Billing – Frequently Asked Questions
Do you have a question about a bill from Pathology Reference Laboratory? 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.
Pathology services are separate from your physician services and you may also receive a separate bill from your physician for those services that were performed at his or her office for the collection and preprocessing of a specimen.
Monday – Friday, 7 AM – 5 PM
210-892-3700 (Option 2)
866-231-8058 (Option 2)
Se habla español
Will Pathology Reference Laboratory file my insurance for me?
Absolutely! Most physician offices and surgery centers provide a copy of your insurance or billing information with the specimen when it is sent for testing. Rarely, the information is missing, inaccurate, or incomplete.
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 210-892-3700 or 866-231-8058 (Option 2 for Billing). Please have your insurance card with you when you contact us.
Does Pathology Reference Laboratory 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 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 call your insurance company to see what your policy will cover and who is a provider for your particular policy.
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 per year. If you have a history of gynecologic problems or have had an abnormal Pap test in the past, they may pay for more than one a year. Currently, Medicare will pay for one screening Pap test every two (2) 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.
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 Pathology Reference Laboratory 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 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. Feel free to contact our billing department if you have any questions.
Can Pathology Reference Laboratory 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.
Will Pathology Reference Laboratory offer a discount if I do not have insurance?
Pathology Reference Laboratory has several payment options for uninsured patients. Please call our Billing Department for details and available options: Monday-Friday 7 AM-5 PM, 210-892-3700 Option 2 or 866-231-8058 Option 2.
What are my payment options?
Payments are accepted by mail, phone, or online. We accept checks and major credit cards. The Billing Department is available Monday-Friday 7 AM-5 PM, 210-892-3700 Option 2 or 866-231-8058 Option 2.
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
This is the amount charged by Pathology Reference Laboratory for each test performed.
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.
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.
This is the portion of allowed charges that is the responsibility of the patient. Most insurance companies require a 10%-30% coinsurance after deductibles.
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.
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.