Billing Overview
Please click on the questions below for answers to the most commonly asked questions regarding MDL's Billing Policies.
What is required for processing HMO insurance plans?
All of the information required for normal insurance billing is required (see Does MDL accept insurance billing?). However, HMO policies require a pre-authorization number for processing. If this number is not provided, the insurance processing cannot begin. Preauthorization for HMO's must be obtained by the patient's primary care physician.
Do all insurance cases have to be placed on hold during insurance processing?
All insurance cases, even ones for which a pre-authorization letter is provided, have to be verified by City of Hope’s billing department. If you would like to avoid the delay of insurance processing, we can begin the test 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.
What is institutional billing?
We offer discounted rates for clients that establish a LINK:discounted billing agreement with us and that allow MDL to invoice the ordering institution directly. Institutions are invoiced within 30 days of completion of the test. Please contact us at mdl@coh.org for a price list
Patient Billing
For patient billing, prepayment for the testing services is required. Certain tests are discounted for out-of-pocket(Please email mdl@coh.org for information). Payment may be by a personal or bank check or by credit card (VISA, MasterCard, Discover, and American Express).
Does MDL accept insurance billing?

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

1. Verification of insurance coverage before sending in the sample. MDL will verify coverage the case before the sample is sent in. For verification: 

  • Fax a completed Test Request Form (TRF) to the fax number on the Contacts page.
  • Clearly write “For Verification” on the top of the test request form and on the fax cover letter.
  • Fax a copy of the insurance card (front and back).
  • Many insurance companies require a letter of medical necessity. It is not required to provide one, however it is strongly recommended.
  • HMO samples are handled differently; please see What is required for processing HMO insurance plans?
  • Allow several weeks for insurance verification.
  • We will contact the “contact person” to let them know what the insurance company will cover. 
  • If the insurance company has denied the claim or the patient is not willing to cover the remainder of the cost, the following options are available:
     The billing can be transferred to institutional billing (see Institutional Billing).
     The patient can decide not to pursue testing.

Here is the Test Request Form (TRF) Sample for Insurance Billing

2. Regular insurance processing. MDL will receive the sample, do the DNA extraction, and hold the sample until the insurance company has decided upon coverage. (If you do not want your sample to be put on hold, 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 the insurance card (front and back).
  • Many insurance companies require a letter of medical necessity. It is not required to provide one, however it is highly recommended.
  • HMO samples are handled differently, please see What is required for processing HMO insurance plans?
  • Allow several weeks for insurance verification.
  • We will contact the “contact person” to let them know what the insurance company will cover.
  • If the insurance company has denied the claim or the patient is not willing to cover the remainder of the cost, the following options are available:
     The billing can be transferred to institutional billing.(see Institutional Billing).
     MDL can cancel the test with no charge for the DNA extraction.

We do not accept Medicaid from states other than California.

Does MDL Accept Medicare?
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.
Does MDL Accept Medicaid?
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.
Which insurance providers are contracted with City of Hope?
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.

 Contact MDL

Client Services
Molecular Diagnostic Laboratory
City of Hope
1500 East Duarte Road
Northwest Building - Second Floor, Room 2236
Duarte, CA 91010
888-8 COH DNA (888-826-4362)
fax: (626) 301-8142
e-mail: mdl@coh.org  
secure e-mail service: https://smail.coh.org/  
secure e-mail help: 626-256-4673, ext: 64357
web: http://www.cityofhope.org/mdl  

© 2012 City of Hope.
1500 East Duarte Road
Duarte, California 91010
626-256-HOPE (4673)
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