like a racket and a price gouging business - $2,500 for a single lab test for my child? This is what is wrong with America and with our entire medical system. They went on to tell me that if I do more tests, the price will get cheaper over time... so completely rape me the first go-round and hope that I return? This makes no sense... if you cannot do volume business, then just charge it up on the first one. Not a sustainable business model - and because I am not on welfare or desperately poor, I get to pay the full amount. WARNING: DON'T ASSUME YOUR DOCTOR KNOWS THE DECEPTIVE PRACTICES OF THESE LABS - there are MANY ALTERNATIVES that deal honestly and fairly.

Review: I take a specific medication that requires routine lab draws. I was unaware that this lab company was the only one who can run this lab. This lab happens to not be in contract with my insurance company,apparently this company is not in contract with many insurance companies, which I found out from their customer service department. I was told that I could pay a discounted price due to my insurance company not wanting to pay any toward the bill. The original bill was $270.00, the new out of pocket price that I paid was $175, they stated that if the insurance company paid any toward the bill I would be refunded. I did appeal with my insurance company. I found out that my insurance company only paid them $30, I asked the insurance company if that would affect me receiving my up front money that I had paid, the insurance company said no, that it was their understanding that the company refund me the money I had paid. I called Prometheus lab company and they said I would only be refunded the $30 that my insurance company paid. They said that was only the agreement between the insurance company and them, that the insurance company would see it as no charge to me, but that they would still bill me for the remaining amount. I stated that this didn't seem fair, that the insurance company that had decided to pay on a bill that they originally didn't want to pay on, I appealed it, and they decided that a huge insurance company would pay $30 and I would be responsible for the rest? This is completely adsorb.Desired Settlement: If the insurance company thinks that I am not responsible for any other payment then I should not be. The insurance company was willing to pay the bill and they arranged for only $30, that is not my responsibility. I should be refunded the money I paid.

Business

Response:

November 21,2013

Ms. [redacted]

Customer Care Representative

Revdex.com of San Diego

4747 Viewridge Ave. Suite# 200

San Diego, CA 92123

Re: # [redacted] - [redacted]

Dear Ms. [redacted]:

This letter is provided to you in response to the consumer complaint submitted on

11/15/2013 ID # [redacted]. This complaint involves diagnostic services performed

from Prometheus Laboratories Inc. ("Prometheus") pursuant to a requisition from

Ms. [redacted]'s physician.

We received the consumer's specimen and corresponding test requisition on July 8,

2013. Ms. [redacted]'s insurance carrier considered the test a non-covered service

under her insurance plan and therefore the $270.00 charge was denied.

Prometheus' billing department offered the patient a prompt payment discount of

$94.50; the consumer accepted and paid $175.50 to Prometheus on November 6,

2013. The consumer informed us on 1115/2013 that an appeal was under way with

the insurance carrier. Prometheus then advised the consumer that if the insurance

carrier issued payment on the claim a refund in the amount that the insurance paid

will be issued back to the consumer.

At the time the consumer filed a complaint with the Revdex.com,

Prometheus has not yet received any payment from the insurance company nor had

any correspondence regarding the status of the appeal. Subsequent to the filing of

the complaint, Prometheus received a payment of$33.54 on November 18, 2013. A

refund in that amount will be issued to consumer.

Thank you for the opportunity to respond to this complaint. Please call or email if we

can be of any assistance to you, or if you have further questions. I may be reached at ([redacted])

Executive Director, Legal Affairs & Compliance

Prometheus Laboratories Inc.