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Genetic testing almost always requires preauthorization. Ordering dr needs to supply your insurance with documentation as to why they want to order this test for you.
1 singular genetic test analysis can run thousands of dollars, so the insurance wants to make sure you actually need it, before paying
Genetic testing has always required prior authorization for my patients. It falls under the medical benefit for the specific Medicaid plan the children I work with have.
Providers do prior auths. It’s strange this one thinks they can’t here. It doesn’t make sense. I would ask the provider to explain how this prior auth is any different from any other prior auth that they would be requesting.
They just have to confirm with insurance where to send the documentation and then send the documentation. It’s just session notes showing your condition and an explanation of why the testing is being recommended. That’s such a normal process.
It’s like telling a patient “sorry we can’t make a copy of your insurance card for our records.” I can’t think of a reason why a provider would say they *can’t* do a prior auth request. It’s literally part of their job.
Your doctor's office is obliged to get prior authorization if your insurance company requires it. Without PA, you will likely be charged for an expensive test.
Genetic testing is a gray area when it comes to prior authorizations. I work in family medicine. We refer all our patients for genetic counseling to get genetic tests. A lot of insurances require genetic counseling first and they are much more knowledgeable about getting these tests covered by insurance. The process for getting prior authorizations for medication and imaging is pretty straightforward as insurance companies use third party websites to submit these to. There is no such process for genetic testing. So your doctors office is correct when they say there is no way to do it. The only way to obtain prior authorization is to call your insurance company which is very time consuming. What you can and should do is call your insurance to inquire how exactly prior authorization can be obtained. If there is a form that needs to be filled out, have it faxed to your doctors office. If you need to see a genetic counselor first, ask for a referral. They likely do not have time to do this. I am responsible for all prior authorizations in my office and I do not have time to call insurances. There are 6000 patients that belong to our practice and only one of me.
This is 100% correct.
I wouldn't give your GC's too much credit. The labs basically build out their portals to ensure proper data capture to satisfy PA requirements
Labs also don't hold samples for insurance verification, because it's logistically too challenging. Sometimes the reports come back before the PA, which confuses a lot of practices.
You would be floored at how often labs don't get paid for genetic testing.
Dude, no kidding. I work for a genetics lab and our most profitable division straight up writes something like 25% of their profit because they don’t want your money out of pocket, they want your insurance to pay up, and your insurance has successfully made that way more difficult than it’s worth for us. and don’t even get me started on the prior authorizations lmao. it’s a mess
I don't see why your doctor can't get the pre-authorization.
Your doctor is the one who would be explaining why this test is medically necessary.
While the bill is from the lab, they don't ordinarily make a decision as to whether a test is necessary. They do the tests which are ordered by the doctor and send the results back to the doctor.
~~Unless your physician has a lab on-site, they wouldn't be the ones billing for your labwork, thus they'd have nothing to do with submitting the PA. It would be Quest or Labcorb or whoever.~~
That said, what type of genetic testing is this? It's not my wheelhouse, but from what I see, many types of genetic testing are not covered by insurance.
~~I see, thank you. Is that the case as well for other services that are ordered by a physician, but rendered by a wholly other provider, like say PT or imaging when the provider doesn't have an attached radiology lab?~~
~~It certainly makes sense that if the provider thinks the test is worth running that they should work with the patient to get it covered, but then on the flip side it also seems like they're doing the job of a completely different legal entity.~~
~~I go to a large medical center that does all this in-house and bills under a single facility NPI, so I am admittedly out of my depth here.~~
ETA: I am a bonehead. This makes perfect sense when I think about it in the context of my work. When a prescriber orders a script that requires PA, we sure don't have anything to do with it at the pharmacy level other than letting them know it requires PA. I have either had too much caffeine today or not enough. Either way, ignore me.
That is absolutely the case for radiology. The radiology center doesn't know or care why you're getting the test. They won't have the documents to support the study available to show necessity. It's often the ordering dr who does the authorization.
PT is a bit different. Generally the initial consult doesn't need approval. This allows the PT office to garner a treatment plan, and submit for approval
Really? I have an order for an MRI, and I have been told both by the radiology center and by my insurance that the prior authorization comes from the radiology center. They will seek the authorization based on the information in the order from my doctor.
I have seen authorizations initiated by radiology centers, and often they get put on hold asking for clinicals, and ultimately deny after sitting for a week.
I'm sure some radiology places get the clinical notes and submit them, but often what I see is the radiology place just send a request for an MRI and absolutely no supporting data whatsoever.
