Yes!   There are two convenient ways to process insurance cases:

 

1. Pre-verification of insurance coverage prior to sending in the sample. For Pre-verification:

• Fax a completed Test Request Form (TRF) to the fax number on the Contacts page.
• Clearly write “For Pre-verification” on the top of the test request form and on your fax cover letter.
• Fax a copy of all insurance cards (front and back).
• Please provide a brief Letter of Medical Necessity (LMN). 
• For HMO policies please provide a hard copy of the authorization. If a hard copy is not available please provide the authorization number and the effective date range on the billing page of the TRF
• Please allow several weeks for insurance verification.
• We will communicate the verified insurance benefits to the “Contact Person” on the TRF. MDL will not contact the patient directly.
• If the insurance provider denies benefits the following options are available:
       The patient can pay-out-of-pocket (see Billing).
       The billing can be transferred to institutional billing (see Billing).
       The patient can decide not to pursue testing.

 

2. Verification of insurance with a sample. MDL will receive the sample, perform the DNA extraction, and hold the sample until benefits have been verified with the insurance provider. (If you do not want the sample to be put on hold, and want testing to begin immediately, an alternate source of payment can be provided as a guarantee. (See Do all insurance cases have to be placed on hold during insurance processing?).
 
Requirements for insurance processing are:

• Send the sample with a completed test request form to MDL.
• Provide a copy of all insurance cards (front and back).
• Please provide a brief Letter of Medical Necessity (LMN). 
• For HMO policies please provide a hard copy of the authorization. If a hard copy is not available please provide the authorization number and the effective date range on the billing page of the Test Request Form.
• Please allow several weeks for insurance verification.
• We will communicate the verified insurance benefits to the “Contact Person” on the TRF. MDL will not contact the patient directly. 
• If the insurance provider denies benefits the following options are available:
       The patient can pay-out-of-pocket (see Billing).
       The billing can be transferred to institutional billing (see Billing).
       The patient can decide not to pursue testing.

All of the information required for normal insurance billing is required (see Does MDL accept insurance billing?). However, HMO policies require an authorization number for processing. If this number is not provided, insurance processing may be delayed. Authorizations for HMO's must be obtained by the patient's primary care physician.  (See What should be included in the insurance authorization for genetic testing at City of Hope?)

All insurance cases, even those for which a pre-authorization letter is provided, must be verified by City of Hope’s Financial Support Services department before testing can begin.  If you would like to avoid the delay of insurance processing, we can begin testing right away if an alternative method of payment is provided. Please write on the test request form “Please do not hold sample. If insurance is not covering the test, bill ____.” The reflex billing can be to either the referring institution or to the patient. For patient billing, a credit card or check must be provided.

MDL Accepts Medicare

 

Following an internal review, we no longer require an ABN for our Medicare cases in which a patient has a clinical diagnosis and the test is medically necessary.

Please remind your patient that there might be a patient component of the total cost of the test. Please feel free to contact us if you have any questions or concerns.

We accept Medi-Cal (Excluding California Medicaid with HMO). All Medi-Cal cases are also verified to determine eligibility.
We do not have established arrangements with Medicaid programs outside of California, and do not accept out of California Medicaid.

 

The following information must be included in the authorization:

 

 

• City of Hope Medical Foundation bills for CPT code 83912 – Tax ID # 953147370

 

• City of Hope Medical Center bills for all other CPT codes – Tax ID # 951683875.

 

Even if it requires two separate authorizations, both providers must be authorized by the insurance provider to perform the requested genetic testing.

 

 

For Example Only:
p53-SEQ     83890, 83898(x5), 83904(x5), 83894, 83912
p53-DEL      83890, 83896(x12), 83909, 83912

 

 

Note:  The Primary Care or Referring Physician and/or Genetic Counselor may need to provide some or all of the following to the insurance provider:  clinical data, diagnosis, procedure codes, letter of medical necessity and why tests are being done at City of Hope Medical Center and City of Hope Medical Foundation.  Once an Authorization is obtained, a copy needs to be faxed to City of Hope @ 626-301-8142. 

A list of insurance providers contracted with City of Hope is available.  

If your insurance provider is not on this list please contact our insurance coordinators for more up to date information.