Understanding Insurance Billing With Quest Diagnostics: A Guide To Navigating The Process

Quest Diagnostics is a provider of laboratory services, working with your physician to test specimens. Quest Diagnostics is in-network with many health insurance plans, including UnitedHealthcare®, Aetna®, Humana®, Cigna®, and most Anthem® and BlueCross BlueShield® plans. Quest Diagnostics will bill your insurance company first, and any amount not covered will be your responsibility. You can pay your bill in one of three ways: online, by email, or with a credit, debit, or health savings card. You can also set up a payment plan.

Understanding the cost of your care

Quest Diagnostics is partnered with some of the biggest names in health insurance, like UnitedHealthcare®, Aetna®, Humana®, Cigna®, and most Anthem® and BlueCross BlueShield® plans. However, it is the patient's responsibility to verify benefits before services are performed. You can check if Quest Diagnostics is in-network with your health insurance plan on their website.

In certain cases, for tests that Quest knows are likely not covered based on a health plan's policies, they will issue an Advance Written Notification (AWN) to notify you of your potential financial responsibility. The AWN provides pricing transparency and gives you the opportunity to make an informed healthcare decision before receiving the service. If you receive an AWN form, you have the option to agree to be financially responsible and have the test performed or choose not to have the test performed.

Quest Diagnostics offers payment plans for patients who are unable to pay their full balance by the due date. They also offer Financial Assistance, which provides free or reduced-fee laboratory services for those who qualify based on U.S. Department of Health and Human Service poverty guidelines.

How to read your Quest bill

Understanding the full cost of your care is an important aspect of managing your health. Quest Diagnostics provides sample lab bills on their website to help you understand how to read your bill. Here are some steps to help you read and understand your Quest bill:

• Review the Tests Performed: Check the details of the bill to know which tests were performed. Quest Diagnostics offers a range of laboratory services, and your bill will outline the specific tests ordered by your physician.
• Insurance Coverage: Determine how much of the bill is covered by your health insurance plan. Quest partners with major health insurance providers, and your coverage will depend on your specific plan. Contact your insurance carrier for detailed information about your coverage.
• Amount Owed: After considering your insurance coverage, identify the amount you owe. This may include deductibles, co-pays, or any charges not covered by your insurance.
• Payment Options: Quest Diagnostics offers multiple payment options, including online payments, mail, or payment during your Quest visit. They accept credit, debit, PayPal, or health savings cards.
• Billing Notifications: You can choose to receive billing notifications and bills via text, email, or paper format. You can update your preferences by contacting Quest Diagnostics.
• Billing Inquiries: If you have questions about your bill, you can refer to the example bill on their website, which defines many of the terms used. You can also contact Quest Diagnostics' customer service for further assistance.
• Additional Information: If your bill requests additional information, provide the requested details to the address or fax number listed. If your insurance carrier needs more information, contact them directly.
• Diagnosis Information: Quest Diagnostics obtains diagnosis information from the ordering physician's office. If your insurance carrier denies your claim due to diagnosis codes, reach out to your physician's office for clarification.
• Draw Fee: A draw fee is charged when you visit a Quest Patient Service Center (PSC) for specimen collection. Insurance may cover this fee, but uninsured patients or those with non-covering insurance plans are responsible for payment.
• Advanced Beneficiary Notice (ABN): This notice is required by Medicare for certain tests that may be denied coverage. It informs you of your financial responsibility and gives you the choice to accept or decline the test.

Remember, the appearance of your Quest Diagnostics bill may vary, and the provided information is a general guide. Always refer to the specific details and breakdown of charges on your bill.

