PATIENT RESOURCES

FAQs

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Are you contracted with my insurance plan?

Cairo Diagnostics works directly with all plans to ensure in-network processing regardless of our network status and we are continually seeking network credentialing across most plans. If our claim is received by your insurance as out-of-network, we will work closely with them to apply your in-network benefits on all our claims.

How do I know if my insurance will pay for the testing?

There are many variables that determine eligibility of our services including the type of testing ordered, family history as well as your insurance plan’s definition of medical necessity for these services. Cairo Diagnostics maintains the most current payor policies which define the conditions of eligibility of services that our billing specialists utilize to understand each plan’s coverage and limitations.

Will I be balance billed for your services?

Our billing team follows guidelines set in each Explanation of Benefits (EOB) which calculate the total patient responsibility. In most cases, this is limited to co-pays, co-insurance and unmet deductible amounts as shown on the EOB. If the EOB shows the patient responsibility as the balance between our charges and the net payment amount, our billing specialist will make every effort to reduce this amount through various means including the reconsideration, appeals and grievances process. This may or may not require limited patient participation in the procurement of necessary documents to ensure full coverage.

Does Cairo Diagnostics accept Medicare, Medicare-based plans, TRICARE, CHAMPUS?

We are a participating Medicare provider and we accept Medicare assignment for all testing performed across all Medicare and Military plans.

What if I am unable to pay the costs related to my testing?

Cairo Diagnostics provides a comprehensive Financial Hardship Program that is tailored to each patient’s unique economic situation. You may be eligible for a reduction in the total cost of the services rendered in addition to a generous payment plan to assist you with the repayment of your bill. Some patients may qualify for a complete reduction in their liability if all eligibility criteria is met.

What should I do if I receive a Surprise Bill?
If you believe that the bill you have received from us is a surprise, we encourage you contact our patient advocate team immediately. Certain state laws prohibit surprise billing and may require additional forms to be signed by you attesting that the bill you have received was a surprise. We will verify with applicable laws and regulations whether this applies to your situation and work with you directly to resolve this issue.

Surprise Billing FAQs

What is the Assignment of Benefits (AOB) form?

The AOB form is a document that allows Cairo Diagnostics to bill your insurance company directly for laboratory services. Signing this form helps us to potentially negotiate with your insurance for in-network benefits, which can minimize your out-of-pocket expenses.

Why do I need to fill out the AOB form?

Completing the AOB form is crucial because it allows us to handle your billing accurately and efficiently. It's also necessary for us to comply with healthcare regulations and protect you from potential surprise billing, which occurs when you receive services from a provider not covered by your insurance network.

What is 'surprise billing,' and how does it affect me?

Surprise billing happens when you receive medical services from a provider outside your insurance network without prior knowledge. In this case, your in-network doctor referred you to our out-of-network lab. Without the AOB form, you could face higher medical bills due to limited insurance coverage for out-of-network services.

What if I don’t submit the AOB form?

If the form is not submitted by the deadline, we may have to proceed with balance billing. This means you might be responsible for paying the
difference between what your insurance covers and our total charges, leading to higher out-of-pocket costs.

Why am I receiving this form if my doctor is in-network?

While your doctor is in-network, Cairo Diagnostics is an out-of-network provider for your insurance. This form helps bridge the gap between out-of-network services and your insurance coverage, aiming to reduce your out-of-pocket costs.

Why can't Cairo Diagnostics just go through my physician, since they referred me to you?

While your physician chose Cairo Diagnostics for your laboratory tests, billing processes for medical services are typically handled directly between the lab (or service provider) and the patient’s insurance company. Your physician’s role is to ensure you receive the necessary medical tests, but they are not involved in the billing and insurance negotiation processes for services provided by other entities like our lab.

Why can't you directly bill my insurance without the AOB form?

To bill your insurance company directly, especially for out-of-network services, we require your explicit authorization, which is provided through the AOB form. This form grants us permission to negotiate with your insurance on your behalf and attempt to secure coverage that might not otherwise be available for out-of-network services. Without this authorization, our ability to effectively manage your billing and minimize your costs is limited.

This request sounds unusual. How do I know it's not a scam?

We understand your concern, especially in today’s environment where scams are unfortunately common. You can verify the legitimacy of this request by contacting your physician’s office to confirm their referral to our lab. Additionally, feel free to contact us directly at Cairo Diagnostics for any verification you need. Our priority is to maintain transparency and trust with our patients. We encourage you to reach out to us directly with any concerns or questions.

My insurance should pay for this. It's not my fault that the lab is out-of-network. Why am I involved?

