About Your Bill
There are several reasons why you may have received a bill from us:
- You may have received a bill from SEP for lab services performed on a biopsy, Pap test or other specimens. These lab services were ordered by your physician and the results are reported back directly to that physician.
- You may have received a bill from SEP for the professional component (PC) of anatomic pathology services provided at various hospitals. This charge is for the pathologist's diagnosis of test results. You may also have received a bill for the technical component (TC) of anatomic pathology services. This charge is for the preparation and processing of these tests.
- You may have received a bill from SEP for the professional component of clinical laboratory services provided at the hospital.
- You may have received a bill from SEP for combined technical and professional (global pathology) services, which include prepping and processing a specimen as well as giving a diagnosis.
Every insurance plan has varying levels of coverage. If you feel your claim was processed incorrectly or have questions about your specific coverage plan, please call your insurance company directly. You can ask your insurance company representative to include one of our billing staff members in a conference call with you if there are issues that don't seem to be correct or clear.
Your insurance company processes claims on a first-in first-out basis. If your claim was processed by your insurance company before the claim from your physician's office was processed, the deductible may have been applied differently than expected. Your deductible is a contract between you and your insurance company and you are required to meet (pay) that deductible before benefits will be paid by your insurance.
Co-payments typically cover physician office visits only. Services such as lab tests that must be sent out for analysis are not covered by the co-pay.
Once an account has been placed with an outside agency for collection, that debt is no longer owed to SEP. You should call the collection agency for quick resolution of a collection account.
For tax purposes, please keep the copy of your original bill from SEP. If you need an itemized bill for an individual insurance policy, please call and we can send it to the address on file for your account.
If your Pap Test requires interpretation by a physician (pathologist), there will be an additional charge listed for that service. If you are covered by medicare, this service may be subject to deductible and co-insurance charges. If your doctor orders additional testing such as HPV, CT or GC, those tests will be listed individually on your bill. If you have questions about why your doctor ordered those tests, please call your doctor.
Each case is different. It is difficult to estimate the exact total price. The pathologist may need to order special stains or additional testing in order to render an accurate diagnosis.
Making a Payment
You can make a credit or debit card payment online under Online Bill Pay. You can make a payment by check or money order in person or by mailing it to our office at 311 West Eighth Street, N.W., Rome, GA 30165. Credit or debit card payments also are accepted at our office, by mail or over the phone, 800.225.8702.
SEP accepts Visa, Mastercard, Discover and American Express credit and debit cards, as well as checks or money orders. Our lobby is open to receive payments by cash, check, money order or credit/debit card Monday through Friday from 8:00 a.m. to 12:30 p.m. and from 1:30 p.m. to 5:00 p.m. at 311 West 8th St., Rome, GA 30165. We also have a mail drop in our door that can be used when we are closed during the lunch hour or for after-hours payments if no receipt is needed.
Just call us at 800.225.8702 and we will be happy to work with you on an individual basis. If you have been approved for a discount for the date of service in question at the hospital or at your physician's office, we can match the discount as long as we have documentation regarding the amount of discount.
No. Due to the nature of laboratory services, you will generally be registered as a new account for each service provided by SEP. If you call, and you know you may have had tests from more than one office or hospital visit, please ask us to check and make sure you don't have any outstanding bills under another account or perhaps even under another name.
You may only receive one or two bills. Mailing costs are high, so don't assume you will get another bill later. Your account may be placed with an outside agency for collection if you do not pay the bill or make payment arrangements. Please note that if you call right away, we may be able to offer you a discount for prompt payment.
Yes, we are required to turn over all amounts to collections if unpaid. In most cases the small balance is part of a co-insurance amount due after your insurance is paid. Our contract with government and private insurance payers requires that we bill the patient and not routinely waive co-insurance amounts. Many of our services are small dollar amounts and the co-insurance is very small. Please help keep health care costs down by mailing these payments promptly. Since so many of our balances are small, and patients can have multiple accounts, even small balances are subject to collection from an outside agency. Also, since our balances are small, in most cases we cannot make phone calls to remind you of the balance due prior to placing an account with a collection agency.
If you have a supplemental insurance policy in addition to Medicare and our bill does not indicate that we have filed a claim to that second policy, please call our office first. We may not have your supplemental insurance on file but Medicare may have forwarded the claim anyway. Calling us might save you from making a payment that will need to be refunded later.
Insurance, Medicare and Medicaid Coverage & Claims
The Explanation of Benefits (EOB) is not a bill. You may receive an EOB when your insurance provider processes a claim from us or another medical provider. It describes the services provided, the amount covered by the insurance, and any remaining balance you may owe. Do not send payment unless you receive a bill from SEP. If you have not received a bill within a few weeks of receiving your EOB and you suspect that you owe a balance, call 1-800-225-8702 to check with our billing staff.
Yes. SEP will file claims to both plans if we have the correct information on file. Please make sure you provide accurate information for both plans to your physician's office. They, in turn, provide the information to SEP. If you receive a bill that does not appear to have been filed with one or both of your insurance plans, please call us with your insurance cards in hand so that we can verify the information we have on file. Please remember that most insurance companies have a time limit to file which can be as little as 45 days, so please call promptly to ensure that your insurance will pay instead of you.
Medicare patients must meet their annual deductible and a 20% co-insurance on most anatomic pathology services. Medicaid patients will not have an out-of-pocket expense. However, Emergency Medicaid does not cover our services, and certain AID categories (such as Qualified Medicare Beneficiary) are not covered and will be billed to patients. Please call us to discuss your payment options.
Medicare covers a routine screening Pap Test for low-risk patients once every 2 full years. Medicare covers a routine screening Pap test for high-risk patients once a year. These screenings are covered by Medicare at 100% with no deductible or co-insurance due. A screening Pap Test is one that is done in the absence of signs or symptoms. Medicare coverage guidelines depend upon frequency of testing plus the reason for the testing (diagnosis code dependent). Those are subject to change based in part on the recommendations of the U.S. preventive services task force. See www.uspreventiveservicestaskforce.org for the latest information on their recommendations.
Medicare was not designed as a program to cover screening tests. If your doctor decides that you may need a screening Pap Test more frequently than is covered by Medicare, it is up to you to decide if you want to have that test and pay for it personally if Medicare denies payment. Your doctor will usually ask you to sign an ABN (Advanced Beneficiary Notice). This form explains that Medicare has frequency limits on coverage and lets you know how much a Pap Test will cost you if Medicare does not pay. if you check YES on the form to agree to have the Pap Test, SEP will file a claim to Medicare. If Medicare denies the claim due to frequency limitations, SEP will bill you for the Pap Test.
Medicare covers diagnostic Pap Tests. This is a Pap Test done due to the presentation of signs or symptoms. The doctor may want the tests performed more frequently than covered by your insurance.
Please call our billing department at 800.225.8702 (dial option "2") Monday - Friday from 8:00 a.m. - 5:00 p.m.