Understanding insurance terms

Insurance terminology can be confusing, but it's important to understand what your insurance covers and what it doesn't. Here are some common insurance terms explained:

• Deductible: This is the amount you owe for covered health care services before your insurance company starts paying. For example, if your deductible is $3,000, you will need to pay the full amount for your medical expenses until you reach that $3,000 threshold. After that, your insurance company will start contributing to the cost of your care.
• Copayment (Copay): This is a fixed amount you pay as your share of the cost for a specific medical service or item. For instance, you might have a $20 copay for a doctor's visit or a $10 copay for a prescription medication.
• Coinsurance: This is your share of the cost for a covered health care service, usually calculated as a percentage. For example, if your coinsurance is 20%, you pay 20% of the allowed amount for the service, and your insurance company pays the remaining 80%.
• Premium: The premium is the amount you pay for your insurance coverage, typically on a monthly basis. This is what you pay to keep your insurance policy active.
• Network: The network refers to the group of doctors, hospitals, and suppliers that your insurance company has contracted with to provide healthcare services to their members. Going to an in-network provider usually results in lower out-of-pocket costs for you.
• In-network: Being "in-network" means that a healthcare provider has a contract with your insurance company to provide services at a pre-negotiated rate. In-network providers typically result in lower out-of-pocket costs for you.
• Out-of-pocket costs: These are the expenses you are responsible for paying out of your own pocket, including deductibles, copayments, and coinsurance.
• Coverage: Coverage refers to the protection against financial loss that your insurance policy provides. It is important to understand what services are covered by your plan and what services are excluded.
• Claim: A claim is a request made to your insurance company to pay for a covered loss or expense.
• Benefits: Benefits are the specific services or items that your insurance company covers under your plan.
• Policyholder: The policyholder is the person who applied for, pays for, and is issued the insurance policy. They are the owner of the insurance policy.
• Insured: The insured is the person who is protected by the insurance policy in case of a loss or claim. The policyholder and the insured may be the same person, or they may be different, such as in the case of a dependent child covered by a parent's insurance plan.

Financial assistance

Quest Diagnostics offers financial assistance to patients who are experiencing financial hardship or who do not have insurance. This assistance is in the form of payment plans and free or reduced-fee laboratory services.

Payment Plans

Quest Diagnostics offers payment plans that allow patients to pay off their balance in monthly installments until the balance is paid in full. To get started, contact billing by calling 1.866.MYQUEST.

Quest Diagnostics also offers financial assistance in the form of free or reduced-fee laboratory services for those who qualify based on U.S. Department of Health and Human Service poverty guidelines. Through their Patient Assistance Program, they tailor solutions for uninsured or underinsured patients based on individual circumstances and may adjust some or all laboratory charges if patients cannot afford to pay for their testing.

To learn more about financial assistance and to see if you qualify, visit the Quest Diagnostics website.

Update or review your insurance

Updating or reviewing your insurance is an important step in ensuring that you and your family are adequately protected. Here are some steps to help you with the process:

Understand the Basics of Your Insurance Policy:

Know the type of insurance you have—is it health, life, home, or auto insurance? Understand the company providing the insurance and keep their customer service information handy. Keep track of your policy number, as you'll need it when communicating about your policy.

Review Your Policy Details:

Be aware of the date your insurance was issued and the expiration date. Know the premium amount and how often it's paid. Understand who the benefits apply to and ensure the beneficiaries are listed correctly. Check for any additional riders or clauses, such as waiver of premium in the event of disability.

Evaluate Your Coverage:

Review your coverage limits and deductibles. Ensure that your insurance adequately covers your belongings, property, and family members. Consider any life changes, such as a new child, marriage, divorce, or a new home renovation, that may impact your insurance needs.

Update Your Information:

Provide your insurance agent with any changes to your personal information, such as mailing address, phone number, email address, and household members. Inform them about any new purchases, home updates, or job changes that could affect your coverage.

Seek Professional Guidance:

Consider enlisting the help of an experienced insurance agent. They can provide expertise and guidance on which coverages may be best for your unique situation. They can also answer any questions you have about your policy and explain its features.

Compare and Adjust Your Coverage:

Shop around and get updated quotes online to ensure you're getting a good price for your insurance. Compare different insurance providers and plans to find the right protection for your current needs.

Remember, reviewing your insurance is an ongoing process. Aim to review and update your insurance information at least once a year or whenever you experience a significant life event or change in circumstances. By staying on top of your insurance, you can have peace of mind knowing that you're protected during unexpected events.

Frequently asked questions