Billing – Frequently Asked Questions
Do you have a question about a bill from Pathology Reference Laboratory or Pathology Associates of San Antonio? Please review the information below to find the answers you’re looking for.
Why have I received a bill from Pathology Reference Laboratory?
Bills from Pathology Reference Laboratory are generally for outpatient laboratory testing (such as biopsies and pap tests) performed at your physician’s office or a surgery center.
These specimens are sent to Pathology Reference Laboratory for processing.
Charges under Pathology Reference Laboratory reflect the “TC” or Technical Component which represents the laboratory (non-physician) processing of the specimen by lab personnel or instruments.
These charges are separate from any physician interpretation of the same specimen(s). Please note these services are separate from your treating physician and/or facility.
Why have I received a bill from Pathology Associates of San Antonio?
Bills from Pathology Associates of San Antonio are generally for the professional interpretation services performed by one of our pathologists. These could be cases referred from your physician’s office, surgery center or for services performed while in a hospital.
Charges under Pathology Associates of San Antonio reflect the “PC” or Professional Component which represents the physician’s review of the slide(s) from the processing of your specimen(s) to render a diagnosis.
Sometimes there may be additional charges, such as special stains, immunohistochemistry stains, FISH probes, etc. These are additional testing that the pathologist requires to make a more definitive diagnosis on your specimen(s). These additional charges cannot be predicted until the pathologist has had a chance to review the initial tissue/fluid submitted under the microscope.
Will Pathology Reference Laboratory/Pathology Associates of San Antonio file my insurance for me?
Absolutely! Most physician offices, surgery centers and hospitals provide a copy of your insurance or billing information with the specimen when it is sent for testing. It is important to be sure you update your clinician or facility with your most current insurance information at the time of service.
If you receive a bill or statement asking for insurance information or any additional information, please call the Billing Department at Pathology Reference Laboratory at 210-249-2800 or 866-603-0555 or you can complete the form under “Forms” tab to update your insurance online. Please have your insurance card with you when you contact us.
Does Pathology Reference Laboratory/Pathology Associates of San Antonio file secondary insurance?
Yes, as long as we have your secondary insurance information. Please contact our billing department if you need to provide this information.
Will my insurance company pay for my laboratory and/or pathology tests?
We accept and are in network with most insurance companies; however, every individual’s plan is different. Prior to any medical services you should contact your insurance company to see what your policy will cover and/or contact the facility to ensure all physicians involved in your care are covered.
I paid my co-pay at the physician’s office. Why am I getting a bill from Pathology Reference Laboratory?
Pathology services are separate from your physician’s services. Co-payments typically cover physician office visits only. Any patient responsibility, typically deductible and/or coinsurance, will be billed to you once your insurance has processed your claim. This will be reflected on your billing statements as well as your Explanation of Benefits (EOB) from your insurance.
Why have I received a bill when I have insurance that covers laboratory testing?
Insurance plans have many benefit levels and only you can be sure that your insurance company processed your claim according to your plan provisions. It is important to verify your coverage for pathology and laboratory services. This information can be found in your Explanation of Benefits (EOB). If you feel your claim was processed incorrectly, please contact your insurance company.
Will my insurance company pay for my Pap test?
Most insurance companies will pay for one (1) screening Pap test every three (3) years or five (5) years. If you have a history of gynecologic problems or have had an abnormal Pap test in the past, they may pay more often. Currently, Medicare will pay for one screening Pap test every three (3) years. Medicare will pay for diagnostics Pap tests more often if the patient is having gynecologic problems, past history of abnormal Pap tests, or previous cancer of the cervix, uterus, or vagina. Most commercial insurance follow this same guidance.
What is an ABN?
Medicare requires that if a physician or laboratory knows that a test will not be covered by Medicare, the patient must be informed in writing prior to performing the test. This is called an “Advance Beneficiary Notice” (ABN). The patient must also be informed as to the reason Medicare may not pay for the test.
Why is the Explanation of Benefits (EOB) I received from my insurance company different from the bill I received?
Please remember that the Explanation of Benefits (EOB) that you receive from your insurance company is not a bill. If Pathology Reference Laboratory and/or Pathology Associates of San Antonio determines that your insurance processed your claim incorrectly, we will appeal that claim to your insurance company. Do not pay anything until you receive a billing statement from us. Feel free to contact our billing department if you have any questions.
Can Pathology Reference Laboratory and/or Pathology Associates of San Antonio tell me how much my tests will cost?
It is sometimes difficult to estimate the total cost of ordered tests. The pathologist may see the need to do additional testing or special stains in order to render a diagnosis. We will give the best estimate for the information known at the time of your request.
Can I receive a discount if I do not have insurance?
Yes, Pathology Reference Laboratory and Pathlogy Associates of San Antonio offer several discount programs available for patients with no insurance or experiencing financial hardship. Please call our Billing Department for details and available options.
What are my payment options?
Payments are accepted by mail, phone, or online. We accept checks and major credit cards.
Billing Department
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Monday – Friday, 8 AM – 5 PM
210-249-2800
866-603-0555
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Understanding Your Explanation of Benefits (EOB)
An Explanation of Benefits (EOB) is the documentation your insurance company sends to explain how your claim was processed. The insurance payment is sent to Pathology Reference Laboratory and a copy of the EOB is sent to you, in order for you to determine how much you may owe. Please remember that the Explanation of Benefits (EOB) that you receive from your insurance company is not a bill. If Pathology Reference Laboratory determines that your insurance processed your claim incorrectly, we will appeal that claim to your insurance company. Do not pay anything until you receive a billing statement from Pathology Reference Laboratory.
Glossary of Terms
Charge Amount
This is the amount charged by Pathology Reference Laboratory for each test performed.
Allowed Amount
This is the amount your insurance company allows for each test before deductibles and coinsurance. Each insurance company determines their allowable rates for each participating provider.
Deductible
This is the amount that must be paid by the patient before insurance will begin reimbursing for covered services. Deductibles generally must be met each year. They are accumulated for all medical services combined.
Coinsurance
This is the portion of allowed charges that is the responsibility of the patient. Most insurance companies require a 10%-30% coinsurance after deductibles.
Amount Paid
This is the amount paid by the insurance company after all adjustments, coinsurance and deductibles have been taken out.
Contract Adjustment or Excess of UCR
This is the portion of the charge that is greater than the amount allowed by the insurance company. If Pathology Reference Laboratory is under contract with the insurance company, this amount is not the patient’s responsibility. If there is no contract between our lab and the insurance company, this amount is owed by the patient. “UCR” stands for usual, customary, and reasonable. Each insurance company sets its own UCR. This does not mean that this test has been overcharged.
Non-Covered
This is a charge that is excluded from your contract and is non-payable by your insurance company. Some reasons could be that the procedure is considered investigational by your particular insurance company, a non-covered diagnosis was provided by the physician office or the test has been performed too frequently for the diagnosis given. In some cases a test may not be covered by your particular plan, especially in the case of ‘Well Woman” coverage. You may be responsible for these charges and this amount will show in the patient responsibility column. The patient responsibility column is the amount you may owe Pathology Reference Laboratory. This amount includes coinsurance, deductible and non-covered service amounts.