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.
P.O. Box 748731
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).

Your Rights and Protections Against Surprise Medical Bills

When Prometheus is out-of-network with your insurance provider, and provides you with emergency care or laboratory services performed while you are at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s allowed copayments, coinsurance and/or deductible.

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

When you receive laboratory services from Prometheus, or 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 other costs or have to pay the entire bill if you receive care from a provider that is “out-of-network” for your health plan or insurer.
“Out-of-network” means the provider has not signed a contract with your health plan to provide services. If Prometheus is out-of-network for your plan or insurer, it may be allowed to bill you for the difference between what your plan agreed to pay Prometheus and the full amount Prometheus charged the plan for a service. This is called “balance billing.”
“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 that you do not or cannot choose.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility typically may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). 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.

Laboratory services at an in-network hospital or ambulatory surgical center

When you get laboratory services from an in-network hospital or ambulatory surgical center, Prometheus may be out-of-network. In these cases, the most Prometheus typically may bill you is your plan’s in-network cost-sharing amount.

Effect of Specific State Rules

Some states have their own laws that may control or influence what Prometheus can bill you for out-of-network laboratory services and which may be different from those described here.

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 also have these protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles) that you would pay if Prometheus was in-network. Your health plan will pay Prometheus directly.
• Your health plan generally 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 deductible and out-of-pocket limit.

If you think you’ve been wrongly billed: you may 1) contact Prometheus’s billing department at (888) 892- 8391; 2) file a complaint with the federal government at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059; and/or 3) file a complaint with your state balance billing regulator, if any, which is identified in the state-specific tabs below. 

Visit https://www.cms.gov/nosurprises for more information about your rights under federal law or visit your home state regulator’s website (included in state links below) for more information about your state balance billing rights.

Arizona | California | Colorado | Delaware | Florida | Georgia | Indiana | Maine | Maryland | Massachusetts | Mississippi  Missouri |Nebraska | Nevada |New Hampshire | New Jersey | New York | Ohio | Oregon | Pennsylvania | Texas | Virginia  Washington | West Virginia

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 1 (888) 892- 8391; or
• Visit https://www.cms.gov/nosurprises/consumer-protections/Understanding-costs-in-advance