Patient Billing Policy

Purpose

The purpose of this policy is to provide clear and consistent guidelines for the billing process at Orion Laboratories. We understand that healthcare costs and insurance complexities can be challenging for patients. This billing policy outlines our procedures for billing, payment, financial assistance, and collections.

Scope

This policy applies to all patients who receive laboratory testing services from Orion Laboratories.

Test Pricing

All laboratory services are billed according to the current fee schedule, which is reviewed and updated periodically to reflect changes in costs, regulations, and market conditions.

Insurance Billing

  1. Patient Registration: Patients must provide accurate and complete demographic and insurance information at the time of registration.

  2. Insurance Verification: We verify the patient's insurance coverage and confirm patient demographics after laboratory testing services are complete.

  3. Billing and Claims Submission: We submit claims to the patient's insurer for payment. Patients are responsible for ensuring their insurer has accurate and up-to-date information.

  4. Patient Statements: We send patient statements for any balance due after insurance payment or other discounts have been applied.

  5. Payment Terms: Payment is due upon receipt of the patient statement. Patients may pay by check or online through our website by credit/debit card or electronic check (ACH).

Denials and Appeals

  1. Appeal Process: If a patient's health plan improperly denies coverage for laboratory testing services, we will appeal the decision on their behalf.

  2. Adjusted Pricing: For unsuccessful appeals, claims will be reprocessed and billed to the patient.

  3. External Appeal: If our internal appeal is denied, the patient may request an external appeal with their insurer or a third-party review organization to request reimbursement.

Financial Assistance

We understand that some patients may experience financial difficulties and offer the following financial assistance options:

  1. Financial Hardship Policy: Patients who qualify for Medicaid or limited-benefit state programs are presumed indigent, and their account balances will be adjusted accordingly. Other patients with household income under the federal poverty level may apply for financial assistance by contacting our billing department within 30 days of the initial invoice. Qualifying patients receive a write-off equal to 50% of all billed charges.

  2. Payment Plans: We offer payment plans for patients with a balance over $50.00. Payment plans can extend up to 12 months with no interest when started within 30 days of the initial invoice.

Outstanding Balances

We will make reasonable efforts to collect outstanding balances from patients. Patients will receive up to three (3) billing statements followed by a pre-collection notice for outstanding balances. If a patient fails to pay their balance after multiple statements, the outstanding balance will be sent to a third-party agency for further action.

Patient Rights and Responsibilities

Patient Rights:

  1. Right to Receive a Detailed Bill: Patients have the right to receive a detailed bill for laboratory testing services.

  2. Right to Receive Test Results: Patients have the right to their test results and all other information available to appeal directly to their health plan.

  3. Right to Request Financial Assistance: Patients have the right to apply for financial assistance, including a payment plan program.

Patient Responsibilities:

  1. Provide Accurate Information: Patients are responsible for providing accurate and complete demographic and insurance information.

  2. Pay Outstanding Balances: Patients are responsible for paying outstanding balances in a timely manner.

  3. Notify Us of Changes: Patients are responsible for notifying us of any changes to their insurance coverage or demographic information.

Good Faith Estimate

Under the law, patients who don’t have insurance or who are not using insurance may have the right to an estimate of the bill for medical items and services upon request or if they schedule an appointment at least three (3) days in advance.

  • Patients have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. The estimate will include only the costs we will bill for the lab services we are requested to perform. As a laboratory, we cannot reasonably predict what other medical services a patient may need and, therefore, cannot provide any estimated costs that may be charged by other unrelated healthcare providers or facilities, including any estimated charges by the healthcare provider who orders a patient's laboratory test.

  • Upon request, we will provide a Good Faith Estimate before an appointment in the above circumstances.

  • If the patient receives a bill of at least $400 more than the Good Faith Estimate, they can dispute it.

  • To request a Good Faith Estimate, call 225-923-6070.

No Surprises Act

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. For questions or more information about the right to a Good Faith Estimate or the No Surprises Act, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Contact Information

For billing inquiries or assistance, please contact our billing department at 225-923-6070 or billing@orion.healthcare.