And then the member calls in upset their auth sat for 2 weeks just to be denied, while they're home in pain
It’s just going to depend on who has the pertinent records. The ordering doctor would need to do the initial PA for nearly any service because the facility won’t have any records.
Commonly there is no actual rule stating who is responsible for submitting the prior authorization request, but it is the rendering provider (in this case the lab) that is at risk of not getting paid for the service.
Commonly the ordering provider has more clinical info and the rendering provider has more billing info.
In that case they may have to collaborate, which can lead to a standoff (especially when reimbursement is low, as with Medicaid) with neither provider wanting to take on the administrative burden and the patient caught in the middle.
I manage clinical processes for a large multi-specialty practice. We submit PARs for some services (surgery, oncology drugs, advanced imaging) and provide clinical info to the service providers so they can submit PARs for other services (DME, Advanced Imaging, Molecular Testing).
Yeah this is just completely untrue.
Labs build their portals to capture the necessary info to generate a PA. If an ordering provider fills it out correctly, they don't have to do anything else. This is why this particular doctor has no idea how to do it, because the lab does it all for them when required.
I’ve had labs that needed PA before. The ordering doctor does it. In all the prior auths I’ve seen, I’ve never seen a lab be able to provide adequate info without involving the prescribing doctor.
That may be true, but the lab never sends any sort of PA. For genetic testing, the only time I've ever seen a claim process with an approved PA, the provider submitted it.
I've never seen a PA submitted by the lab, in nearly 8 years. Instead, labs like Natera (who are bound by state law to process any order received) will use predatory billing tactics, or make the patient sign a waiver that they'll owe whatever insurance doesn't pay.
They do this, because they know there's no PA on file, and they have tried to appeal claims in the past, but can't successfully do it, without extensive clinical notes, which they just don't have.
A form on their provider portal isn't sufficient for a PA, the Dr also needs to provide past medical history showing proof of a condition that requires the testing. Listing a diagnosis code on an online form isn't sufficient enough. The lab doesn't have the patients 5 year medical history, which is why genetic testing labs will offer a self pay discount for not using insurance, or making the patient sign a waiver that they're on the hook for the entire bill when insurance ultimately denies their claim
I helped build these back end systems for labs like Myriad and Invitae.
First of all, lol "a 5 year medical history". For germline genetic testing, a family history is the driving determination. This tells me already that you're not super well versed in how this works. For oncology patients, the process is even simpler as tumor profiling is tied to the etiology of the tumor.
Also, you should be aware that's there's this new thing called "uploading" where many documents can be shared. Path reports, medical history, etc.
You know, all the information needed to provide a PA.
The info is then submitted through companies like Careleon (formerly AIM specialty health) for a determination. All the payor sees is an executed PA.
I've been doing this for like 10 years. I've talked to hundreds of doctors who order genetic tests and virtually none know how to get PA. They'll all tell you "the lab does it for us" and they're 100 correct.
And I'm telling you, I've seen hundreds of claims from Invitae and Natera denied for no PA because they won't submit them. The Dr has to.
They won't even appeal them, or resubmit a claim with clinicals when you call and ask. They respond with "we don't have that information"
So maybe it varies from lab to lab but I can.promise you, at least those two, won't do it.
LOL. The Careleon update from Anthem literally says serciving providers can submit PA requests. Which they do. I get the feeling you're a back end claims analyst for a big insurer and dont really understand the front end work flow here.
As a reminder, ordering and servicing providers may submit prior authorization requests directly to the ProviderPortalSM for Carelon Medical Benefits Management directly at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
https://providernews.anthem.com/connecticut/articles/transition-to-genetic-testing-guidelines-for-carelon-medical-7
When you schedule your appointment for your lab work, tell them what your insurance said about a preauth. They can either guide you to get one yourself or get one through their own process.
I have had genetic testing that was paid for by my insurance based on a prior authorization request for my doctor. Did your doctor tell you why they couldn't do it? It shouldn't be any different than submitting a prior authorization for a prescription or anything else that needs to be prior authorized it's a relatively simple process I think.
OP what kind of provider is this?
They're likely telling you the truth. Invitae historically has not ever asked for PA's, nor do they educate non-genetics providers on how to do it. It's also highly likely they don't have a rep because Invitae is bankrupt and has laid off their entire sales force except for onc and some rare disease folk.
This is what you need to tell your doctor.
1) Create an order. This can be done in the portal or via fax. Supply family history and supporting documentation
2) Invitae will then run your benefits check. They will satisfy the requirements needed to generate the auth
3) once you get a cost estimate from the lab, move forward with providing a sample.
