Health Insurance Coverage & Payment FAQ’s
In general, most all of the testing provided by Orange County Labs is considered to be routine clinical diagnostic laboratory testing and as such, medical insurance providers have traditionally covered these services. Many factors may affect the coverage decision to reimburse for the testing services provided by Orange County Labs, such as the patient’s diagnosis or a specific coverage determination by an insurance provider, and in these instances the testing may not be reimbursed by the insurance provider. We believe that every eligible patient should have access to Orange County Labs testing, regardless of coverage determination by your insurance provider or your financial situation. Orange County Labs will assist patients with the following:
- Help determine whether your insurance plan covers the test
- For eligible, insured patients, bill insurance plans directly
- Process the claim once the test is complete, as required
- Direct the patient to the Orange County Labs Financial Assistance Program for qualified applicants (including uninsured and under-insured patients).
Yes, Orange County Labs is a provider for Medicare and will adhere to all Medicare policies for laboratory testing for eligible Medicare beneficiaries.
If your insurance provider pays you directly, please sign the back of the check and
write “Payable to Orange County Labs” and forward the check to the address listed
below and include a copy of the Explanation of Benefits (EOB) that you received
along with the payment.
Orange County Labs offers a Financial Assistance Program for qualified applicants
(including uninsured and underinsured patients) that is designed to help those
patients obtain Orange County Labs testing regardless of their financial situation.
When visiting your physician’s office, laboratory services are commonly ordered to help diagnose your illness. Pathology specimens Pap smears and biopsies are always send out to a laboratory for interpretation.
Yes, however, we will bill our patients for their co-payments and deductible balances as indicated or required by the insurance company.
The balance after your insurance has been paid represents your deductible, co-payment or any out-of-pocket amount that you owe. Most insurance companies provide you with an explanation of benefits (EOB) to help answer your questions.
Policies vary, while some may cover routine services, others will not, depending on your plan benefits. Also, payment and patient responsibility will vary depending on the diagnosis code used by the ordering physician. Orange County Lab, Inc. will bill your insurance company with the diagnosis code provided by your physician. The majority of insurance companies will require a diagnosis code to properly adjudicate, and process claims for medical necessity.
Patients/Clients without insurance coverage will be expected to pay at time of service. Orange County Labs, Inc, will honor a 40% discount if paid at time of service. Otherwise, you will be billed for 100% of the laboratory service charges.
Yes, we do. By accepting assignment, Orange County Labs, Inc. agrees to not bill the patient for any charges Medicare disallows. However, we do bill patients for deductibles, co-pay amounts and non-covered services.
Orange County Labs, Inc. bills only for the services that we have rendered, these will be separate from the bill you may get from your physicians visit. Approximately 95% of the testing we do is performed in-house. However, if your physician ordered a test that is not in our test menu, then we will, as a courtesy, forward it to one of our reference specialty labs.
Coverage varies. Please contact your insurance company or plan administrator (the phone number on your insurance card) to verify coverage. Some plans have limited coverage based your specific diagnosis codes, based on your medical necessity established by your physician.
- Know your insurance plan’s provisions and requirements. Do you have an HMO, PPO or indemnity policy? Be sure to read your benefits handbook and question your insurance company on any areas that are unclear.
- Price quotes for services are estimates only. Your bill will indicate services as ordered by your physician. Your final bill will reference your total charges, amounts paid and balance due.
- Diagnostic information is sent to your insurance company and is part of your clinical records. Any questions regarding diagnosis coding needs to be addressed with your physician, who will contact our billing department to make any changes.