It’s understandable to feel this way, especially when faced with unexpected billing circumstances. The issue arises from the fact that while your insurance may cover certain costs, their coverage for out-of-network providers like our lab can be different. The Assignment of Benefits (AOB) form is a tool that enables us to work directly with your insurance to negotiate for the best possible coverage under their out-of-network policy. Without this form, your insurance may not fully cover our services, and as a result, you might face higher out-of-pocket expenses. We are trying to prevent this by asking for your authorization through the AOB form, which is a standard practice in healthcare to ensure that all billing procedures are conducted correctly and in compliance with regulations.

I am hesitant to sign anything. What happens if I choose not to sign the AOB form?

Your reluctance to sign the Assignment of Benefits (AOB) form is understandable. It’s important to know that by not signing the form, you may lose certain protections against surprise billing. Without the AOB form, Cairo Diagnostics cannot negotiate with your insurance on your behalf for potential coverage as an in-network provider. Consequently, this could lead to balance billing, where you might be responsible for a larger portion of the lab fees. We recommend you review the form and consider its benefits in protecting you financially. If you have any specific concerns or questions about the form, please feel free to reach out to us. We are here to provide clarity and support to help you make an informed decision.

I have secondary insurance. Can you bill that insurance instead?

If you have secondary insurance, we can certainly look into billing that provider. However, we would still need you to complete the Assignment of Benefits (AOB) form for this secondary insurance. The AOB form allows us to communicate and negotiate with any of your insurance providers on your behalf. Once you provide us with the details of your secondary insurance, we will do our best to work within their coverage policies. It’s important to understand that each insurance provider has its own policies regarding out-of-network services, and our ability to maximize your coverage depends on these policies. Please let us know about your secondary insurance, and we’ll take the necessary steps to assist you in this process.

What is balance billing, and how could it affect me as a patient?

Balance billing occurs when a healthcare provider bills a patient for the difference between the provider’s charge and the amount covered by the patient’s insurance. This usually happens in cases where the provider is not part of the patient’s insurance network. For instance, if your insurance covers less for out-of-network services, and Cairo Diagnostics is an out-of-network lab for your plan, you may be responsible for paying the balance that your insurance doesn’t cover. This can lead to higher out-of-pocket costs than expected. Completing the Assignment of Benefits (AOB) form helps us negotiate with your insurance company, which can potentially minimize or prevent balance billing.

I already sent a copy of the AOB form to your office. Why are you asking for it again?

Thank you for taking the time to send the AOB form earlier. If you’ve already submitted the form to our office, there might be a few reasons why we’re requesting it again:

  • Processing Delay: There might be a delay in processing your form within our system.
  • Record Mismatch: Sometimes, forms can be misplaced or not matched to the correct patient account, especially if there’s missing or unclear information.
  • Data Verification: In certain cases, we may require a resubmission for data verification purposes to ensure accuracy in our records.

To resolve this, please let us know the method and approximate date you sent the form. This will help us locate your submission in our records. If there was an issue with your initial submission, we’ll work with you to rectify it promptly. Your cooperation is greatly appreciated to ensure everything is in order for your billing process

I no longer have the insurance I had at the time of the service. Do I still need to sign the AOB form?

Even if you no longer have the insurance you held at the time of your tests, it’s important to complete the AOB form for a few reasons:

  • Billing for Past Services: The AOB form pertains to the insurance coverage you had at the time of your laboratory tests. It allows us to bill that insurance for services already rendered.
  • Record Accuracy: Completing the form helps ensure that your billing records are accurate and up-to-date, reflecting the insurance that was active at the time of service.
  • Compliance with Regulations: Our request for the AOB form is also part of maintaining compliance with healthcare billing regulations. It’s a standard practice to secure this documentation for all services rendered, regardless of subsequent changes in a patient’s insurance status.

If you have new insurance now, please inform us so we can update your records accordingly. However, for the services already provided, the AOB form related to your previous insurance is still necessary.

Why did my doctor refer me to an out-of-network lab instead of an in-network one?

Physicians often refer patients to specific labs based on various factors, including the quality of testing, the availability of specialized tests, the reliability of results, and their familiarity or previous experience with the lab. Your doctor, might have referred you to Cairo Diagnostics due to specific tests or services we offer that align closely with your medical needs, which might not be available at in-network labs. Additionally, some physicians may not be fully aware of a patient’s insurance network details or the network status of every lab. It’s always beneficial for patients to discuss these aspects with their doctors and insurance providers to make informed decisions about where to receive care