MLabs bills the patient or the patient’s insurance carrier directly for tests performed by MLabs provided we are able to do so successfully. Direct patient or third-party payors are billed according to the University of Michigan third-party payor fee schedule. Patients are billed for any copays or deductibles applied by the plan. Please advise patients that they may receive a bill for laboratory services from the University of Michigan Health System.

 

If MLabs is a participating provider with the patient’s health plan, out-of-pocket costs are usually limited to co-payments, co-insurances and/or deductibles. If we are not participating with the health plan, we will bill the client at a discount rate. Examples of non-participating are non-Michigan Medicaid and non-Michigan HMO plans. We recommend the patients contact their insurance providers with any questions regarding benefits or services covered. Please refer to our Insurance List for participating and non-participating carriers. 

Insurance List
GET LIST
Prior Auth Packet
GET PACKET
Billing Guidelines
GET GUIDELINES

PATIENT BILLING

BILLING REQUIREMENTS

In order for MLabs to bill a patient or a patient’s insurance carrier, it is essential that complete patient demographics, insurance information and ICD-10 diagnosis codes be provided. MLabs reserves the right to bill the client if this information is not provided or if the claim is denied.

 

The following information is necessary and expected at the time the specimen is submitted in order for MLabs to successfully bill a third-party payor

  • Patient’s full legal name as validated on a drivers license or state identification card.
  • Patient’s Social Security number (optional)
  • Patient’s sex
  • Patient’s date of birth
  • Patient’s primary phone number
  • Patient’s home address
  • Parent or guardian’s full name and date of birth if patient is under 18
  • If patient has any commercial insurance, complete address and phone for each company
  • Complete information for ALL relevant patient insurance policies (with priority ranking, group #, service codes, etc.)
  • Referring physician & NPI
  • All diagnosis (ICD-10) codes that support medical necessity
  • Prior authorization number and/or copy of prior authorization (if applicable)
  • If patient has Medicare, signed Advance Beneficiary Notice (ABN) (if applicable)
  • If patient has Medicare, patient status on date of specimen collection (inpatient, outpatient, or nonpatient)