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Billing Policies for Practitioners

 

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Billing Policies for Practitioners

 

 

Billing Policies for Patients

About Insurance Filing

A couple of patients reviewing their statement. Diagnostic Solutions Laboratory is not contracted with any commercial insurance company and is considered out-of-network. To determine whether a claim may be covered please contact your insurance provider. If you are concerned that a claim may not be covered, you can choose to prepay for your testing, and we will provide you with a statement that you may then submit to your insurance provider for coverage determination. If approved, payment will be made directly to you.

Diagnostic Solutions Laboratory can bill your primary and if needed, your secondary insurance company for testing on your behalf. Based on the test ordered, a deposit is required at the time of test submission (with the exception of Medicare). Claims are submitted to the insurance carrier upon release of the test results. In order to have Diagnostic Solutions Laboratory bill your insurance company, a deposit for services is required. Your physician will inform you of the deposit amount required based on the test ordered.

Claims will be submitted at regular list price. You will be responsible for any deductible, co-pay, co-insurance, non-covered or disallowed services. If your insurance company does not pay out the total billed by Diagnostic Solutions Laboratory, you will be responsible for the remaining amount.

Insurance Claim Requirements

In order for Diagnostic Solutions Laboratory to submit claims on your behalf, please be sure to fill out the Test Request Form (provided in your collection kit box) completely and include all insurance information. If possible, send in a copy of your insurance cards (front and back). Also, be sure that your physician has completed the ICD coding section. Missing information may resolve in denial of claim/payment.

Deposit payments can be made by check, money order or major credit card. If you chose to pay the deposit amount by credit card, be sure the card holder signs the authorization to bill, in the credit card section of the Test Request Form. Missing information may delay testing.

Please be aware that we are out-of-network with all commercial insurance carriers, but as a courtesy, we will verify and file your claim with your insurance carrier; however, we cannot guarantee payment. You are responsible for payment of any deductible, co-payment/ co-insurance, and any non-covered services.

Many insurance companies have additional stipulations which may affect your coverage. Further, insurance companies have different requirements for coverage and may require additional documentation from the ordering provider to justify medical necessity. If your insurance company denies any part of your claim or if you or your provider fail to include information needed to file, payment will be expected from you.

Verification is only an explanation of benefits based upon information that we receive from your insurance carrier. It is not a guarantee for payment. Please contact your insurance carrier directly to confirm your individual benefits for out-of-network testing services.


If You Have Traditional Medicare

Diagnostic Solutions Laboratory is a participating provider for Medicare. In order to submit claims to Medicare be sure to check the Medicare billing option on the Test Request Form and provide your Medicare information in the Primary Insurance section. If you have a Medicare supplement policy, include the insurance information in the Secondary Insurance section of the Test Request Form.

Please note that Medicare will only accept claims ordered by Medicare participating providers, which are PECOS certified. In most cases Medicare will only process claims ordered by the following clinicians, MD, DO, PA and NP.

Medicare Advantage/Replacement plans are treated as commercial insurances. We are not contracted with Medicare Advantage/Replacement Plans.

  • Please call our Customer Service Line at 877-485-5336 to find out if we are able to file a claim to your patients insurance plan. If we can, please be sure to ask your patient to fill out the Test Request Form completely and include all insurance information (include copy of insurance cards front and back). Also, be sure that you have completed the ICD10 coding section.
  • Missing information may result in denial of claim/payment. Please be aware that Medicare Advantage Patients without out of Network benefits will be responsible for the discounted cash rate.

 


Additional Insurance Information

Our patients are the center of everything we do. Your trust is very important to us and sharing information is one way to help ensure we continue to earn this trust.

Medicare Advantage plans are commercial insurance plans and are not the same as traditional Medicare.

Medicare Advantage plans are managed by commercial insurance companies on behalf of Medicare and offer a specific network of contracted labs, which may not include Diagnostic Solutions Laboratory. We are considered out of network with all commercial insurances.

We do accept original Medicare and supplement plans, sometimes referred to as Traditional Medicare.

Diagnostic Solutions Laboratory is out-of-network and is not contracted with any insurance plan. Therefore, we are unable to file with insurance plans which do not sufficiently cover out-of-network services. Your benefit coverage is determined solely by your insurance company and is based on the provisions of your specific medical benefit plan.