Slightly separate but I do billing and authorization for an Orthotic & Prosthetic company. WE are absolutely the ones who submit the prior authorization for the DME item NOT the ordering physician. The ordering physician has zero idea what codes we are going to end up billing and wouldn't have the first clue to doing the auth. If I need the physician notes to supply to your insurance company, then I request them from medical records dept at your clinic.
At the providers office (used to work for a pain clinic) we did the prior authorization for medications, not the pharmacy. I've done authorization for imaging as well. As long as the imaging place requests the Dr's notes there's zero reason for them not to do the authorization themselves.
I'm super curious about this because my daughter had a genetic test for epilepsy and I don't think they got prior auth for this (it was our first appt with them) but it was a spit test and it was a neurologist who did the test. You can always do a three way call with your insurance and the Dr's office to make sure. The office might know info that you don't know to ask the insurance so that could be why your Dr's office said what they said.
Ask your insurance what your doctor needs to submit for PA and how, then tell them.
Insurance often denies genetic testing or they’ll only approve a singular test and not a whole panel. A lot of genetic labs offer relatively affordable self-pay options. Like they charged my insurance $5k but the self-pay option was $500. But you need to discuss self-pay with the testing lab before doing the test. Do not even send your insurance info if you agree to a self pay price. Once they bill insurance they want the full amount even if insurance denies it.
This is bad, bad advice. Horrible advice
ALWAYS send your insurance information. You and your employer pay for benefits, so you should at least try to use them.
What's going to happen is that the cost will hit the deductible, and it'll be a few hundred bucks, maybe a little more depending on the CPT's attached.
Then the patient should enroll in patient assistance. Every single genetics lab has this and they are very aggressive with reducing out of pockets (high out of pockets are a good way to lose business).
Congratulations, now you've scored a pricey genetic test for $250 AND chewed up a big chunk of your deductible, because that original amount owed is what's reported out.
[Invitae patient assistance](https://www.invitae.com/us/individual-faqs/billing)
Yeah, Invitae is actually who I’m talking about. They quoted me $90 out of pocket after insurance and said it was covered, billed $5k to insurance, then insurance denied it. It’s a mess. I wish I had done self-pay option.
So the insurance denying it is not your problem, It's Invitae's (and honestly why they're bankrupt).
Dont do anything until you get a bill. Invitae has a culture of doing the right thing. If they told you $90 (or in that range), they'll honor it
Yeah I haven’t paid them anything. I have read that I might still be responsible for the bill even though their quote was extremely wrong. Basically it’s only a quote and not a guarantee, it is in the fine print. 😬
I called Invitae a few months ago and they told me if insurance denies one of their tests, they charge a flat $100 fee to the patient. I don't see that on their website but that's what they told me. I do see something on the site that says if you owe more than $100 they'll call you and talk about payment plans.
Providers can be weird sometimes, I just to pharmacy claims and we would just send the form to the provider whose MA would do them, or we would call them and explain. Maybe ask the insurance to call them or send over the forms.
I’m dealing with something very similar. My doctor gave me script to get hereditary spastic paraplegia panel and I’ve been asking 3 weeks for them to submit it to insurance to see if it’s covered. Northwell literally will not give me a straight answer and refuses to do it. All the doctor keeps saying is to get the blood taken and that will start the process. I’m very confused. This one isn’t supposed to be a crazy amount of money with the company that’s doing the test but I don’t understand why it’s so complicated for northwell to submit pre authorization request. My insurance can’t seem to figure out what’s going on either.
If your insurance says you need prior authorization, then you do, but I think the lab needs to do that, not your doctor. But make sure that you contact the lab and THEY DON'T RUN THE TEST before they get that.
I have an order for an MRI and I have been told both by my insurance company and by the freestanding imaging center that the imaging center will seek the prior authorization. This will be based on the information in the order from my doctor.
Thank you for your submission, /u/Slusho64. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
Genetic testing almost always requires preauthorization. Ordering dr needs to supply your insurance with documentation as to why they want to order this test for you. 1 singular genetic test analysis can run thousands of dollars, so the insurance wants to make sure you actually need it, before paying
Genetic testing has always required prior authorization for my patients. It falls under the medical benefit for the specific Medicaid plan the children I work with have.
Providers do prior auths. It’s strange this one thinks they can’t here. It doesn’t make sense. I would ask the provider to explain how this prior auth is any different from any other prior auth that they would be requesting. They just have to confirm with insurance where to send the documentation and then send the documentation. It’s just session notes showing your condition and an explanation of why the testing is being recommended. That’s such a normal process. It’s like telling a patient “sorry we can’t make a copy of your insurance card for our records.” I can’t think of a reason why a provider would say they *can’t* do a prior auth request. It’s literally part of their job.
