Billing FAQ’s

Is Pacific Rim Pathology in-network with my health plan?

We are a participating provider with many major health plans, state Medicaid programs, and Medicare. However, we may not be an in-network provider for your health plan.  In addition, certain genetic tests we offer may not be covered by state Medicaid. To find out, please call the billing department at (855) 777-4327 Extension 3.

Contracted Insurance

Pacific Rim Pathology has many contracts with national and regional health plans throughout the United States. A patient’s financial responsibility depends on the benefits provided by the patient’s health insurance plan.  We will bill the patient for any co-pay, deductible, coinsurance, or required amount after we have received the explanation of benefits (EOB).

In addition, some health plans require the health care provider to call for prior authorization before the patient receives testing or counseling.  Failure to obtain prior authorization may increase the patient responsibility portion of the bill. The patient should check with their health insurance plan and doctor’s office about obtaining prior authorization before receiving services from Pacific Rim Pathology, and be sure the authorization number is provided with the requisition form for the test.

Non-Contracted Insurance

Even if a health insurance plan is not contracted directly with Pacific Rim Pathology, the health insurance plan may still cover some portion of the bill. If the health insurance plan has an out-of-network benefit, we will bill you for any co-pay, deductible, co-insurance or other required amount, after we have received the explanation of benefits (EOB).

Denied Medical Claims and Uninsured Patients

A patient’s health insurance plan can deny payment for treatment or medical services for many reasons. If the claim is denied and the patient has reason to believe it should be covered, the patient should contact their insurance company first before contacting Pacific Rim Pathology. In the event that a claim is denied and no amount is paid by the insurance plan, the patient will be treated as uninsured.  In these cases, patients may call the billing department at (855) 777-4327, Extension 3, to discuss payment plan and Patient Assistance Plan options. 

If my Pacific Rim Pathology testing is covered by my health plan, will I have any financial responsibility?

The amount you may have to pay for testing will depend upon your specific plan benefits. In all cases, if a co-payment, deductible or coinsurance is required by your plan, we are required by law to bill you directly for these amounts.

All patients are encouraged to contact their insurance carrier to understand and confirm their specific insurance coverage prior to testing, and to obtain any necessary prior authorization.

Ask your insurance provider the following questions:

  1. Is Pacific Rim Pathology in network? (Provide tax id number 330766564)
  2. Is my test covered? (Provide CPT code (Example: NIPT – 81420))
  3. What is my patient responsibility?

Remember you will owe your copay PLUS what you still owe to meet your deductible.

I have questions about the Explanation of Benefits I received from my health plan.

After the tests selected by you and your healthcare provider have been completed, you may receive a document from your health plan called an Explanation of Benefits (EOB). The EOB summarizes the status of our claim to your health plan and describes what the insurance company perceives your responsibility to be. This can change over weeks or months as we appeal for payment from the insurer. It is important for you to understand that the EOB is not a bill. If you have questions regarding the amounts shown on your EOB, please call the billing department at (855) 777-4327, Extension 3.

I have questions about a bill I received from Pacific Rim Pathology.

If you should receive a bill directly from Pacific Rim Pathology showing that you have a balance due, please call the billing department at (855) 777-4327, Extension 3, to verify the amount due and to discuss your payment options. Flexible payment options are available, and you may be eligible for our Patient Assistance Program, which may be applied to limit expenses for qualified patients.

I have concerns about the cost of my testing.

At Pacific Rim Pathology, we believe all patients should have access to affordable testing. That’s why we offer our Patient Assistance Program, which provides payment assistance for patients who are facing financial difficulties. To discuss your options, please call the billing department at (855) 777-4327, Extension 3.

I received a payment from my health plan for the testing services provided by Pacific Rim Pathology.

In some rare circumstances, the insurer may mistakenly send reimbursement directly to the patient, instead of to Pacific Rim Pathology. If you do receive a payment from your health plan for our laboratory services, please call the billing department at (855) 777-4327, Extension 3, for instructions on how to forward the payment.

Can I pay my bill online?

Yes. If you’ve received a bill from Pacific Rim Pathology and would like to pay online via credit card, go to our secure payment page

www.ePayitOnline/pdmstl

You will need your 16-digit account number from your bill.

You will need the Code ID: PDMSTL11.

You will need the 11-digit Access # from your bill.

I received a bill.  Where should I mail my payment?

Payments can be made by check or credit card using the information on your bill.

If you received a bill and need to mail a check, or credit card payment information to Pacific Rim Pathology, please include a copy of your bill and send it to:
PACIFIC RIM PATHOLOGY MEDICAL CORP.

FILE 1440

PASADENA, CA 91199-1440

I would like to pay cash at the time of service.

In order to qualify for the lowest cash-pay price, payment must be made at the time of service and submitted with the specimen.

I have other questions about my insurance coverage or my bill.

We’d be happy to address your questions – please call the billing department at (855) 777-4327, Extension 3.  Please do not call your healthcare provider’s office with billing questions, as they will not be able to assist you with your Pacific Rim Pathology bill.

We accept all patients and most insurance types.

We offer many payment options, including up-front payment discounts, interest-free payment plans, and a Patient Assistance Program for patients with financial needs (subject to certain limitations).

No insurance?  No problem.

We support patients with a variety of payment options, up-front payment discounts, and a Patient Assistance Program for those who qualify.

Payment Plan

Pacific Rim Pathology may work with patients to arrange a payment plan for up to four monthly installments. Please call the billing department at (855) 777-4327, Extension 3.

Patient Assistance Program

Patients who are uninsured, or under-insured may be eligible for financial assistance under the Patient Assistance Program.  The patient must complete the PAP Application or contact Pacific Rim Pathology directly to determine eligibility for the PAP. The patient may be required to submit proof of eligibility for these programs, or most recent W-2 to verify income.

Patient Assistance Program Application

The following information serves as a preliminary guide to help determine if the patient qualifies for PAP:

Patient Assistance Program Application