Because our laboratory is considered a specialty laboratory, our biopsy processing procedure is covered under your patient’s MEDICAL insurance, NOT DENTAL insurance.
Our laboratory offers 3 convenient billing options for you and your patient:
Please check the Referring/Ordering Doctor payment option on the submission form to choose this option. With this option, you may either send in a check, pay on-line, call in a credit card payment to the billing department, or opt to have an invoice sent to you.
NOTE: All contributing dentist/surgeons whose patient has a Medicare-involved insurance plan must be a registered PECOS provider eligible to refer for Part B Medicare services in order for us to accept the specimen. Any specimen from a patient on Medicare, received from a contributor who is not a PECOS provider will be returned to the contributing dentist/surgeon, unless the service is pre-paid for by the contributing doctor or patient. For more information on this, please see “Important Information for Non- Medicare Providers”.
Our billing department at UTHealth at Houston School of Dentistry can help file with your patient’s medical insurance company. In order to do this, provide the following when you ship the specimen to us:
SPECIAL NOTE FOR BCBS and MEDICARE HMO INSURANCE HOLDERS: Because we are in network with BCBS and are a registered Medicare PECOS provider, pre-authorization for a diagnostic pathology service such as ours is required for all BCBS HMO subscribers and Medicare managed plans. It is the responsibility of your office and the patient to determine if this is needed. BCBS and Medicare managed HMO cases sent to us without prior authorization or proof of denied pre- authorization, will be returned to you because we are not able to bill the patient’s insurance or the patient without this.
If the patient does not have medical insurance, or wishes to self-pay instead of filing with their insurance, the patient will have to pre-pay for the biopsy processing service in the amount of $160. The patient may pay by giving their doctor a check for them to include in the biopsy kit they send to us, by pre-paying online, or by calling the billing department (713-486-4405) to pre-pay with a credit card. The patient will receive an invoice for any biopsy processing charges over the $160 amount.
NOTE REGARDING MEDICAID: Unfortunately, our laboratory does not accept Medicaid at this time. For specimens we receive in which the patient’s Medicaid card is supplied, the doctor will be contacted and asked to contact the patient to ensure that they would like us to continue processing the specimen. The patient will need to pre-pay before we will process the specimen.
Important Information for Non-Medicare Providers
Even if your practice does not accept Medicare, if you are a registered PECOS provider, who are eligible to refer for part B services, we will accept your patient’s specimen. Please provide a copy of your patient’s Medicare card and complete an ABN form so our billing department can file a claim for your Medicare-insured patient as a courtesy service.