Billing is an important component of testing. CMDL can directly bill the insurance, an institute, or the patient. Please note that we now offer comprehensive insurance verification and authorization.
Insurance Billing: CMDL accepts insurance billing. For insurance cases with a sample verification of insurance eligibility and benefits check is done prior to starting the test. Patients may choose to be informed if their share of cost (co-pay, co-insurance, and/or unmet deductible) is greater than $250. In this scenario provider will be informed of the benefits prior to starting the test. If a patient has an HMO or the insurance requires an authorization, CMDL will request an authorization. Please note that a letter of medical necessity (LMN) is needed for cases that require an authorization, and may be requested from the provider.
Additionally, for insurance cases without a sample in lab,CMDL can do pre-verification (verify eligibility and do a benefits check) if the required paperwork is sent to the lab. Please note that insurance authorizations will not be obtained prior to a blood draw.
Insurance Billing TAT: Please allow 3-5 business days for insurance verification and benefits check. If an authorization is needed, on an average, it may take 7-10 business days. The turnaround time for an authorization depends on how quickly we can gather the supporting documentation as well as the time it takes for insurance providers to process the authorization request. CMDL works diligently to minimize this turnaround time.
Institutional Billing: We offer discounted rates for clients that establish the discounted billing agreement with us and that will allow CMDL to invoice the ordering institution directly. Institutions are invoiced within 30 days of completion of the test. Please contact us at [email protected] for the price list and the contract for discounted billing.
Patient Self-Pay / Out-of-Pocket Billing: For patient billing, prepayment for the testing services is required. Tests are discounted for out-of-pocket payment (please email [email protected] for information). Payment may be by a personal or bank check or by credit card (VISA, MasterCard, Discover, and American Express).
Tel:888-8 COH DNA (888-826-4362) option 3
Fax: (626) 301-8142
e-mail: [email protected]
For faster insurance verification please send the completed paperwork mentioned below with the sample. If pre-verification is needed before a sample is sent to the lab, completed paperwork can be faxed to (626) 301-8142: Complete the insurance test request form (TRF). Click here for a sample of a completed TRF. Include a clear copy of all insurance cards (front and back). Please provide a clinic note or patient information form (recommended). For HMO insurance policies please provide a brief Letter of Medical Necessity (LMN). Note: We may contact you if the insurance provider requires any additional information.
We will communicate the verified insurance benefits to the referring physician / contact person on the TRF. Please let us know if you wish for us to discuss the benefits with the patient.
If the insurance provider denies benefits the following options are available: The patient can pay-out-of-pocket. The billing can be transferred to institutional billing. The patient can decide not to pursue testing.
If a guarantee of payment is provided, testing can be started prior to insurance approval.
Following an internal review, we no longer require an ABN for our Medicare cases in which a patient has a clinical diagnosis and the test is medically necessary. Please remind your patient that there might be a patient component of the total cost of the test.
We accept Medi-Cal (excluding Medi-Cal HMO not contracted with City of Hope Medical Center). All Medi-Cal cases are also verified to determine eligibility. We do not accept out of California Medicaid.
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