Optimizing your unique health journey

Insurance and Billing

Prometheus was founded to develop and provide diagnostic testing services for patients suffering with GI and autoimmune diseases. With a primary focus on the diagnosis, prognosis and monitoring of gastrointestinal and inflammatory diseases and disorders, our goal is to deliver products that help enable clinicians to optimize care and make a meaningful difference in their patients’ lives.

Prometheus offers a variety of specialty testing that may not be available at your regular laboratory facility. We recommend checking with your insurance company about your coverage and whether you may need prior authorization before having your specimen collected.

Prometheus may have agreements with hospitals or laboratories in your area, which may help lower your out-of-pocket expenses. If your physician does not direct you to a specific laboratory for testing, contact Client Services for assistance in locating a lab for specimen collection.

• Prometheus is a Medicare participating provider.
• As a courtesy, Prometheus will bill your primary insurance carrier (complete information must be provided), but we cannot predict the level of reimbursement.
• Prometheus may bill you for any unpaid balance due to deductibles, co-payments, co-insurance and non-covered services.

Payments

Payment for services is due upon receipt of an invoice from Prometheus. We accept payment by most major credit cards, check or money order. To ensure that your payment is processed correctly please include the patient name and patient reference ticket number(s) / ID number with your payment. Credit card payments can be processed by phone. Payment by mail should be sent to:

Prometheus Laboratories Inc.
2706 Media Center Dr.
P.O. Box 473173
Los Angeles, CA 90074-8731

If you feel that your insurance company should pay some or all of your bill, but your statement indicates that no claim was filed, please contact our billing department immediately with the information necessary to file a claim. If a claim was appropriately filed and you feel that your insurance company should pay some or all of the balance due, please contact your insurance company to resolve this as soon as possible.

If you have any questions about our services, please call our billing department at 888-892-8391. Our professional billing specialists can assist you Monday-Friday between the hours of 6:00am and 4:30pm PT (Closed from 12:00-1:00pm PT Thursdays).

No Surprises Act

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, under the No Surprises Act, you are protected from surprise billing or balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

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 also may have additional costs or have to pay the entire bill if you receive care from a provider that isn’t in your plan’s network.

• “Out-of-network” means the provider has not signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays 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 plan’s deductible or annual out-of-pocket limit.
• “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

What are your protections under the No Surprises Act?

You are protected from “balance billing” for:

1. Emergency services: If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get at the facility caring for you after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
2. Certain services at an in-network hospital or ambulatory surgical center: When you get services from an in-network hospital or ambulatory surgical center, certain providers that provide services in connection with your care may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
3. Certain services if your plan is subject to certain state-law requirements: Certain states have their own laws relating to balance or surprise billing with additional protections that might apply to your health plan. Click on your state below to learn about to get more information.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to Prometheus directly. Generally, your health plan must:

• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

What if you think you’ve been wrongly billed?

• If you have coverage regulated by your state, please click on your state below to learn more about contacting your state’s enforcement agency or the U.S. Department of Health & Human Services to file a complaint and/or for more information about your rights under state and/or federal law.
• If you have self-funded or self-insured coverage through your employer (federally regulated under ERISA), you may file a complaint with the federal government and/or learn more about your rights under federal law at www.cms.gov/nosurprises/consumers or by calling 800-985-3059. However, if your plan was issued in Georgia, Maine, Nevada, New Jersey, Virginia, Texas, or Washington, your plan may have opted-in to state law. Click on your state to learn more.

Alabama | Alaska | Arizona | Arkansas | California | Colorado | Connecticut | Delaware | District of Columbia | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | Maine | Maryland | Massachusetts | Michigan | Minnesota | Mississippi | Missouri |Montana | Nebraska | Nevada |New Hampshire | New Jersey | New Mexico | New York | North Carolina | North Dakota | Ohio | Oklahoma | Oregon | Pennsylvania | Rhode Island | South Carolina | South Dakota | Tennessee | Texas | Utah | Vermont | Virginia | Washington | West Virginia | Wisconsin | Wyoming

Prometheus last updated the following state-specific information in September 2024. Prometheus updates this information annually. This information does not have the force and effect of law and is not meant to bind the public in any way, unless specifically incorporated into a contract. This information is intended only to provide clarity to the public regarding existing balance billing requirements under the law. Please reach out to Prometheus at 888-892-8391 if you have any questions.

Uninsured and self-pay patients have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under federal law and regulations, health care providers, like Prometheus Laboratories (Prometheus), need to give patients who don’t have insurance or those who are not using insurance (self-pay) an estimate of the bill for medical items and services under certain specified circumstances.

Who is Entitled to a Good Faith Estimate?

Only patients who don’t have insurance or who are not using insurance are entitled to receive a good faith estimate under federal law.

When you are Entitled to a Good Faith Estimate

Under federal law, uninsured and self-pay patients have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services rendered by a provider when they:

• Schedule a service with a provider in advance or
• Request a good faith estimate from a provider before scheduling a service.

Content of the Estimate

The Good Faith Estimate must include, among other information relating the provider, items or services that are reasonably expected to be provided in conjunction with your scheduled or anticipated item or service. As a laboratory, Prometheus generally cannot provide an estimate of costs other than those for the laboratory or pathology services that it provides itself or arranges for you through other labs, such as the costs charged by the health care provider that orders your laboratory test.

Timing of the Good Faith Estimate

• When you schedule a service with Prometheus at least 3 business days in advance, it will provide you with a good faith estimate of your total cost for the service in 1 business day, or less, after the date of scheduling;
• When you schedule a service with Prometheus at least 10 business days in advance, it will provide you with a good faith estimate of your total cost for the service in 3 business days, or less, after the date of scheduling;
• When a good faith estimate is requested by an uninsured (or self-pay) individual, Prometheus will provide you with a good faith estimate of your total cost for the service in 3 business days, or less, after the date of the request.

Rights Affected by the Good Faith Estimate

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, either:

• Call Prometheus at 888-892-8391; or
• Visit www.cms.gov/nosurprises/consumer-protections/Understanding-costs-in-advance