Patient Billing

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Understanding
Insurance Terms

Allowed Charges – The amount your insurance has approved for payment.

Coinsurance – The percentage of costs you are responsible for after your deductible is met.

Coordination of Benefits – When more than one insurance plan covers a service.

Deductible – The amount you must pay out-of-pocket before insurance coverage begins. Plans may have individual, family, or network deductibles.

  • Once a family deductible is met, insurance covers all family members at the coinsurance rate.
  • In-network and out-of-network deductibles are separate, meaning an in-network deductible does not apply to out-of-network services.

Explanation of Benefits (EOB) – A statement from your insurer detailing what was covered and what remains your responsibility.

Patient Responsibility – The amount you owe after insurance processes your claim, including deductibles and coinsurance.

Patient Billing FAQs

DOES PRETORIAN BILL INSURANCE?

Yes, Pretorian will submit a claim (bill) to your health insurance for ordered tests. Please ensure you provide current and active insurance information, including any secondary and tertiary coverage, at the time of sample collection.

If you do not provide your insurance information, you will be classified as self-pay and will receive a patient bill for services ordered by your provider*.

*In some cases, services may be covered under bundled care where your ordering provider receives payment for the laboratory service and the laboratory bills the provider directly. This is referred to as Client Bill and your provider or health program will inform you if this applies to you.

IS PRETORIAN IN-NETWORK WITH MY INSURANCE?

Pretorian is in network with many health insurance plans, including:

  • Medicaid
  • Medicare
  • Commercial Insurance
  • Workers’ Compensation
  • Military

Before receiving services, check with your insurance carrier to verify network status. Pretorian Labs Ohio NPI is: 1609565100.

For Commercial (employer based) insurance if you do not have out of network benefits and Pretorian Labs is not in-network, you are encouraged to use an in-network provider.

We appreciate patient support to get in network with restrictive health plans, ask us how.

I RECEIVED AN EXPLANATION OF BENEFITS (EOB) AND MY INSURANCE DID NOT PAY, WHY?

After claim submission, your insurance company will issue an Explanation of Benefits (EOB) explaining the payment or denial of services based on your plan coverage. If your insurance did not cover a service, please:

  • Check your insurance coverage policies
  • Contact your insurance carrier directly
  • Reach out to us if you have additional questions, contact us.

If your insurance determines that you are responsible for certain costs (e.g., deductibles or coinsurance), Pretorian Labs will issue a bill for those charges. We do not engage in balance billing—meaning we will not bill you beyond what your insurance has determined to be your responsibility.

WHY DID I RECEIVE A BILL FROM PRETORIAN LABS?

You may receive a bill for the following reasons:

  1. Self-Pay: If you did not provide active insurance at time of service and no coverage was found or updated, the service is self-pay. If you have updated coverage for the date of service, please enter and submit your insurance information to us using the Patient Billing Inquiry Form and we will process your claim to insurance.
  2. Patient Responsibility: Based on your health plan benefits, your insurance company has determined that a portion of the cost (such as deductibles or coinsurance) is your responsibility.

If you have a questions regarding your bill, please contact us.

HOW DO I PAY MY BILL?

  • Online: Click Here or click Pay Invoice above.
  • By Mail: Send a check using the payment slip included with your invoice.
  • By Phone: Call 740-672-3366 to make payment over the phone.
IS FINANCIAL ASSISTANCE AVAILABLE?

If you are uninsured or do not have coverage for testing, Pretorian Labs offers a Patient Assistance Program, which can assist you with making your lab testing costs more affordable. To learn more or apply, please fill out the Patient Billing Inquiry Form.

WHAT ARE MY EXPECTED COSTS FOR TESTING?

The costs you pay for testing are dependent on:

  • Whether you have health insurance
  • Your specific insurance coverage and benefits
  • Bundled care/ special program with your doctor covering service cost (client bill)

If you are paying out of pocket (self-pay), you have the right to request a good faith estimate. Please complete the Patient Billing Inquiry Form, and we will provide an estimate.

WHY AM I BEING ASKED TO SIGN AN APPEAL LETTER?

If your insurance denies coverage for a service that should be covered, Pretorian Labs and your provider may need your consent to submit an appeal on your behalf.