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.”

It wasn’t cancer, but the nearly $600 invoice she got from an unfamiliar company called Peoria Tazewell Pathology was hardly a relief. The bill cut into the family budget for her daughter’s 21st birthday and led Ritchie to switch doctors to prevent a similar incident. The delay pushed her surgery to January 2019, which means her roughly $3,000 deductible will be reset.

“It isn’t necessarily the doctor’s responsibility to look out for me,'' said Ritchie. “But at the same time, whose is it?” 

Some doctors are more careful. Wayne Siegel, who runs a solo practice in gastroenterology and liver disorders in Secaucus, New Jersey, orders lab testing for about 30 percent of the patients he sees on a daily basis. Each time — before he draws blood or accepts a sample — he checks to make sure the test is covered by insurance and sent to a facility covered by the patient's plan.

“I would never send a specimen to a laboratory where a patient would get a balance bill” for uncovered services, said Siegel. If it's absolutely necessary, he said he discusses it with the patient beforehand.

Martin Makary, a professor of surgery at Johns Hopkins Medicine in Baltimore, said providers should be on the hook for labs that repeatedly gouge patients. But doctors with large practices can’t be expected to police the lab-testing world and ensure that every patient is getting matched with an in-network diagnostic firm, especially when they don't get paid for doing so.

“There’s no formal training for some of this stuff,'' said Makary. “By and large, patients do not have navigators.”

Sometimes the frustration over billing can send patients all the way to Congress. Charles Bulson, 44, was charged more than $1,000 for blood tests not covered by his insurance. The reason? He was erroneously coded as a 16-year-old.

Bulson quickly found himself in a Bermuda Triangle of health care. For more than a year, he was bounced around between the testing firm Laboratory Corp. of America Holdings, insurer Blue Cross Blue Shield and his New-York based doctor’s office. Nobody would change the code, and the full amount of more than $1,000 was sent to a collections agency.

“I said, Can you look at the date of birth? Do you have the date of birth on your file?” said Bulson.

Bulson, who never received a clear diagnosis for the illness that prompted the blood test, wrote to U.S. Senator Charles Schumer in September 2017 and finally found relief. Schumer forwarded his case to New York regulators, and he never heard from the collections agency again.

“I don’t believe it’s truly LabCorp’s fault. I don’t believe it’s truly Blue Cross’s fault. I don’t believe it’s the doctor’s fault. And I’m not trying to put fault on anybody,” said Bulson, who on multiple occasions offered to pay the proper amount due.

“It’s this entire medical system that needs to be picked up, thrown down into a thousand pieces, and put back together again,” he said.