Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Insurance Contracts

Our pathology group is independent of Lexington Medical Center (won't necessarily have same contracts as the hospital) and is a "contracted provider" of pathology services for a small number [see below] of the thousands  of insurance companies in the USA. We have contractually agreed to  fee schedules for this group, below, on which they pay a high percentage of their determination of our fee "allowable" (they reprice our bill according to their "allowable"...always less than our charge or fee schedule) after your deductible has been met (but, your deductible relates to the balance due based on the repriced bill & is why we urge you to be sure that our billing company has all of your up to date insurance info). Essentially all of the other companies  (except for Mail Handler's Benefit Plan) will allow/pay a substantial part of our fee by viewing us pathologists as "out-of-network providers".

Because our group MUST perform the pathology exams on all tissue and cytology specimens obtained in the Lexington Medical Center main hospital in West Columbia, or centers in the town of Lexington or the Lexington center in Irmo, your insurance must pay your bill from us (because you had no power to make your specimen go to their "preferred provider").

We are contracted with:

  • Aetna: Not contracted! We applied to be participating providers July 2003,  and their 16 July response stated, "I regret to inform you that the [provider] network in your area is currently at capacity, and we are not accepting new providers in your field of practice at this time." So, we could not even get to first base with them. But, we protested and have sent in the forms as of 15 August 2003. We have not been able to get any further response. Our hospital contracted as of 4/15/07 after an 18 month negotiation...we remain hopeful.
  • YES!...The Best Chance Network...female patients only, 803-750-1693
  • YES!...Blue Choice Health Plan of S. C., Inc. (replaces Companion as 1 July 2005)
  • YES!...Blue Cross Blue Shield Federal employees.
  • YES!...Blue Cross Blue Shield of S. C.
  • YES!...Blue Cross Blue Shield (State employees of S. C.).
  • YES!...Carolina Care Plan ( formerly Physicians Health Plan [PHP]). 803-750-7400 [On 5/8/07, announced to be bought by Medical Mutual of Ohio & is effective 1 Jan. 2009, Carolina Care Plan (CCP)/SuperMed].
  • YES!... Champus Tri-Care, 800-403-3950 or ; Humana Military healthcare services (HMHS) serviced TRICARE beginning in 2004; Palmetto Government Benefits Administrators, div. of BC-BS through 2006; then changed name to InStil Health Insurance Company, TRICARE HealthCare Services (of BC-BS).
  • YES!... Cigna (including Cigna-Healthsource, a CIGNA HealthCare Company, 800-720-3150) . As of 6/1/2011, we are also with GWH-CIGNA and Great-West Healthcare.
  • Companion (see MedCost) HealthCare a BC-BS of SC HMO: Not contracted! 803-786-8466 changed to BlueChoice, above.
  • YES!...Health Care Savings (HCS): by merger Jan. 2005 between Health Care Savings (operating subsidiary of Carolina Doctors Care of the North Carolina Medical Society) & Physician's Care Network, S.C. Medical Association's PCN insurance program; HCS bought 18 July 2006 by MedCost, see below.
  • DEFUNCT...HMO Blue: Not contracted! (as of 1 Jan. 2001...defunct as of 7/2003) .
  • YES!...InStil Health... see Champus-Tricare above.
  • YES!... Medicaid of S. C.: for sure, we are with state Medicaid, but not sure about private Medicaid, such as Healthy Connections
  • YES!...Medical Mutual of Ohio 800/523-8558 bought Carolina Care Plan & Premier Health Systems as of 1 January 2009, Premier/SuperMed Access, see Premier, below.
  • YES!...Medicare: we accept federal Medicare but not sure about the various Medicare HMOs, etc.
  • YES!... MedCost: 800-824-7406 as of 1 July 2003.
  • YES!...Palmetto SeniorCare (PSC): This is a Medicare replecement entity that does not require a contract and simply pays at Medicare rates; a PACE program in central South Carolina.
  • YES!... PCN...see Health Care Savings, above.
  • YES!... PHP...see Carolina Care Plan, above.
  • YES!... PPC...see Preferred Blue, below.
  • YES!...Preferred Blue of S. C. [formerly PPC] (BC-BS of SC), 800-288-2227
  • YES!... Premier Health Plan (Premier Health Systems, Inc.), 800-773-1445 [On 12/15/08, announced to be bought by Medical Mutual of Ohio & is effective 1 Jan. 2009 Premier/SuperMed Access]
  • Not contracted!...Private Healthcare Systems (PHCS): we began negotiations with this network April 2007...nothing ever materialized.
  • YES!... S. C. State Employees (BC-BS of SC), 800-868-2520 and click on "site index" and scroll down for "State Employees".
  • YES!...TRICARE...see Champus-Tricare, above.
  • YES!... United Health Care (UHC): Contract signed by us 11/22/04 & is in effect for dates of service 1/1/05 & beyond.
  • YES!...Vocational Rehabilitation.
  • YES!...WellPath/Coventry: We THOUGHT we began with them in Jan. 2011 but currently not sure.
  • YES!...Workers Compensation.

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(posted May 2002; last addition 7 July 2014)

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