PhenoPath will make every effort to bill the patient’s insurance unless circumstances exist that prevent the direct billing to the insurance company.
One such circumstance (among others) is where the patient chooses to pay for the test; in which case the patient can instruct PhenoPath not to share treatment information with his or health plan.
PhenoPath offers flexible payment plans.
If a patient has been granted financial assistance by another medical entity, then to the extent that medical entity’s policy is consistent with PhenoPath’s financial assistance policy, PhenoPath will grant financial assistance.
If the patient is uninsured or has insurance but cannot afford the out-of-pocket expense, they should contact our Billing Department to make arrangements for financial assistance or to set up an interest-free payment plan for any out-of-pocket costs.
PhenoPath bills patients for co-pays, coinsurance or deductibles consistent with the patient’s insurance coverage.
The patient will likely receive an Explanation of Benefits (EOB), however it is important to note this is not a bill.
PhenoPath is a Medicare provider and will submit claims to any and all insurance plans consistent with coordination of benefits requirements, except where the patient chooses to pay for the test personally.
PhenoPath accepts checks, money orders and most major credit cards.
PhenoPath Billing Process
PhenoPath is committed to making the billing process as simple and easy to follow as possible.
The revenue cycle process for PhenoPath service is as follows:
PhenoPath receives a request for services from the ordering physician that includes complete insurance information as well as the appropriate requisition form.
PhenoPath performs the test(s) and delivers the report(s) to the requesting entity. Results are available dependent upon the type of test and provided to the ordering entity within 24 hours (Flow) to 3 to 4 days (FISH).
In addition, upon written request by a patient (or the patient’s representative), PhenoPath will provide the report directly to the patient or his/her personal representative within the timeframe required by law.
PhenoPath will bill the patient’s insurance for the test as the provider of service.
The average turn-around time is 60 to 90 business days for the insurance to respond to PhenoPath claim(s) submission(s).
The patient will also receive a response from insurance in the form of an Explanation of Benefits (EOB). This is NOT a bill. The document will explain the coverage initially provided by the insurance for the service provided.
If the insurance company denies coverage, PhenoPath works on behalf of the patient to attempt to obtain coverage and payment.
We will also assist the patient in submitting an appeal in an effort to minimize the patient’s financial burden when appropriate.
We may contact the medical practice or client for assistance in the appeal process.
We may also reach out to the patient to assist, as some insurance companies do not allow providers to submit appeals on behalf of the patient.
Upon receipt of payment from the insurance company, PhenoPath will determine what, if any, patient financial responsibility remains.
Depending on the terms of the patient’s health care plan (or in the case of an uninsured patient), there may be financial responsibility for charges or for co-payments, coinsurance or deductible for the test.
There may also be financial responsibility for non-covered services.
We offer flexible payment plans when appropriate as well as providing financial assistance arrangements to patients who qualify for financial assistance at another medical entity; to the extent that PhenoPath’s financial assistance policy is consistent with the other medical entity’s policy.
When the expense of acquiring payment exceeds the possible allowable reimbursement, PhenoPath will consider applying balance adjustments in compliance with Washington state and Federal laws and regulations.