Billing Information for Healthcare Professionals
Billing Information Sheet
We want you to be able to focus on the care of your patients, and to leave the insurance process to us. We are committed to doing all we can to help your patients manage any expenses related to our tests.
Biotheranostics believes every clinically eligible patient should have access to our tests, independent of their insurance or financial status. We accept all insurance plans and offer a robust patient assistance program for patients in need.
This process starts with ensuring your patient's complete insurance information is provided on the Biotheranostics test requisition prior to sending it in to us.
We then contact the pathology department to have the specimen sent for testing. After the test is performed by us, the results are delivered to the ordering physician.
We bill the patient's insurance company. Biotheranostics' Patient Services Team is available to discuss the billing process and options that may be available to your patients to help manage any out-of-pocket expenses.
The billing process will take several months and during this time your patient will receive a communication from the insurance company called an Explanation of Benefits (EOB). This is NOT A BILL.
In addition to the EOB from the insurance company, your patient will receive a welcome letter from Biotheranostics that outlines our billing and appeals process and contains an important document that they will need to sign and return to us. This Authorization of Representation form allows us to appeal to insurance companies on a patient's behalf.
The insurance company will send payment to us for the test. Your patient may be responsible for a deductible, co-payment, and/or co-insurance as indicated by the insurance plan and required by federal/state regulations. Our Patient Assistance Program is designed to help manage these out of pocket expenses and is based on household income and financial responsibilities.
IF YOUR PATIENT IS A MEDICARE BENEFICIARY
Medicare accepts CancerTYPE ID® and Breast Cancer IndexSM as medically necessary and covers the tests at a predetermined rate with no fees charged to the patient when specific criteria are met under a local coverage determination (LCD)*. In most cases, Medicare will be billed directly. However, in certain situations with CancerTYPE ID®, we are obligated to bill the hospital; the “14 Day Rule” is a regulation set by the Centers for Medicare and Medicaid Services (CMS) that requires laboratories, including Biotheranostics, to bill the hospital for clinical laboratory services and the technical component of pathology services provided to Medicare patients when services are ordered less than 14 days after the patient was discharged.
IF YOUR PATIENT IS INSURED BY COMMERCIAL INSURANCE
We accept all insurance plans, and are currently in network with a growing number of plans. In the event your insurance company sends payment to your patient, please have your patient forward the check to us. If an insurance company denies coverage, we will work on behalf of the patient to attempt to obtain coverage and will assist in pursuing any appeals on the patient's behalf.
IF YOUR PATIENT DOES NOT HAVE INSURANCE
Biotheranostics will bill patients directly for services ordered. Please inform you patients that they can apply for assistance through our Patient Assistance Program or Payment Plan.
PATIENT ASSISTANCE PROGRAM
Our robust Patient Assistance Program can help lower the bill for patients. This requires patients to provide a paystub, W-2 or other documentation of income.
We offer a discounted “direct pay” price for patients who wish to pay cash for our testing. We offer a 6 month interest free payment plan option for patients who need to make payments in installments.
To discuss our Patient Assistance Program and eligibility requirements, contact our Patient Sevices Team at 1(844) 319-8111.