When the decision is made to order lab work, then a decision also needs to be made how to handle the financial charges. There are some tests that are done in the Student Health Center lab such as urinalysis, rapid strep, mono and pregnancy tests. There is a small fee for these tests and all students must pay for them at the time of check-out.
Other laboratory testing is sent to the Vanderbilt Medical Center laboratories and the results are forwarded to us. There are two ways to handle payment for such tests:
1. The patient can pay Student Health Center at the time of check out and we reimburse the medical center. This is called “Client Billing” whereby the Student Health Center is the “client” of the medical center. The rates for these tests are significantly lower than the “regular” rates since we have eliminated the “middle man” – the insurance companies. If the decision is made to file with insurance instead and the insurance company is billed that decision cannot be changed. In other words, if the patient chooses to file lab work charges with their insurance and the insurance company rejects the claim, the student is then liable for the charges. He/she will owe the full “regular” charge to the medical center and cannot then pay “Client Bill” charges.
It may make sense to take the “Client Bill” route under some circumstances such as:
- Privacy: If the tests are billed through insurance, then parents will usually receive a report of the tests ordered from their insurance company or the medical center.
- High deductible: Healthy patients who rarely use their health insurance may not meet their deductible if it is high. So for an acute illness such as mononucleosis where lab tests may be ordered, it makes sense to bypass the insurance company and pay the lower charges since those costs will be out of pocket anyway.
- Non-Covered Tests: Some insurance companies will not pay for certain screening tests without a “diagnosis” attached to them. So, if a healthy patient with such insurance wants a cholesterol test or blood typing those tests may not be covered and it may make sense to bypass the insurance company completely.
- Great Discrepancy between Client Bill prices and Medical Center Charges: In some cases, there is a great discrepancy between the two charges, so that even after filing with an insurance company, the patient’s share is greater than the bill would have been by paying up front.
2. For tests associated with a “diagnosis” and for patients with insurance companies that have low deductibles and reasonable co-pays on such tests, it may make sense to have the Medical Center file your lab charges with your insurance company. In that case, you would not pay at the time of check-out at the Student Health Center. You would later receive an EOB (Explanation of Benefits) from the insurance company and be billed by the Medical Center for any remaining charges after your insurance company paid their share.
The complexities involved in making the decision of “Client Bill” (pay up front) versus “Insurance Bill” are sometimes difficult for patients to sort out on their own. Your healthcare provider can help you make the right financial decision at the time that lab work is ordered if you are aware of your specific insurance information and coverage.