Received a Bill From Us?

A tissue or body fluid (pathology specimen) 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. You will receive separate billing statements from your treating physician and/or the facility where you were seen.

EOB stands for Explanation of Benefits. The insurance carrier sends the patient and the provider a form summarizing the insurance plan's coverage for a specific medical event (procedure, test or supplies). This is not a bill. You will receive billing statements from CellNetix for any patient responsibility amounts, such as coinsurance or deductible.

There are several reasons why you might receive a bill even though you have medical coverage:
• Missing Insurance Information: Our Billing Department may not have received complete insurance and patient information to submit a claim.
• Claim Denial: Sometimes the insurance carrier has been billed, but the payment was denied. If the 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 the denial.
• Medicare 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 charges whenever the patient has signed the Advance 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 877-340-5884, or you can email us at billing@cellnetix.com.

Common Procedural Terminology or CPT codes are used to report medical services performed to insurance payors for reimbursement. In pathology, the same CPT code is sometimes used to report slightly different or separate procedures. For example:

Biopsies: If your surgeon submitted five different specimens to CellNetix for evaluation, each biopsy will be separately reported for payment, resulting in multiple identical CPT codes.

Immunohistochemistry staining (IHC): If IHC staining was performed on your specimens, each antibody stain performed will be separately reported for payment. This will again result in the same CPT code being duplicated for each antibody used.

Flow cytometry is a valuable tool in the diagnosis and management of blood cancers, which are known as leukemia and lymphoma. The testing method measures the number of cells in a sample as well as certain characteristics of cells, including the presence of normal and abnormal markers on the cell surface. Our CellNetix pathologists will review your clinical information and all pathological material available and order the appropriate flow panel as medically indicated. A panel includes multiple markers necessary to obtain the critical diagnostic and therapeutic information. After the technical staff performs the testing, the results of the panel are interpreted by our CellNetix pathologists.

The CPT codes used to report flow cytometry will be based on the number of markers tested. CellNetix will report each marker test separately for payment.

CellNetix is a participating provider with most major insurance carriers. Please see our list of In-Network Health Plans.

Under the No Surprises Act, when you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. Some states have their own laws relating to balance or surprise billing for out-of-network laboratory or pathology services. For patients in our Alaska service area, visit the Centers for Medicare & Medicaid Services (CMS) website for details. For Washington state, visit the Washington Office of the Insurance Commissioner website for details.

Under the No Surprises Act, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. Your estimate will include only the costs CellNetix will bill you for the pathology services it is requested to perform. CellNetix cannot provide estimates for medical services charged by other unrelated health care providers or facilities.
• If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit the Centers for Medicare & Medicaid Services website, email FederalPPDRQuestions@cms.hhs.gov, or call 1- 800-985-3059.