Apollo Laboratory performs specialized urine drug toxicology and molecular testing for infectious diseases. Once performed the results are reported in an easy to read format to the ordering provider. At that time, Apollo will submit the claim to the patient’s respective insurance carrier (Payer).
The factors that affect a payer’s decision to reimburse these specialized tests include the patient’s diagnosis, the payer’s policy or specific coverage determination to reimburse such tests.
Once the claim has been received by the payer, the claim is processed and an Explanation of Benefits (EOB) statement is sent to the patient showing the services provided by Apollo. It should be noted that
Patients and the ordering physician will receive EP letters from Apollo requesting missing demographics information related to insurance policy such as identification number, date of birth, full name of policy holder, ordering physician information, medical necessity, etc.
The definition of “Medical Necessity” by Medicare and various insurers states that the items or services be “reasonable and necessary” for the diagnosis or treatment of illness to be eligible for payment. Not only Medicare but other payers request such information. Unless the requested information is provided the claims will not be processed expediently and will be delayed.
If a payer denies paying the claim, or pays only a portion, Apollo will submit an appeal on patient’s behalf to the payer. Apollo is committed to completing up to three levels of appeals, including independent medical review if available in patient’s state. Apollo may ask the patient and the physician to assist in the process as needed. Depending on the payer, this can be a very lengthy process. Apollo will keep the patient notified as needed during this process.
Payers require Apollo to bill patients for any applicable deductible, outstanding balance, and co-insurance, as reflected on EOBs or similar statements furnished by the payer. The amounts are determined by the patient’s insurers, not by Apollo. Patients will receive a patient statement from Apollo, which will indicate the balance due for the testing services provided.
Payers require Apollo to register with them at first and then process applications to get credentialed. When credentialed, a contracted reimbursement rate is generally established with the payer.
Apollo bills patient for the amount designated by their plan as the patient’s responsibility, including and balances remaining on the bill if the payer pays less than the “usual and customary,” “reasonable” or “allowable” charge (collectively termed the “Allowable Charge”) for the service provided. The payer will determine the Allowable Charge on the EOB. If the full Allowable Charge is paid to Apollo by the payer, patient will not be billed by Apollo.
Some payers have a policy to send reimbursements directly to the patient for the testing services rather than to Apollo. If a patient receives such a payment from their insurance company for our testing, it is the patient’s responsibility to pay Apollo Laboratory within ten days of receipt of that payment.
If the patient’s insurance plan deems this testing as research or investigational and the patient believes the clinical benefits outweigh the financial cost, the patient can pay out of pocket for testing.
If Apollo Laboratory determines that an over-payment that been made the credit balance will be submitted for refund to the proper party, regardless of whether a refund has been requested.
Yes, if you have insurance and have given us your current information, we will send bills straight to your insurance company for payment. We will also bill more than one insurance plan for you.
We allow 30 days after billing for your insurance to make payment. If your account is not paid within that time, we will ask for your help to get your insurance company to pay. You are responsible for charges not covered by your insurance, including deductible and/or co-payment.
Your physician ordered laboratory testing and contacted us to perform these services.
Apollo Laboratory will bill insurances directly for any testing we perform. These tests are billed separately from what your physician may bill.
As required by law, Apollo Laboratory will attempt to collect only those fees which your insurance carrier considers you responsible for. You may also receive a bill if your insurance carrier does not cover lab testing or if you are uninsured.
If you have insurance, and are not a Self-pay patient, simply update your insurance information by emailing us a photocopy of the front and back of your drivers license and insurance card, or mail it to:
Apollo Laboratory
Attn: Billing
300 W. Vine Street, Suite 14300
Lexington KY, 40507
Some insurance companies pay the patient directly for laboratory services. If you have received a check for our services, please:
You can pay your bill online, or by sending a check to:
Apollo Laboratory
Attn: Billing
300 W. Vine Street, Suite 14300
Lexington KY, 40507
Apollo Laboratory understands that providing quality testing has associated costs, which may cause financial hardship for some patients. Apollo Laboratory is committed to working with patients and making the billing process as stress-free as possible while providing exceptional patient care.
Patients are encouraged to contact us to discuss financial assistance options at (859) 320-0412 Ext. 111 (Billing)
We know that being able to decipher medical terms can be at times be overwhelming. Here are some of the more common terms and definitions.
Allowed Amount – The amount your insurance company will cover for healthcare services. This can vary based on your health plan.
Billed Amount – The amount Apollo Laboratory billed to your insurance company for services rendered.
Claim – A payment request to the health plan for covered services provided to an individual enrolled in the health plan. A claim can be submitted by the patient, the patient’s representative or by the health care professional who provided the service.
Co-Insurance – The percentage a covered person must pay (for example, 20 percent) of the allowed amount for covered health services after the health plan begins to pay, usually once the plan deductible has been met. This may also refer to the percentage of covered expenses paid by a health benefit plan.
For example, if your health plan’s allowed amount for a doctor visit is $200, your co-insurance is 20%, and you have met your deductible for the year, your co-insurance payment will be $40.
Co-Payments – A fixed amount the patient pays for services covered by his/her health plan. The amount can vary by the type of covered service and the health plan.
Deductible – An individual deductible is the amount a covered person needs to pay each plan year before the plan starts paying for covered services. A family deductible is the total amount the enrollee and their covered dependents need to pay each plan year before the plan starts paying for covered services.
For example, if a patient’s deductible is $500, their insurance company will not pay for any services rendered until the patient has covered $500 worth of services. Applications of deductibles can vary based on your health plan, so contact your insurance company with questions regarding your deductible.
Explanation Of Benefits (EOB) – A primary communication between health insurance carriers and their customers. It details recent care charges and benefit plan payments. Whenever health care services are received, the carrier sends an EOB to the primary account holder.
3191 Beaumont Centre Circle Suite 150 Lexington, Kentucky 40513
PH: (859) 320-0412 EXT. 503 FAX : (888) 977-1886
Monday - Friday 9:00AM - 5:00PM
ApolloBilling@Apollo-Laboratory.com