The following information is updated periodically and is subject to change. This list is not meant to be all-inclusive. Please check with your health plan to verify coverage.

Plans Diagnostic Solutions Laboratory Will File With

  • Most PPO insurance plans
  • Traditional Medicare
  • Tricare

You may also contact our customer service directly for more details about insurance coverage at 877-485-5336, or via email at cs@diagnosticsolutionslab.com.

Diagnostic Solutions Laboratory Is Unable to File With Commercial Plans Listed Below

  • Anthem
  • Blue Cross & Blue Shield of MN (Provider must be registered with them)
  • Blue Cross and Blue Shield of Hawaii HMSA
  • Blue Cross and Blue Shield of SC
  • Blue Cross Blue Shield of AZ
  • Blue Cross Blue Shield of D.C.
  • Blue Cross Blue Shield of Kansas City
  • Blue Cross Blue Shield of LA
  • Blue Cross Blue Shield of Maryland Carefirst
  • Blue Cross Blue Shield of MA
  • Blue Cross Blue Shield of MI
  • Blue Cross Blue Shield of MT
  • Blue Cross Blue Shield of NC
  • Blue Cross Blue Shield of NE
  • Blue Cross Blue Shield of NJ
  • Blue Cross Blue Shield of OK
  • Blue Cross Blue Shield of OR Regence
  • Blue Cross Blue Shield of PA (Highmark, Independence & Capitol Blue)
  • Blue Cross Blue Shield of RI
  • Blue Cross Blue Shield of TX
  • Blue Cross Blue Shield of UT
  • Blue Cross Blue Shield of VT
  • Blue Cross Blue Shield of Wellmark IA
  • Blue Cross Blue Shield of WI
  • Blue Shield of WA Regence
  • Calpers
  • Carefirst Administrators
  • Christian Healthcare Ministries
  • Community Insurance Company – Blue Cross Blue Shield of OH
  • Delta Health Systems
  • Federal Blue of GA
  • Harvard Pilgrim
  • Health Net CA
  • Home Town Health
  • Kaiser of California
  • Liberty Health Share
  • Medi Share
  • Medicaid
  • Medicare Advantage/Replacement Plans
  • Medicare Secondary
  • Presbyterian Health Plan
  • Rocky Mountain Hospital
  • Select Health
  • Summa Health Network
  • Total Health Care
  • Total Health Plan Inc.
  • Tufts Health Plan
  • United Health Care
  • US Family Health Plan (USFHP)

Upon payment, Diagnostic Solutions Laboratory will provide an itemized receipt by request if we cannot file with your insurance. This receipt can be turned into your insurance for reimbursement. (Not applicable for Medicare Advantage/Replacement Plans)


Uninsured (Self-Pay) Or Underinsured Patients

You may be considered underinsured if you have a:

  • High deductible
  • High out-of-pocket maximum requirement
  • Limited benefit plan(s)

Diagnostic Solutions Laboratory will provide an itemized receipt by request if we cannot file with your insurance. This receipt can be turned into your insurance for reimbursement. (Not applicable for Medicare Advantage/Replacement Plans)

Diagnostic Solutions Laboratory is noncontracted with any insurance plans: Many insurance companies do not agree to Diagnostic Solutions Laboratory rates — patients will have a greater out-of-pocket expense as the coverage amount allowed by your insurance plan can differ from our rates. You will be responsible for the difference.


Uninsured (Self-Pay) Discount

Please contact our Customer Service to find out about Diagnostic Solutions Laboratory Uninsured Discount Policy. Call 877-485-5336 or email cs@diagnosticsolutionslab.com. Diagnostic Solutions Laboratory offers discounted prices to all qualified uninsured patients for medically necessary care.


Insurance Denials

Insurance claims may be denied for many reasons. If your Diagnostic Solutions Laboratory claim has been denied, a good first step is to consult the list below for suggestions on the next steps toward resolving your claim.

  • The benefits maximum for this period has been reached – Some insurance companies limit the dollar amount they will pay per year for certain services, or they limit the number of services eligible for coverage per year. If your statement shows that you have a balance due because you exceeded your benefit limit, it is because this is the information we received from your insurance company. They are stating that they have paid up to the maximum limit they provide coverage for and that the patient is responsible for the remaining balance. Unfortunately, because we are not aware of other claims your insurance is processing for you, we can never be aware of exactly how much of your benefit limit has been reached until our claim processes. If you are disputing this, we recommend calling your insurance company so they can tell you the details of why your benefit limit has been reached/exceeded.
     
