Billing

Yes, UC Davis Dermatopathology offers third party billing for these services. If a pre-authorization for the services is required by the patient’s insurance, the referring physician is responsible for obtaining that authorization.

Yes, we can bill for cases that are not patient specific. Please email our us to discuss your specific interest and the representative can confirm that the specific work can be done.

HS-DermpathBilling@ucdavis.edu or call directly 916-551-2692 or 866-323-9061

UC Davis Dermatopathology does accept limited healthcare insurance outside the state of California. That said, use of UC Davis Dermatopathology services by out of state patients often requires pre-authorization. We recommend confirming coverage directly with the patient’s insurance company.

We do have the capability to review insurance and possibly do a one-time contract through our contracts department with a Letter of Acceptance (LOA). Please contact us if you are interested so the information required can be obtained. This can take up to 24-48 hours.

 HS-DermpathBilling@ucdavis.edu or call directly 916-551-2692 or 866-323-9061

Please email our billing representative at  HS-DermpathBilling@ucdavis.edu or call directly 916-551-2692 or 866-323-9061

For bills email:  HS-DermpathBilling@ucdavis.edu call directly 916-551-2692 or 866-323-9061

Please fill out the UC Davis Dermatopathology Lab request intake form and instructions, with patients’ demographics and billing information https://health.ucdavis.edu/dermatopathology/

Yes, your report is about you, and you have a right to receive a copy. However, we strongly recommend that you review your report with your medical practitioner to establish the most effective treatment plan for you.

Your physician, or another lab, referred your biopsy or slides to our Service for processing and interpretation. Our services are billed separately from your treating physician's services

HS-DermpathBilling@ucdavis.edu or call directly 916-551-2692 or 866-323-9061

Please see below our list of accepted insurances. As each insurance plan differs, and plans offered by the same insurer may have different levels of coverage, we suggest contacting the insurance company directly to confirm status. You may be asked for our group NPI or Tax ID.

Coverage for testing at UC Davis Dermatopathology is determined by the patient’s insurance company and is based on the provisions of the specific plan.

UC Davis Dermatopathology involve two separate components. First is the technical services related to processing the specimen and the second is the professional services related to the physician work of interpreting those results and rendering diagnosis. Our physician and hospital technical services each have an NPI and Tax ID number (below).

                Professional Services                                                                     Technical Services

Group NPI: 1043208948                                                                  Group NPI: 1710918545

Group Tax ID: 68-0334324                                                             Group Tax ID: 94-6036494

No. Out-of-pocket costs of copays, deductibles, and coinsurance are part of the benefit design with your health coverage, and you are expected to pay these amounts up to the out-of-pocket maximum limit defined by your coverage. Note that in-network benefits can differ significantly from out-of-network benefits. You may have higher out-of-pocket costs if your coverage is considered out-of-network at UC Davis Health.

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or must pay the entire bill if you see a provider or visit a health care facility that is not in your health plan’s network. “Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you cannot control who provides your care. Emergency care or being treated by an out-of-network provider at an in-network clinic are examples of when they may occur.

The No Surprises Act takes effect on January 1, 2022, and provides patients financial protections against surprise medical bills, and prohibits balance billing for certain out-of-network (OON) care.

Individuals with Medicare, Medicare Advantage, Medicaid/Medi-Cal, Indian Health Services, VA health care, or TRICARE insurance plans are not covered under the No Surprises Act because these federal insurance programs have existing protections in place to minimize large, unforeseen bills.

                                Protections Against Surprise Medical Bills (No Surprises Act)

Consumer Protection Disclosure

In addition, UC Davis Health will provide patients with a Consumer Protection Disclosure that includes information in clear and understandable language which explains:

• When there are bans on balance billing
• Any state laws that protect you from balance billing
• What state or federal agency to contact if you think your provider or hospital has not followed the bans on balance billing

Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate (“Good Faith Estimate”) of the bill for medical items. Please contact your treating physician for any estimates related to your care

No. But you will likely pay higher out-of-pocket costs when seeing an out-of-network provider.

Your insurance provider will send you an Explanation of Benefits (EOB) notice that details the amount it has paid, any non-covered or denied amounts and the remaining balance that you are responsible for paying. Review your EOB carefully, compare it to your hospital and/or Physician paper statement and call your insurance provider or a Customer Service Representative right away if you have questions or concerns.

The most common insurance denials received on claims are:

• Your insurance carrier needs additional information from you
• You were not covered by your insurance plan on the date of service
• No authorization/referral is on file for services
• The service you received was not covered under your plan
• The insurance information recorded at the time of service was inaccurate, incomplete, or outdated.