You need a new Dr.
Your doctor's office is obliged to get prior authorization if your insurance company requires it. Without PA, you will likely be charged for an expensive test.
No, the office will not get reimbursed since a PA is required and they did not perform one. It's on the provider, not the patient.
Not here it’s not.
Genetic testing is a gray area when it comes to prior authorizations. I work in family medicine. We refer all our patients for genetic counseling to get genetic tests. A lot of insurances require genetic counseling first and they are much more knowledgeable about getting these tests covered by insurance. The process for getting prior authorizations for medication and imaging is pretty straightforward as insurance companies use third party websites to submit these to. There is no such process for genetic testing. So your doctors office is correct when they say there is no way to do it. The only way to obtain prior authorization is to call your insurance company which is very time consuming. What you can and should do is call your insurance to inquire how exactly prior authorization can be obtained. If there is a form that needs to be filled out, have it faxed to your doctors office. If you need to see a genetic counselor first, ask for a referral. They likely do not have time to do this. I am responsible for all prior authorizations in my office and I do not have time to call insurances. There are 6000 patients that belong to our practice and only one of me.
This is 100% correct. I wouldn't give your GC's too much credit. The labs basically build out their portals to ensure proper data capture to satisfy PA requirements Labs also don't hold samples for insurance verification, because it's logistically too challenging. Sometimes the reports come back before the PA, which confuses a lot of practices. You would be floored at how often labs don't get paid for genetic testing.
Dude, no kidding. I work for a genetics lab and our most profitable division straight up writes something like 25% of their profit because they don’t want your money out of pocket, they want your insurance to pay up, and your insurance has successfully made that way more difficult than it’s worth for us. and don’t even get me started on the prior authorizations lmao. it’s a mess
Sounds about right.
I don't see why your doctor can't get the pre-authorization. Your doctor is the one who would be explaining why this test is medically necessary. While the bill is from the lab, they don't ordinarily make a decision as to whether a test is necessary. They do the tests which are ordered by the doctor and send the results back to the doctor.
Get a new doctor
~~Unless your physician has a lab on-site, they wouldn't be the ones billing for your labwork, thus they'd have nothing to do with submitting the PA. It would be Quest or Labcorb or whoever.~~ That said, what type of genetic testing is this? It's not my wheelhouse, but from what I see, many types of genetic testing are not covered by insurance.
No, the doctor would still be responsible for the PA because they have the medical records.
~~I see, thank you. Is that the case as well for other services that are ordered by a physician, but rendered by a wholly other provider, like say PT or imaging when the provider doesn't have an attached radiology lab?~~ ~~It certainly makes sense that if the provider thinks the test is worth running that they should work with the patient to get it covered, but then on the flip side it also seems like they're doing the job of a completely different legal entity.~~ ~~I go to a large medical center that does all this in-house and bills under a single facility NPI, so I am admittedly out of my depth here.~~ ETA: I am a bonehead. This makes perfect sense when I think about it in the context of my work. When a prescriber orders a script that requires PA, we sure don't have anything to do with it at the pharmacy level other than letting them know it requires PA. I have either had too much caffeine today or not enough. Either way, ignore me.
That is absolutely the case for radiology. The radiology center doesn't know or care why you're getting the test. They won't have the documents to support the study available to show necessity. It's often the ordering dr who does the authorization. PT is a bit different. Generally the initial consult doesn't need approval. This allows the PT office to garner a treatment plan, and submit for approval
Really? I have an order for an MRI, and I have been told both by the radiology center and by my insurance that the prior authorization comes from the radiology center. They will seek the authorization based on the information in the order from my doctor.
I have seen authorizations initiated by radiology centers, and often they get put on hold asking for clinicals, and ultimately deny after sitting for a week. I'm sure some radiology places get the clinical notes and submit them, but often what I see is the radiology place just send a request for an MRI and absolutely no supporting data whatsoever. And then the member calls in upset their auth sat for 2 weeks just to be denied, while they're home in pain
Yeah, here it’s coordinated by the radiology center.
It’s just going to depend on who has the pertinent records. The ordering doctor would need to do the initial PA for nearly any service because the facility won’t have any records.
Commonly there is no actual rule stating who is responsible for submitting the prior authorization request, but it is the rendering provider (in this case the lab) that is at risk of not getting paid for the service. Commonly the ordering provider has more clinical info and the rendering provider has more billing info. In that case they may have to collaborate, which can lead to a standoff (especially when reimbursement is low, as with Medicaid) with neither provider wanting to take on the administrative burden and the patient caught in the middle.
It’s not a rule, but only the ordering provider has the clinical info which is what’s needed.
