Disconnect between Lab and Insurance. Can’t get them to submit claim properly.

Insurance is Highmark administered through HealthNow. This is an employer plan.

Back in December my wife had her yearly wellness exam. Went to Quest who billed it to insurance but used wrong diagnostic code (I will refer to this as claim #A)

We contacted our doctor, and they gave Quest an updated code that would get the test covered under preventative. Quest submitted an entirely new claim (claim #B) instead of updating Claim #A

Insurance rejected claim #B saying it was a duplicate. After waisting 2 months trying to get insurance to accept claim #B, i contacted my company's HR department where I found out that Quest needed to send a revision to Claim #A and not a new claim.

The insurance reached out to Quest and told them this. Quest though keeps saying they can't submit an update because they need updated codes from the doctor. They have the updated code which they used in claim #B. I can't get anyone from Quest or the insurance to comprehend this.

I did contact the dr who said they did contact Quest. They gave them the same code used in Claim #B. Quest then told them that it was the same code they already submitted that insurance denied. They said there's nothing more they can do.

Is there some agency I can file a complaint to? It's complete incompetence between Quest and insurance. I requested a 3 way call between everyone, but insurance won't agree. They said they want to give Quest 1 more week (We are on month #4 trying to get this resolved) to get the updated code from the doctor. The doctor though already gave them the code 3 months ago which they used in claim #B.

submitted by /u/sheik482
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