Usual and Customary Charge
If a patient's insurance carrier assigns a usual and customary charge (U&C) that is lower than SpectraCell's third party fee, SpectraCell will accept it and invoice the patient for the co-payment that is based on his/her insurance carrier's U&C - not SpectraCell's third party fee.

Insurance Denial
If a patient's claim is denied by his/her insurance carrier, SpectraCell's billing staff will file an appeal. If a patient's claim is still denied after appeal, the patient will then receive an invoice from SpectraCell explaining the claim denial by the insurance carrier. The patient will receive an invoice at SpectraCell's third party fee but will be offered a prompt-payment discount option.

Request for Medical Necessity
Insurance carriers occasionally request a statement of medical necessity pertaining to a claim that must be provided to SpectraCell by the patient's healthcare provider. Should SpectraCell need to contact the healthcare provider's office for this information, simply use the Request for Medical Necessity form that we provide instead of writing a letter, which will save time. Then simply fax or mail the completed form to SpectraCell's billing staff. The form may be completed by any member of the healthcare provider's staff, however, the healthcare provider must sign the form before forwarding it to SpectraCell.

Pre-Determination of Insurance Benefits
In an effort to assist our clients with the verification of insurance benefits for SpectraCell's test components, a Request for Pre-Determination of Insurance Benefits form is available by calling our billing staff at 800.227.5227. This form may be used as a guide when verifying benefits by telephone. If a written request is preferred by an insurance carrier, this form will need to be printed on the healthcare provider's letterhead to ensure proper handling by the insurance carrier.

Please be advised that most insurance carriers will include a disclaimer that the benefits they quote are not a guarantee of reimbursement.

There are a limited number of insurance carriers that will not cover SpectraCell’s testing, including:

The Guardian
Employers Health/Humana
UniCare
Principal Financial Group
American Medical Security
G.E.H.A. (Government Employees Health Administration)
Blue Cross/Blue Shield-Federal Employees Account

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