Paying Your Bills

Medicare does not cover or has very limited coverage for many routine laboratory tests. In addition, Medicare has strict requirements regarding the medical necessity of the tests ordered. If your physician has ordered a test which is not covered or has medical necessity requirements, TriCore or your physician will give you an Advanced Beneficiary Notice advising that Medicare may not pay for the ordered tests. If you wish to proceed with testing, your signature is required to acknowledge liability for any denied services.

Your provider must submit diagnosis codes which meet the medical necessity for the laboratory tests ordered. Tests not considered medically necessary to your medical condition and/or if the diagnosis supplied by your provider is not covered by your health plan may lead to patient financial liability. This includes procedures which are deemed experimental. Consult with your provider regarding the medical necessity of the tests ordered for you.

You or your provider are responsible for contacting your insurance company before a laboratory test is performed. If prior authorization is not obtained or the test is not approved, you may be held financially responsible for the cost of the performed test. Consult with your provider and insurance company to know your financial responsibility.