  • Charges exceed your contracted fee schedule – Charges exceed the fee schedule/maximum allowable or contracted/legislated fee arrangement. Denial code is denoted on the EOB/ERA from an insurance company when the insurance plan contractually allowed amount is lesser than laboratory billed charges.
     
  • Claim or service lacks information for payment processing – Your insurer wants to see medical records or EOB. (We do not have access to your medical records. This may require you to reach out to your provider to request the relevant information).
     
  • Insufficient or incomplete requested information – Your insurer wants to see medical records or EOB. (We do not have access to your medical records. This may require you to reach out to your provider to request the relevant information).
     
  • Non-covered services or diagnosis codes (ICD10) – Your insurance plan does not cover the particular test, or your provider did not use a diagnosis code that deems the test medically necessary.
     
  • Not medically necessary – Your insurance plan does not deem the particular test as medically necessary, or your provider did not use a diagnosis code that deems the test medically necessary.
     
  • Service deemed experimental/investigational or not proven to be effective

 

Your benefit coverage for laboratory testing provided by Diagnostic Solutions Laboratory is determined solely by your insurance company and is based on the provisions of your specific medical benefit plan.

 

Please contact the customer service department on the back of your member identification card to confirm if you have out-of-network access to Diagnostic Solutions Laboratory testing, as well as your benefit level.

In most cases, Diagnostic Solutions Laboratory will appeal after a denial, which may or may not be successful. You may also wish to check with your insurance provider and review some general hints on insurance appeals.

 

Payment Options

Insurance Billing

Diagnostic Solutions Laboratory will file claims to commercial insurance plans with out-of-network coverage (including Medicare Advantage Plans).

Follow these steps to qualify for the lowest out-of-pocket cost and learn about our insurance process:

  • Submit the required initial deposit with your specimen.
  • Once test results are complete, Diagnostic Solutions Laboratory will file the claim with the insurance company.
  • Once the insurance company has processed the claim, they will mail the patient an Explanation of Benefits indicating how much of the claim they have paid. If the insurance company does not pay a claim in full, Diagnostic Solutions Laboratory will send patients a billing statement with the amount due stated under patient responsibility.
  • Payment is due by the date indicated on the statement, as applicable discounts are time sensitive and will expire.

In some instances, commercial insurance plans may send the payment of the claim directly to the patient. If so, it is the patient's responsibility to forward the payment directly to Diagnostic Solutions Laboratory.


Cash Pay (No Insurance Billing)

This option is for patients who do not have insurance or choose not to have Diagnostic Solutions Laboratory submit a claim to their insurance company. Payment is due with the submission of the test.


Clinician Billing

This option is for when you pay your provider directly for testing.


Medicare (Not Applicable to Medicare Advantage Plans)

As stated above, please make sure your practitioner is PECOS certified and is a qualifying degree type (MD, DO, PA and NP).

Diagnostic Solutions will file claims to Medicare (and Tricare) plans.


How to Pay Your Bill

Diagnostic Solutions Laboratory offers discounted cash pricing for testing services. Please contact your ordering physician for pricing. Payment for testing must be included at the time the sample is submitted.

We accept check, money order and major credit cards. Please be sure to check the payment option of your choice on the Test Request Form.

If you choose to pay for your test by credit card, be sure the card holder signs the authorization to bill in the credit card section of the Test Request Form. An itemized receipt will be mailed to the card holder by request. This receipt can be filed with your insurance company for benefits determination.

If you are a patient wishing to make a payment, you may either call us and provide your credit card information over the phone or mail your check directly to us.

  • Pay by Phone:
    877.485.5336
     
  • Mail in Payments:
    Diagnostic Solutions Laboratory
    31 Lupi Ct., Ste 250
    Palm Coast, FL 32137

Questions About Your Bill?

Please call us at 877.485.5336 if you have questions about your bill. Medical billing can be complex, especially when insurance is involved. We are here to help!

Canceling or Changing Ordered Testing

Canceling or changing any ordered testing must be done by the ordering provider — before results are reported. Once results have been reported, charges for the ordered test will occur.