[Histonet] Pathology billing for consultation

[Demarinis, Carolyn]

I would like to know how other pathology labs are billing for
consultations that are sent out by pathologist for second opinion.
Our process is to notify the physician's office that a case is being
sent to an expert and, if required, the physician's office is
responsible for obtaining precertification if the patient's insurance
require it.
Unfortunately, this has caused us a number of problems.  If the
consultant is not "in-network", the insurance does not cover this
expense, and the patient is responsible for the bill.
Is it a better option for the hospital to receive all bills from
consultants, and in turn, the hospital will bill the patient?  If so,
are there problems associated with this?
Or are other laboratories having the consultants bill the patient's
insurance directly, and if so, are they experiencing similar problems?
Thanks.
Carolyn DeMarinis, Pathology Supervisor
Saratoga Hospital Laboratory




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