MedTest Laboratories will bill the hospital, reference laboratory, clinic, medical group, patient’s insurance company or the patient according to the necessary billing information provided at the time of testing.
MedTest Laboratories is a participating provider for several of the insurance providers. Please complete the insurance information on the requisition form and provide copy of the both sides of the insurance card.
Patient’s full name
Patient’s full address
Patient’s date of birth
Guarantor’s (insured person’s) group number
Guarantor’s (insured person’s) policy number
Advanced Beneficiary Notice (ABN) Form if needed
Appropriate ICD-9 code
Referring physician’s full name/signature