Insurance and Billing Frequently Asked Questions

Click on a question below for more information:

What insurance plans do you accept?
Do you bill patients and their insurance directly?
Who do patients call if they have a billing question?
Do you accept credit cards?
Why didn't insurance company pay for the entire bill?
Why did patients receive 2 bills?
Are there other types of bills that patients may receive?
How much do you charge?


What insurance plans do you accept?
We accept most plans in Oregon. A partial list of participating insurance companies is below. Please note that many insurance companies in Oregon use provider networks, and we are a member of many of these networks.

In the unlikely event that your patients receive an explanation of benefits that indicates Pacific Pathology Associates, Inc. is not "in network", please call Michelle Cheney at 503-561-2228 so that we can get credentialed with that company.


Aetna
Blue Cross Blue Shield of Oregon
Care Oregon
CareMark
CHAMPUS
Cigna
Clear Choice
First Choice Health
Great West
Health Net
Healthcare Direct
Healthnet Medicare
HMO Medicare
Lifewise
Managed Health Care Northwest
Marion Polk County Health Department

Mid Valley IPA Employee Benefit Trust
MPCHP Advantage
ODS
One Health
Oregon Breast and Cervical Cancer Program
Oregon Health Systems, Inc.
Oregon Medicaid
Oregon Medicare
Oregon Worker's Comp.
Pacificare
PacificSource Preferred
Providence Health Systems
Providence Medicare
Secure Horizons
Tri Care
United HealthCare


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Do you bill patients and their insurance directly?
Yes, we bill both primary and secondary insurance. Please provide complete patient demographic information, including insurance information and authorization numbers with the specimen. We will bill the patient any applicable co-pay, co-insurance or deductible.
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Who do patients call if they have a billing question?
We use APS Medical Billing as our billing agent. Your patients may call them at 1-866-587-6731.
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Do you accept credit cards?
Yes, we accept Visa, Mastercard and Discover.
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Why didn't insurance company pay for the entire bill?
The most common reason is that there is a deductible, co-insurance or co-payment due from the patient. Sometimes there is a limit to how many times in a year patients can receive a service, a reason that Pap tests are often denied.
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Why did patients receive 2 bills?
For Pap tests, PPA bills for the Pap processing and the interpretation.

HPV, Chlamydia, and Gonorrhea tests are billed by Salem Hospital.

Most pathology tests have 2 charges, a technical component (TC) and a professional component (PC). The easiest example to use is a mole removal. A mole is removed, put into a formalin solution bottle, and sent to Pacific Pathology Associates, Inc.

The mole is then cut, processed and stained and a slide is prepared for examination under a microscope by a pathologist to determine the presence of disease.

The technical charge (TC) is for the supplies to store the tissue, chemicals to process the tissue and for the technical staff labor to create the slides.

The professional charge (PC) is for the Pathologists' services and expertise in examining the tissue, reviewing the slides, interpreting the findings and sending a report to the ordering provider.

In most cases, patients get one bill from Pacific Pathology Associates, Inc. for both the TC and the PC components, this is called a global bill. In other cases, usually an inpatient hospital stay, another hospital or lab bills for the TC portion and Pacific Pathology Associates, Inc. bills for the PC portion.
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Are there other types of bills that patients may receive?
Yes, for send out tests, other lab tests and 2nd opinions.

Some types of disease require additional testing to confirm a diagnosis or to help determine a treatment plan. A medical provider or the pathologist may order these tests. In some cases, patients may get a bill from an unfamiliar lab.

The most common send out tests are cytogenetic tests for bone marrow and blood specimens. We are sensitive to the increased costs of these tests and take great care to limit them to only the most clinically relevant tests available.

Patients and referring providers can also request a 2nd opinion and we will send the slides and the report to another pathology office via overnight mail. There will be a charge from the consulting pathologist for this service. Please have patients check with their insurance company regarding coverage for 2nd opinions. This charge can be from $250 - $500, more if additional tests are ordered and the patient is responsible for this bill.
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How much do you charge?
Please call Michelle Cheney at (503) 561-2228 for a price quote.
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