Billing Process

How Billing Works

Overview

How it works

At Counsyl, our goal is to bring transparency to healthcare billing, so you have all the information you need to make decisions about your care. We have designed a unique flow which allows you to receive a personalized cost estimate, learn about the available payment options, and choose the option that makes the most sense for you.

The process

How does billing work?

Learn more about Counsyl’s simple and transparent billing experience.

  • 1

    Before getting tested

    You can find out if Counsyl is an in-network provider with your insurance company. View the full list of insurance plans. We can also help you understand the different medical criteria and guidelines required for coverage of our tests.

  • 2

    Counsyl receives and starts processing your sample

    Ask your healthcare provider to order the test for you. Once Counsyl receives your sample, we will immediately start processing it to make sure you get your results as soon as possible.

  • 3

    You will receive a personalized cost estimate within two business days

    If you provided your contact information to your provider, you will receive an email or text linking to your personalized out-of-pocket cost estimate and payment options.

    Your estimate is based on the information provided with your order and the information we received from your insurance company. The estimate is not a bill or a guarantee of your costs. Your actual costs and benefits may vary depending on your insurance company and your specific benefit plan.

  • 4

    You review your payment options

    Your estimate explains your payment options including how to request financial assistance.

    When your sample has finished processing, we will file a claim with your insurance unless another payment option was chosen. Once we have filed a claim with your insurer, the option to pay without insurance will no longer be available.

  • 5

    You will receive your final invoice

    After your insurance processes the claim, we will send you an invoice for the final patient responsibility as determined by your insurer. If you chose to pay without insurance, you will receive an invoice once your sample is done processing. You can pay online, over the phone or by mail.

BILLING RESOURCES

Insurance 101

We want you to be informed about your healthcare costs and we’re here to help. We have put together a quick guide of insurance terms as well as some of the most frequently asked questions we have received about insurance.

You can also find out if we’re in-network with your insurance.

TERMINOLOGY

An overview of terms

This breakdown gives you an overview of how insurance works.

  • Your responsibility
  • Insurer's Responsibility
  • Overview
  • Deductible
  • Co-pay/Co-insurance
Your responsibility is the amount you should expect to pay.

This amount includes what you pay toward your deductible combined with any co-insurance or co-pay. Keep in mind that insurance will not pay until after your deductible has been met.

Whatever you pay for your in-network deductible, co-pay, and co-insurance will apply toward your annual out-of-pocket maximum. This is the most you are expected to pay in one year before insurance will pay the remaining cost for covered services.

More questions about insurance terminology? Check out these two resources:

Deductible

This is a specified amount of money that you must pay out-of-pocket before your insurer will pay for any healthcare expenses.

For example, let’s say that your health insurance plan has the following:

  • Deductible of $500
  • Coinsurance of 10%
  • Copay of $20

Before you’ve met your deductible, you would be responsible for 100% of the cost until you reach your $500 deductible.

Once you’ve met your deductible, you would be responsible for 10% of the cost of the covered healthcare service provided.

Keep in mind that whatever you pay towards your deductible will be contributed toward your annual out-of-pocket maximum.

More questions about insurance terminology? Check out these two resources:

Copay

A copay is a pre-determined, fixed amount you are required to pay for a covered healthcare service, usually at the time of service. The fixed amount is based on the type of service and can vary depending on your health benefit plan.

For example, let’s say that your health insurance plan has the following:

  • Deductible of $500
  • Coinsurance of 10%
  • Copay of $20

For a visit to your primary care physician, you would be responsible for $20.

Keep in mind that whatever you pay towards your coinsurance will be contributed toward your annual out-of-pocket maximum.

Co-insurance

Co-insurance is a portion of the amount you are required to pay for a covered healthcare service. The percentage is based on your insurance plan as well as the service. Co-insurance only applies after you have met your deductible.

For example, let’s say that your health insurance plan has the following:

  • Deductible of $500
  • Coinsurance of 10%
  • Copay of $20

Once you’ve met your deductible, you would be responsible for 10% of the cost of the covered healthcare service provided.

Keep in mind that whatever you pay towards your copay will be contributed toward your annual out-of-pocket maximum.

More questions about insurance terminology? Check out these two resources:

  • Insurer's Responsibility

Your health insurer’s responsibility

Your health insurer is responsible for paying some or all of your healthcare costs in exchange for a premium, which is usually paid each month jointly by you and your employer or solely by you.

More questions about insurance terminology? Check out these two resources:

FREQUENTLY ASKED QUESTIONS

Answers to common questions

What is a CPT code or a diagnosis code?

A Current Procedural Terminology (CPT) is a billing code. It is an identifier given to a medical/diagnostic procedure that describes the services rendered. These codes are used by hospitals, physicians and healthcare providers to communicate procedures or tests ordered to your insurance carrier.

Diagnosis (ICD-10) codes communicate why a medical procedure or test should be performed. Together with CPT codes, your physician, hospital and healthcare providers like Counsyl can tell your insurance carrier exactly what procedure or screen was performed and why.

See the CPT codes for our tests:

What is prior authorization?

Prior authorization is a process used by some health insurance companies to determine if they will cover a service. This authorization is usually needed before the service is rendered and some insurers have special requirements. Prior authorization is not a promise your health insurance or plan will cover the cost of the service.

As needed, Counsyl will work with your healthcare provider to request an authorization for this screen. Counsyl cannot guarantee that authorization will be provided in all cases and prior authorization is not a guarantee of coverage. Coverage may vary depending on product, location, specific benefit plan or the payor’s medical policy guidelines.

What is a health saving account (HSA), flexible spending account (FSA), and healthcare reimbursement account (HRA)?

A health savings or medical savings account is available to taxpayers who are enrolled in a High Deductible Health Plan. The funds contributed to the account are not subject to federal income tax. Funds must be used to pay for qualified medical expenses and roll over year to year if you do not spend them.

A flexible spending account is usually available through your employer to help pay for your out-of-pocket medical expenses with tax-free dollars. You decide how much of your pre-tax wages you want taken out of your paycheck and put into your FSA. There is no carry over for FSA funds.

A person’s employer funds a healthcare reimbursement account for them. It is used to reimburse employees for qualified medical expenses and is owned by the employer.

Counsyl screens fall under the category of laboratory fees and are generally eligible medical expenses for HSAs, FSAs, HRAs.

*Counsyl does not provide tax or legal advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax or legal advice.

If my insurance company says a test is covered, why would I get a bill?

Coverage does not necessarily mean that your insurance will pay the full cost of the service. It means that the cost of the service will apply toward your benefits, which includes your responsibility for any deductible, coinsurance and copayment amounts that you are required to pay under your specific benefit plan.

What is an Explanation of Benefits (EOB)?

An Explanation of Benefits or EOB is a document that your insurance carrier sends to you to indicate how much money they have paid a healthcare provider for services provided to you.

An EOB is not a bill. It is simply a notification of how your insurance processed the claim for your healthcare service. You should expect to receive an invoice separate from the EOB, which will tell you the final amount that you owe. See more EOB information here.

Learn more about billing

Counsyl Access Program

Learn more about how we make screening more accessible

How billing works

Learn about Counsyl’s unique billing experience and basic insurance terminology

Before ordering

Learn about each test, what affects your final cost, and available payment options

After ordering

Learn about your estimate and answers to common questions

Invoice & Payment

Understand your bill, how to pay, and available payment options