Frequently Asked Questions About Health Plans and Billing

Do you accept the same health plans that the hospital accepts?

Yes. Actually we are members of most of the health plans in the area, including Monarch Health Care. However, Monarch Health Care HMO patients seeking clinical outpatient lab services must go to their specific contracted lab.

Will we received a bill from the pathologist for their service?

We submit our bill to your health plan only for our professional service. This generally means billing your health plan for the actual microscopic interpretation of your biopsy or other tissue. A separate bill from the hospital is submitted to the health plan for the technical aspects of the biopsy. This includes the preparation and staining of the actual microscopic slides by a histotechnologist, chemical reagents and instrumentation, and transcription of the surgical pathology report.

How does the billing work if my biopsy requires additional studies or review from another institution?

If we decide that additional studies or expertise is needed on your biopsy, we may have to send your biopsy out to a larger reference laboratory or to an academic institution such as Stanford Medical Center. Any additional charges will be billed to your health plan by the consultant (pathology expert or outside laboratory).

Who handles the billing for the professional services of the pathologists at SCMC?

The pathologists at SCMC are members of Laguna Pathology Medical Group, Inc. All billing for professional service is managed by MEDICORP, a local billing service based in Laguna Niguel. Any questions concerning your bill for professional pathology service from Laguna Pathology Medical Group, Inc. should be directed to MEDICORP. They maintain all the billing and health plan records for all of our patients. They may be reached at (949) 643-3345.