I Already Paid at the Office. Why Am I Getting a Bill From the Lab?

Why You Got a Separate Bill From the Lab

One of the most common questions we hear is: "I already paid at my appointment. Why am I getting a bill from a lab I've never heard of?"

This usually happens after a visit where something was sent out for testing, such as a biopsy, a removed growth, a skin scraping, a culture, or blood work. It's a fair question, and here's what's going on.

Your Visit and Your Lab Work Are Two Separate Services

When a sample is taken during your visit, two different services take place:

Our provider takes the sample. This is part of your visit with us, and it's billed by our office.
A lab processes and reads the sample. This is done by a separate lab or dermatopathology group, and it's billed by them.

Anything you paid at our office, such as a copay or a payment toward your deductible, applies only to the services we provided. It doesn't cover the lab's work, because the lab is a separate company that sends its own claim to your insurance.

What Is Dermatopathology?

A dermatopathologist is a physician who specializes in examining skin, hair and nail samples under a microscope. After your biopsy, your sample is prepared on slides, and a dermatopathologist reviews it to make a diagnosis. They send the report to your provider, who goes over the results and next steps with you.

This is skilled medical work by a separate doctor, and it's billed just like any other medical service.

Why Is the Lab Billing Me?

The lab sends its own claim to your insurance. Your plan then processes it under the same rules as any other claim. That means your copay, coinsurance or deductible can apply to the lab's charges, even if your plan covers the service.

Once your insurance finishes processing the claim, it tells the lab how much you owe. That amount is your "patient responsibility," and the lab is required to bill you for it.

Because the lab is a separate company, our office doesn't set its prices, doesn't have access to the lab's billing system, and can't reduce or waive its charges.

In rare cases, such as when a patient doesn't have insurance, the lab may bill our office its self-pay fee, and we then bill the patient for it on the lab's behalf. When that happens, the lab charge comes from our office instead of the lab.

Why Did the Bill Arrive Weeks After My Visit?

The lab can't bill until it has finished reviewing your sample and has sent a claim to your insurance. Insurance plans can then take anywhere from a few days to 30 to 90 days or more to process a claim. That's why a lab bill often shows up well after your appointment, and sometimes after you've already gotten your results.

What If I Still Have Questions?

If you're unsure about a lab bill, here are the best steps to take:

Look at who sent the bill. Many people assume every bill after a visit comes from our office, but a lab bill comes from the lab itself. Check the name and phone number at the top of the statement. Questions about a lab bill should go to that lab, since our office doesn't have access to the lab's billing system and can't change their charges.
Make sure the lab has your insurance information. If a lab bill shows the full charge with no insurance applied, the lab may not have your current insurance on file. Calling the lab to give them your insurance details often fixes this.
Review your Explanation of Benefits (EOB). Your insurance sends one for the lab's claim too. It shows what was billed, what your plan covered and what you owe.
Contact your insurance company if you have questions about how your plan applied the charges.
Contact our office if you need help figuring out which visit the bill is for, or a copy of the insurance information we have on file.

Medical billing can be confusing, especially when more than one provider is involved in your care. The lab, your insurance company and our office can each help explain their part.