PreventionGenetics Breast & Colon Cancer Billing Policy
This policy only applies to the following tests:
Hereditary Breast and Ovarian Cancer (HBOC)
Breast Cancer - High Risk
Breast Cancer - High / Moderate Risk
Breast Cancer - Comprehensive Risk
HBOC - BRCA1 & BRCA2
HBOC- High Risk and Lynch Syndrome
HBOC - Expanded and Lynch Syndrome
For other cancer tests, please refer to our General Billing Policy.
PreventionGenetics is committed to providing the highest quality genetic testing to all patients. Our philosophy is that genetic testing should enhance the quality of clinical care for the patient and be affordable to everyone. Regardless of the nature of payment or payer, we strive to provide the prices among the lowest in the market and therefore, our prices do not vary for different payment options. Our prices are transparent and openly published on our website.
We offer three (3) convenient payment options for testing services: we can bill the ordering institution/provider directly (institutional billing), we can bill the patient directly (self-pay), or we can bill the patient's commercial insurance company (insurance billing).
The billing option is selected on page 3 of the Breast and Colon Cancer Test Requisition Form (TRF). Simply check the appropriate billing option and provide only the information required for the selection as indicated on page 3 or 4. All appropriate billing information for the selected option must be provided prior to beginning the test.
Institutional Billing - We will invoice the institution or provider directly for the total test fee once the report has been sent to the ordering healthcare provider.
Self-pay (un-insured patient billing) - The individual accepting financial responsibility for the test fees must sign the acknowledgement statement on the TRF. The responsible billing party must be at least 18 years old.
We do not bill for the test until testing is complete. We do not require a credit card to be on file, however, having a credit card authorization on file allows for easy payment processing once the test has been completed. PreventionGenetics accepts Visa, MasterCard, and Discover. We can also accept payments by bank wire transfer, ACH, or check.
Insurance Billing - PreventionGenetics will file an insurance claim on behalf of the patient with any commercial insurance company. Page 4 of the TRF indicates the information needed for insurance billing. This section must be completed in its entirety before testing can begin. This includes additional information such as pre-authorization information, pertinent medical record information, and/or a letter of medical necessity.
Other than any unmet deductible, co-insurance, or co-payment amount(s) which is (are) the patient's responsibility, PreventionGenetics will accept the amount the insurance company pays as payment in full regardless whether we are considered in-network or not. We will not balance bill the patient.
Upon request, PreventionGenetics will file a pre-authorization on the patient's behalf with their insurance carrier. On all pre-authorization requests, we will call the patient to inform them of any unmet deductible, co-insurance, or co-payment that they will be responsible to pay. For assistance please complete the insurance Pre-verification/Pre-authorization Form found on our website or contact our insurance specialists.
MEDICARE AND MEDICAID
We are a contracted provider for Medicare and Wisconsin Medicaid. We do not accept any other state's Medicaid.
The patient must meet Medicare criteria for genetic testing in order for the services provided to be considered covered and reimbursable by Medicare. We do require Medicare patients to sign a completed Advance Beneficiary Notice (ABN) in advance of testing to acknowledge financial responsibility should the testing not meet Medicare criteria for covered service. For cancer tests that have specific testing criteria published by Medicare, we do not require an ABN as long as we have sufficient clinical information to support that the patient meets the criteria. Our genetic counseling team can assist with testing coverage details.
An invoice detailing date of service, patient name and date of birth (DOB), CPT Code, test name, and testing fee is generated once testing is complete and a report has been sent to the ordering healthcare provider. Date of service (DOS) on the invoice will be the accession date. If the DOS must reflect the date that testing is started (rather than accession date), please contact our billing team to make arrangements.
The invoice will be mailed to the responsible party selected in the billing option of the TRF. Payment is due 30 days from the date of the invoice, or 30 days from the date the insurance claim closes. We do offer interest free payment plans for self-pay individuals. Please contact our billing team to make arrangements.
Statements showing outstanding invoices and the balance due are mailed at the end of each month for self-pay invoices. Statements are also available for institutional billing services upon request.
If an insurance claim is filed, a monthly statement will be mailed to the patient indicating an insurance claim is in process. No payment will be required from the patient until the insurance claim has been processed and closed.
If you need to cancel a test, please contact our client services department.