Why Patients Aren’t Paying Your Lab Tests and How to Fix It

Aug 9, 2023 | Blogs

The medical laboratory billing process is an essential piece in effectively managing and growing a laboratory. Without giving proper attention to setting up an efficient billing environment before laboratories send claims out, patients are increasingly being driven away by the complexities and frustrations associated with completing the billing process: paying the lab. The most common reasons behind patients’ reluctance to pay their medical laboratory bills can often be avoided by partnering with an experienced outsourced vendor who has solutions to these issues.


Lack of Price Transparency in Laboratory Billing


One of the primary challenges patients face is the lack of price transparency in the laboratory billing process. Many patients are unaware of the costs associated with specific tests and procedures, making it difficult for them to plan for potential expenses. The absence of clear, upfront pricing information can leave patients feeling apprehensive about seeking medical lab services and raises concerns about unexpected financial burdens. The No Surprises Act has played a large role in preventing surprise costs from landing on patients’ bill. If your lab is not equipped with providing clear pricing upfront, you risk delayed revenue as well as facing compliance violations.

Confusing Laboratory Billing Terminology


Laboratory billing often involves complex codes and technical jargon that can be challenging for patients to understand. The use of unfamiliar terminology in billing statements can create confusion and miscommunication, leading to delayed or incorrect payments. Patients may become frustrated and overwhelmed, feeling as though they are being presented with a convoluted system they cannot navigate. Many lab’s in-house billing teams are not trained for answering complex questions from patients, or their current outsourced vendor off-shores staff who present patients with more frustrations and lack of knowledge to their claim. Patients who do not have access to laboratory billing staff who can readily answer their questions are left frustrated and confused about why they owe money and are less likely to ever return that money to the lab. An experienced, local patient support team is necessary for encouraging more patient payments, faster.


Insurance Complications and Denials


Navigating insurance coverage can be a daunting task for patients seeking medical lab services. Complicated insurance policies, unclear coverage guidelines, and unexpected claim denials contribute to the growing frustration among patients. Denials may result from incorrect coding, lack of prior-authorization, or other administrative errors, leaving patients to bear the brunt of unexpected costs and, in some cases, leading them to avoid future lab tests altogether. A clean claim submitted correctly the first time has the highest chance of being paid, and most lab’s fall short with in-house teams or outsourced vendors who cannot keep up with payer requirements, correct coding and documents, and other requirements that are specific to laboratory billing that are not seen in other medical billing processes.

This is where true experience, knowledge, and technology play a role in a successful and efficient billing environment. Automations and claim scrubbing used specifically for lab billing can prevent up to 90% of upfront errors that may cause denials. A team of responsive, trained professionals can handle coding complexities, insurance follow up, and prior authorizations when claims have more complex issues to be addressed.


Delayed Billing and Inconsistent Charges


Lab bills are often not promptly delivered to patients, leading to delays in payment processing. Patients may receive bills long after their visits, making it challenging to remember the specific details of the tests performed. Moreover, the inconsistency in billing charges for the same service at different facilities can cause confusion and undermine patients’ trust in the healthcare system. Timely filing and clear, digestible statements can help patients better understand where their bill is from and for what procedure. Automations, accurate claim scrubbing and submission, clear statements, accessible payment options, and a team of on-shore, trained staff all contribute to saving time and lost revenue.

Financial Burden and Fear of Debt


For many patients, the financial burden of medical lab services can be overwhelming, especially when coupled with other medical expenses. Fear of accumulating medical debt can prevent individuals from paying their existing bills in a timely manner. Helping patients understand they have both time and options when it comes to paying their laboratory bill can help you receive delayed or partial reimbursement owed as opposed to none at all. Laboratory billing statements that encourage patients to speak with a representative can help you get in contact with them to explain their due dates and responsibilities can allow some patients relief if they cannot pay right away. Some lab’s may also opt to include payment plans and reduced prompt pay discounts to further encourage collecting reimbursement. Having a seamless and digestible system of statements to patient support teams is vital in helping recover lost revenue from patients who fear the financial burden of your laboratory bill.


 Better Your Patient-Focus to Better Your Lab’s Reimbursements


The laboratory billing process plays a significant role in shaping patients’ perceptions of the healthcare system and their own access to better health. The lack of price transparency, confusing billing terminology, insurance complexities, delayed billing, and inconsistent charges all contribute to patient dissatisfaction and drive them away from paying for their lab services. To address this issue, laboratory stakeholders must prioritize patient-centric billing practices, ensuring that pricing information is transparent, billing statements are clear and easy to comprehend, insurance coverage is efficiently managed, and their billing environment is equipped with expert staff and technology built for labs.

Efforts to streamline the billing process, enhance communication with patients regarding costs, and implement technology solutions for more efficient billing and claims management can help alleviate the burdens associated with medical lab billing. A trusted billing partner who only serves laboratories can both provide end-to-end solutions as well as promote the growth of your lab.

Contact our team of experts today to see how Phytest can partner with you to help your lab expand capability for growth and increase collections.


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