Billing Policy
Predictive Bioscience has established a billing policy based on federal and state regulations. Specifically, Predictive Biosciences follows billing standards that have been identified as “acceptable” by the Office of the Inspector General (OIG), as well as other contracted third party payers.
General Billing Information
Predictive Biosciences will bill all payers and insurance companies directly if complete and accurate insurance information is provided on the test requisition. We must also have a copy of the front and back of the patients’ insurance ID card(s). If a patient has primary and secondary insurance coverage, be sure to provide information and copies of ID cards for both the primary and secondary insurance.
Patient Billing Responsibilities
At Predictive Biosciences, patient specimens receive the highest level of attention by our highly trained, certified and licensed staff. As a service to patients we will bill the patient’s insurance company whether or not we participate with their insurance plan.
If the insurance company has informed us that the patient has a financial responsibility, we will issue a billing statement to the patient for the identified amount. Our billing department is available for consultations with patients.
Medicare Patients
We accept 100% of the Medicare allowable amount for our services. If there is a deductible, co-insurance or co-payment, the patient is responsible for those amounts. The patient responsibilities are clearly identified on the Explanation of Medicare Benefits (EOMB) which is sent to the patient and Predictive Biosciences. For Medicare patients who have a supplemental insurance to Medicare, we will also bill this supplemental (secondary) as long as the insurance information for the supplemental or secondary insurer has been provided to us.
If a patient has a Third Party Insurance Carrier contracted with Predictive Biosciences:
We will accept 100% of the contracted amount for our services. We will bill according to the Explanation of Benefits (EOB) provided by the patient’s insurance carrier. If the health plan instructs us to bill the patient for co-pays, co-insurance, deductible, and non-covered services then we are required by law to adhere to these instructions.
If a patient has a Third Party Insurance Carrier not contracted with Predictive Biosciences:
We will bill the patient’s carrier. Depending on the insurance carrier a patient may have a higher out of pocket expense if they receive medical services from a non-participating provider. At the patients request we will work directly with the patient to appeal the claim, as these claims may be reconsidered for a higher benefit on a case by case basis. If the third party insurance carrier pays the patient directly we will bill the patient to collect what the insurance company reimbursed directly to the patient.
Self-Pay Patients
If a patient does not have any insurance coverage, we will reduce the charge so it is in line with allowable amounts paid by other insurance companies.
In cases where a patient has extenuating financial circumstances, requests for documentation will be required.
This billing policy applies to all patients regardless of their coverage (Medicare or Third Party Insurance) without discrimination.
All billing questions should be directed to 1-866-363-0203. A billing customer service representative is available Monday-Friday 8am-7pm EST.
Remittance Address:
Predictive Biosciences / OncoDiagnostic Laboratory
PO Box 7250
Cleveland, OH 44192-0501
