Billing Questions

Where should I call if I have a billing question?

If you have questions about your outpatient laboratory bill call (585) 922-1900. Billing and compliance is open from 8:30 am - 4:30 pm Monday through Friday.

What information should I have ready when I call?

Please have your insurance card ready or explanation of benefits from your insurance so the representative answering the phone may help you.

Why do I get a separate bill for each visit?

Insurance companies pay according to dates of service, by having separate accounts the payments can be applied to the appropriate date of service.

Will Medicare pay for the tests?

Not all lab tests are paid for by Medicare. Some tests may be billed to the patient. These include:

• Tests that are not considered necessary by Medicare for the patient's diagnosis or treatment

• Tests that are ordered as "screening" tests for routine physical exams where there is no evidence of disease.

• Tests which are ordered more often than Medicare recommends

• Tests which are not approved by the Food and Drug Administration (FDA) because they are considered experimental or investigational

Under what circumstances can a physician order these tests?

• Medicare will pay for certain tests only if they are supported with the appropriate diagnosis provided by the physician

• The physician must provide a diagnosis code on the test requisition form

• Medicare has a list of predetermined covered conditions (i.e., diagnosis codes)

If Medicare will not pay for the test, is the test necessary?

The physician knows the clinical background of the patient and is best suited to make that determination. Tests are often ordered to screen for a variety of factors which may be used to assess the patient's health. Examples of these factors include personal, family, medications, or age-related concerns.

What is required if the test is not on Medicare's list of predetermined coverage conditions?

The patient will be asked to sign an Advance Beneficiary Notice if the diagnosis for the test ordered is not on Medicare's list of predetermined covered conditions. A signature is required in order for the laboratory to perform the test. A signature acknowledges that the patient may be billed for the test and that he or she agrees to pay should Medicare deny payment.

What is the pathology center's billing process?

• The laboratory test will always be billed to Medicare prior to being billed to the patient

• The patient will be billed for the laboratory test only if Medicare denies payment

• The patient should contact Medicare if he or she believes the test should be covered

• If the patient is billed, the price will be the same as was billed to Medicare

• If the patient has supplementary insurance, the denied test may be covered under that policy. The patient should contact his or her supplementary insurance representative for assistance

Has a payment been made by my insurance plan?

When a payment has been made, your insurance provider will send you a remittance advice. It will indicate the services performed, the dates of service, and amount paid by your insurance plan. The remittance advice will also indicate any amount that is not covered by the insurance plan and any amounts that are owed to the service provider. You may also check on the status of your claim, by calling a Patient Service Representative at: (585) 922-1900.

I'm covered by an insurance plan. Why did I get a bill?

You may be responsible for a deductible, co-payment or balance because your plan does not cover 100% of the charges. Please check the remittance advice from your insurance provider for an explanation of the additional amount that is owed.

What is the balance owed on my account?

For your account balance, please call a Patient Service Representatives at: (585) 922-1900 and have your account number ready. We will also be able to advise you of the status of any insurance claim filings that we may have made on your behalf.

Can I make payment arrangements?

We would like to work with you if you are experiencing difficulty in paying your bill in full. You may use your Visa, MasterCard, or American Express to charge your bill and extend payments, or you may call one of our Patient Service Representatives to make monthly payment arrangements with us at: (585) 922-1900.

I don't understand my bill. Can anyone help me?

One of our Patient Service Representatives would be pleased to explain the detailed charges on your bill. We will also be able to advise you of any insurance claim filing options that may be available to you. Please call us at: (585) 922-1900.

My insurance provider made a payment. Why did I receive a bill?

Depending on the coverage for your plan, you may be responsible for deductibles, co-payments, or balances because the insurance plan does not provide for 100% of charges. You may want to check the remittance advice from your insurance for an explanation of the additional amount that was owed after your insurance made a payment.
Both my insurance provider and I have paid for the same services.

How do I get a refund?

If you are aware of a duplicate payment and have not already received a refund, please call one of our Patient Service Representatives
 

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