BILLING INQUIRIES – FAQ’S
As the billing for healthcare services can be complex, here are answers to common questions to help you understand the billing procedures.
Q: WHY DID I RECEIVE AN AMERIPATH BILL?
A: Your physician has chosen AmeriPath Anatomic Pathology or Dermpath Diagnostics, divisions of AmeriPath, to diagnose and interpret the specimen removed at the time of your recent office visit.
Widely recognized as the premier anatomic pathology/ dermatopathology laboratory network in the U.S., our outstanding record of achievement and success is the basis on which we guarantee that you will receive the most timely and accurate diagnosis possible.
As with any medical service, questions or issues concerning coverage or medical billing may arise. If they do, please call the AmeriPath Customer Service Department at (toll free) 800.890.6220. They will resolve all relevant questions or issues in an efficient and timely manner.
Q: WHO IS AMERIPATH, AND WHAT IS ITS FUNCTION?
A: AmeriPath is a nationwide network of anatomic pathology laboratories. It is the nation’s leading provider of cancer diagnostics, genomic and related information. AmeriPath employs more than 400 board-certified anatomic pathologists with multiple subspecialties. Furthermore, its specialists are linked through numerous modes of communication and are able to pool their expertise and respond quickly when consulting on unique or difficult cases.
Q: DO AMERIPATH’S PATHOLOGISTS TREAT PATIENTS DIRECTLY?
A: AmeriPath’s pathologists do not treat patients directly. Rather, they assist your physician by establishing a definitive diagnosis and providing consultations regarding effective treatment plans.
Q: HOW IS AMERIPATH RELATED TO THOSE DIVISIONS KNOWN AS ANATOMIC PATHOLOGY AND DERMPATH DIAGNOSTICS?
A: They are important subdivisions of AmeriPath. Dermpath Diagnostics, for instance, is AmeriPath’s foremost entity in the diagnosis, treatment and management of skin disease. AmeriPath centrally manages all matters of insurance, medical billing and customer service for these divisions.
Q: WHAT IS THE FUNCTION OF THESE ANATOMIC PATHOLOGY LABORATORIES?
A: Their board-certified pathologists diagnose the existence of disease and provide invaluable assistance to your physician concerning the diagnosis, treatment and management of disease.
Q: WHAT ARE ANATOMIC PATHOLOGY TESTS?
A: They are tests that involve the application of established scientific laboratory procedures for the evaluation of organs and tissues. The interpretation of test results usually requires the services of a board-certified pathologist, such as a dermatopathologist who specializes in the diagnosis, treatment and management of skin disease.
Q: HOW ARE MY TISSUES EVALUATED BY MY DOCTOR?
A: Having sent your tissue sample (biopsy) or cell sample (body fluid or PAP smear) to his or her supporting AmeriPath anatomic pathology laboratory for evaluation and interpretation, your physician is now in possession of the definitive information needed for the proper diagnosis and treatment of disease
Q: WHO IS RESPONSIBLE FOR PAYING FOR ANATOMICAL TESTING?
A: Ultimately, the patient is responsible for the payment of fees related to pathology testing. These fees are independent of those charged by your physician for visitations to his or her office.
Q: WHO BILLS MY COMMERICIAL INSURANCE COMPANY FOR PATHOLOGY SERVICES RENDERED?
A: When provided with all of the information required, AmeriPath will submit billing claims to your commercial insurance carrier on your behalf. Patients are responsible for the payment of unpaid balances.
Q: WHAT ABOUT CLAIMS TO MEDICARE?
A: AmeriPath diagnostic services are covered under Medicare Part B, and AmeriPath will submit your Medicare claim on your behalf. AmeriPath accepts assignment on all pathology testing, meaning that it will accept the dollar amount (as the amount you will be charged) that Medicare allows for these services. Since Medicare pays only 80% of the allowed amount for this type of testing, you will be billed for the remaining 20%, along with any deductible. Should you have a secondary insurance carrier, AmeriPath will submit your claim on your behalf for the remaining 20% to that carrier. Again, patients are responsible for the payment of unpaid balances.
Q: WHAT ABOUT OTHER INSURANCE PLANS?
A: Should your insurance company contract directly with AmeriPath for anatomic pathology services, AmeriPath will file a billing claim to your insurance company on your behalf for any pathology testing requested by your physician. All remaining balances will then be submitted to you for final payment. If not contracted with AmeriPath, however, your insurance company may pay only a portion (or none) of your claim. Prior to the actual conduct of anatomic pathology services, you are urged to check with your insurance carrier for verification of coverage in that you are ultimately responsible for any unpaid balance.
Q: WHY DIDN’T MY INSURANCECOMPANY COVER THE ENTIRE AMOUNT?
A: Some insurance plans do not cover all of the pathology services rendered. When this occurs, AmeriPath bills the patient for the remaining co-payment, deductible or balance due. If you believe that your insurance company erred in processing your claim, please call the AmeriPath Customer Service Department (toll free) at 800.890.6220. They will work with you to assess coverage issues and assist you in interpreting your insurance carrier’s payment determination.
Q: WHICH TESTS ARE CONSIDERED ANATOMICAL?
A: The following are examples of anatomical laboratory tests that could appear on your statement:
- Surgical Pathology
- Cytopath Smear Review
- Fine-Needle Interpretation
- Special Stains
- Histopathology Examination
Q: HOW WILL AMERIPATH INFORM ME OF THE STATUS OF MY ACCOUNT?
A: Should our laboratory perform anatomical tests, AmeriPath will send you a billing statement after Medicare responds to your claim. A typical statement will include the following:
- List of charges
- Test description/CPT code
- Date of service
- Name of referring physician
- Name of pathologist
- Insurance information
- Medicare payment or response
- Remaining balance
Q: WHY COULD I RECEIVE TWO BILLS AFTER A SINGLE VISIT TO MY DOCTOR?
A: You may receive one bill from your doctor for services performed at his or her office, e.g., the collection and preprocessing of a specimen. You may receive a second bill from AmeriPath for the completion of laboratory, interpretative and diagnostic tasks (requested by your doctor) pursuant to your specimen. Please remember that both your doctor and his or her supporting pathology specialists have separate fee structures and billing procedures. Should questions persist, please contact the AmeriPath Customer Service Department (toll free) at 800.890.6220.