If you need to update any information, please contact us

 HS-DermpathBilling@ucdavis.edu or call directly 916-551-2692 or 866-323-9061

Through UC Davis Health vision to heal humanity through science and compassion, one patient at a time, ensuring that all patients are treated with dignity and respect is a priority. To better understand patient rights and their responsibilities, information is available through a variety of ways such as posters in all clinical areas, brochures, braille booklets, and audio files.

https://health.ucdavis.edu/medicalcenter/patients/patient_rights.html

Preauthorization vs prior authorization

Prior authorization is also referred to as preauthorization. These terms are used interchangeably, and both refer to a medical necessity review made by health insurance providers for patients to receive the approval before care is provided (except for a medical emergency). This allows health insurance providers to determine if a medical process or care is necessary or, in some situations, covered. If a treatment is not deemed necessary, there will be no reimbursement. The standards for this review are developed by insurance companies through medical guidelines, utilization, cost, etc.

If an insurance company determines there’s a need for the PA request, the healthcare provider will have to find out additional details about each CPT code (aka diagnosis code). Additionally, when submitting the final claim, it must get the payer's unique number that matches to the earlier auth request and include it.

Prior authorization forms may differ from plan to plan, but usually health professionals need to provide provider information.

Prior authorization vs referral

Referral is a written order by a primary care physician that asks a patient to see a specialist or receive medical services. Many healthcare organizations require that patients get a referral before they receive medical care from anyone that’s not their primary care provider (PCP). If a patient goes to see a specialist without the approval of their primary care provider, the patient will have to bear almost all the cost of the treatment. A patient will also have to bear the cost of the treatment if they see a specialist that’s not credentialed by the insurance company.

Prior authorization, on the other hand, is used to determine if a service is medically necessary. Insurance companies use prior authorization to see if a patient is eligible to receive certain procedures. 

Prior authorization is usually the first step to ensuring that patients have the medical insurance to provide payment for whatever medical procedure they need. It simply functions as a means of confirming a patient's eligibility for specific treatment without stating how much coverage.

There are many reasons why we would require prior authorization for services:

• Your insurance is an HMO (Health Managed Organization), such as Kaiser, Hills Physician, Sutter, Mercy, etc.
• Your insurance is not contracted with UCDHS and is considered Out of Network (OON), such as EPO (Exclusive Provider Organization) or narrow network plans

These processes can take time to complete and will defer treatment for the patient, we do offer other ways for the patient to pay out of pocket at our discounted cash rate.

Prior Authorization usually is completed by the treating physician, but sometimes patients can reach out to their insurance plan directly to obtain one. If you would like to obtain authorization for these services, please make sure to request the following:

While the format and requested information for prior authorization form may differ from plan to plan, they generally require this information below:

• Identifying information for the member/patient such as:
• Name, gender, date of birth, address, health insurance member number and other contact information
• Identifying information for the referring physician and servicing physician
• Information including the Provider Name and National Provider Identification Number
• UCDHS Dermatopathology NPI# 1043208945
• UCDHS Dermatopathology Tax ID# 68-0334324
• Clinical information specific to the treatment requested
• Service type requiring authorization, UCD Dermatopathology is an Ancillary Service
• Service start date
• CPT and ICD codes

The following CPT:

• 88305 x1
• 88312 x1
• 88313 x1
• 88342 x1
• 88341 x3
• 88321 x1
• 88323 x1

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The Board of Regents has designated the University of California as a HIPAA hybrid covered entity. The university is a Single Health Care Component for the purposes of complying with the HIPAA Rule. All entities at UC covered by the HIPAA Privacy and Security Rules — medical centers, medical clinics, health care providers, health plans, student health centers — are a single entity for purposes of compliance with HIPAA.

Medical research, however, is excluded from HIPAA coverage at UC. As such, research health information that is not associated with a health care service is not subject to the HIPAA Privacy Rule. Other state and federal laws govern privacy and confidentiality of personal health information obtained in research.

For more information please see the US Department of Health and Human Services HIPAA informational pages.

The Privacy Rule

The HIPAA Privacy Rule created federal standards to protect individuals’ medical records and protected health information (PHI). These standards apply to health plans and health care providers that conduct certain electronic health care transactions. The Privacy Rule requires reasonable safeguards to protect the privacy of PHI and limits the types of use and disclosures that may be made regarding such information without patient authorization. The Privacy Rule also gives patient rights over their health information, including, but not limited to. the right to view and obtain a copy of their health records and to request corrections.

The UC Davis Health Notice of Privacy Practices details patient privacy rights and how patient medical information is used and disclosed at UCD Health.

UC Davis Health patients can request copies or changes of their medical records from the Health Information Management Department (HIM).

More information on both HIPAA for individuals and patients and HIPAA for health care providers and professionals is available from the U.S. Department of Health & Human Services.