Why did I receive a bill for pathology services?
Many patients wonder why they are being billed by a doctor they never saw. During your visit with your doctor, tissue from your body was obtained for testing. Examples of this would include a biopsy, a Pap smear, a fluid sample, or a scraping. This tissue was sent to Outpatient Pathology Associates to be examined by a pathologist.
A pathologist is a medical doctor specialist with years of extra training in the diagnosis of diseases, primarily by examination of tissue samples under a microscope. Examples of diseases which can be determined by a pathologist include cancer, infection, autoimmune diseases and trauma.
Before a diagnosis can be made, however, the tissue must be processed onto glass slides and stained, sometimes using special techniques. Then it is ready to be examined under the microscope. At this time the pathologist makes a diagnosis and dictates a written report that is sent to your doctor(s). This process typically takes two business days.
Your bill is Outpatient Pathology Associates’ charge for this specialized medical examination of your tissue specimen.
Your doctor chose Outpatient Pathology Associates because of our special experience in the diagnosis of disease in patients outside of the hospital, because of our special training in the medical problem you may be having, and because your doctor trusts that our doctors will do their very best to help them take the best care of you.
Why did a pathologist have to examine my tissue?
Perhaps you went to your doctor to have a lump or nodule removed because it bothers you. You may wonder why it needed to be examined any further. Your doctor sent the tissue to us to make sure that the tissue did not show any changes that might require further treatment or followup. The most serious of these changes would be cancer. Sometimes tissue which does not seem worrisome to you actually shows disease which undetected could lead to serious problems and even death.
Sometimes the pathologist can be very confident that the tissue does not show serious changes just by looking at it with the naked eye (“gross examination”), but often microscopic examination is necessary. You can be certain that every effort has been made to limit testing to only that which is necessary.
What is an HMO?
HMO stands for Health Maintenance Organization. This is an organization that provide health services to its members in return for a fixed prepaid fee.
What is a PPO?
PPO stands for Preferred Provider Organization. This is an organization that provides medical services to patients at contractually preset fees to the patients’ insurance company.
What is an EOB?
EOB stands for Explanation of Benefits. This is a report included with or without a check from the insurance company which explains the benefits that were paid and/or charges the insurance company will not pay. Sometimes the rejected charges must be paid by you (“copay”), and sometimes the charge need not be paid at all because it is more than the preset fee arranged with the doctor.
What is a deductible?
A deductible is the amount which the patient must pay toward the cost of medical treatment before the insurance company begins to pay benefits. Different health insurance policies may have different deductibles.
I still have questions.
Please feel free to contact our billing office with any additional questions you may have. Have the following ready when you call:
your Medical insurance card,
your EOB (Explanation Of Benefit),
your bill from Outpatient Pathology Associates (if you have received it)
Our Billing department can be reached at