Medical billing is a complex system even for those who deal with it every day. There are many different insurance carriers, each with its own contract and terms of coverage. At CellNetix, it is our policy to work with our customers to reach swift and compassionate resolution of financial questions.

How to begin

Patients are requested to contact our billing office at 1-800-374-4045, Monday–Friday, 6:00am to 5:00pm, or email billing@cellnetix.com to initiate a conversation to resolve financial issues.

Following are answers to our most frequently asked billing questions.

1. Who are you?
2. What is this bill for?
3. Which doctor sent this invoice?
4. What is an “EOB”?
5. Why didn’t you bill my insurance?
6. My Pap smear was reported as “Negative” yet it was reviewed by a pathologist. Why was it reviewed by a pathologist and why was I, as the patient, not informed of additional evaluation and additional charges?

Q: Who are you?
A: We are a group of physicians, board certified in the specialty of pathology, who provide professional laboratory support to healthcare providers at various medical centers, in managed care organizations, in private practices, as well as at public clinics. Pathologists evaluate Pap smears, lab tests, and biopsy and surgical specimens for attending healthcare providers.

Q: What is this bill for?
A: A tissue or body fluid obtained at either a doctor’s office or medical center and labeled with your name was submitted to the laboratory for evaluation. Our pathologists are the specialists who evaluate the pathology specimen and consult with your doctor as to whether the sample submitted contains any abnormality.

Q: Which doctor sent this invoice?
A: The physician who referred your case for professional evaluation is referenced on the CellNetix invoice.

Q: What is an “EOB”?
A: EOB stands for Explanation of Benefits. The insurance company sends the patient and the provider a form summarizing the insurance plan’s coverage for a specific medical event (procedure, test, or supplies).

Q: Why didn’t you bill my insurance?
A: There are several explanations why you might receive a bill even though you have medical coverage:

• Perhaps our billing department did not receive the complete insurance information or patient details for us to submit a claim.
• Sometimes the insurance carrier has been billed but the payment was denied. If a denial is the cause of your receiving a bill from CellNetix Pathology, please refer to the EOB (Explanation of Benefits) mailed by your insurance company. The EOB form states the reason(s) for denial.
• If you are a Medicare patient, it is possible that payment for a Limited Coverage Test was denied. In those instances, the patient is responsible for the charges whenever the patient has signed the Advanced Beneficiary Notice before the specimen was collected.
• If you wish to submit billing information directly to our billing office, please contact our Billing Department at 800-374-4045, or email billing@cellnetix.com.

Q: My Pap smear was reported as “Negative” yet it was reviewed by a pathologist. Why was it reviewed by a pathologist and why was I, as the patient, not informed of additional evaluation and additional charges?

A: Many Pap slides are interpreted in the initial screening to contain reactive or reparative changes, atypical cells of undetermined significance, or to be in premalignant or malignant categories. CLIA ’88 Regulations (as published in the Federal Register, Vol. 57, No. 40, February 28, 1992, Section 493.1257, Paragraph c:1) mandate that these conditions be evaluated by a pathologist. The initial screening of a Pap smear is considered part of the Technical Component.

A Pathologist’s Review of a Pap smear is not considered additional testing but is, rather, a continuation of the original Pap evaluation as requested by the healthcare provider and does not require notification to the patient. Sometimes the initially suspected condition results in a “Negative” report as determined by the pathologist.

There is an additional charge for the Pathologist’s Review because it is considered a professional consultation and as such is an independent and different procedure code (CPT code) from the technical component. The Pathologist’s Review of a Pap smear is considered a Professional Fee. The Professional Fee may be billed separately from the original screen by a cytotechnologist.

Advance notice to a patient of a required Pathologist’s Review is impossible because conditions requiring review are not determined until the initial screening of a Pap smear.