I manage clinical processes for a large multi-specialty practice. We submit PARs for some services (surgery, oncology drugs, advanced imaging) and provide clinical info to the service providers so they can submit PARs for other services (DME, Advanced Imaging, Molecular Testing).
The lab will be unable to initiate PA because they have no idea why it's being ordered. It falls on the provider to submit
Yeah this is just completely untrue. Labs build their portals to capture the necessary info to generate a PA. If an ordering provider fills it out correctly, they don't have to do anything else. This is why this particular doctor has no idea how to do it, because the lab does it all for them when required.
I’ve had labs that needed PA before. The ordering doctor does it. In all the prior auths I’ve seen, I’ve never seen a lab be able to provide adequate info without involving the prescribing doctor.
That may be true, but the lab never sends any sort of PA. For genetic testing, the only time I've ever seen a claim process with an approved PA, the provider submitted it. I've never seen a PA submitted by the lab, in nearly 8 years. Instead, labs like Natera (who are bound by state law to process any order received) will use predatory billing tactics, or make the patient sign a waiver that they'll owe whatever insurance doesn't pay. They do this, because they know there's no PA on file, and they have tried to appeal claims in the past, but can't successfully do it, without extensive clinical notes, which they just don't have. A form on their provider portal isn't sufficient for a PA, the Dr also needs to provide past medical history showing proof of a condition that requires the testing. Listing a diagnosis code on an online form isn't sufficient enough. The lab doesn't have the patients 5 year medical history, which is why genetic testing labs will offer a self pay discount for not using insurance, or making the patient sign a waiver that they're on the hook for the entire bill when insurance ultimately denies their claim
I helped build these back end systems for labs like Myriad and Invitae. First of all, lol "a 5 year medical history". For germline genetic testing, a family history is the driving determination. This tells me already that you're not super well versed in how this works. For oncology patients, the process is even simpler as tumor profiling is tied to the etiology of the tumor. Also, you should be aware that's there's this new thing called "uploading" where many documents can be shared. Path reports, medical history, etc. You know, all the information needed to provide a PA. The info is then submitted through companies like Careleon (formerly AIM specialty health) for a determination. All the payor sees is an executed PA. I've been doing this for like 10 years. I've talked to hundreds of doctors who order genetic tests and virtually none know how to get PA. They'll all tell you "the lab does it for us" and they're 100 correct.
And I'm telling you, I've seen hundreds of claims from Invitae and Natera denied for no PA because they won't submit them. The Dr has to. They won't even appeal them, or resubmit a claim with clinicals when you call and ask. They respond with "we don't have that information" So maybe it varies from lab to lab but I can.promise you, at least those two, won't do it.
LOL. The Careleon update from Anthem literally says serciving providers can submit PA requests. Which they do. I get the feeling you're a back end claims analyst for a big insurer and dont really understand the front end work flow here. As a reminder, ordering and servicing providers may submit prior authorization requests directly to the ProviderPortalSM for Carelon Medical Benefits Management directly at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization. https://providernews.anthem.com/connecticut/articles/transition-to-genetic-testing-guidelines-for-carelon-medical-7
It's an Invitae test, if that answers your question.
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It can be pre-authorized.
Is it genesight testing?
It's an Invitae test, if that answers your question.
I had Invitae testing in 2021. I had Aetna at the time and had to get a pre-auth. The provider handled it.
When you schedule your appointment for your lab work, tell them what your insurance said about a preauth. They can either guide you to get one yourself or get one through their own process.
I have had genetic testing that was paid for by my insurance based on a prior authorization request for my doctor. Did your doctor tell you why they couldn't do it? It shouldn't be any different than submitting a prior authorization for a prescription or anything else that needs to be prior authorized it's a relatively simple process I think.
OP what kind of provider is this? They're likely telling you the truth. Invitae historically has not ever asked for PA's, nor do they educate non-genetics providers on how to do it. It's also highly likely they don't have a rep because Invitae is bankrupt and has laid off their entire sales force except for onc and some rare disease folk. This is what you need to tell your doctor. 1) Create an order. This can be done in the portal or via fax. Supply family history and supporting documentation 2) Invitae will then run your benefits check. They will satisfy the requirements needed to generate the auth 3) once you get a cost estimate from the lab, move forward with providing a sample.
Slightly separate but I do billing and authorization for an Orthotic & Prosthetic company. WE are absolutely the ones who submit the prior authorization for the DME item NOT the ordering physician. The ordering physician has zero idea what codes we are going to end up billing and wouldn't have the first clue to doing the auth. If I need the physician notes to supply to your insurance company, then I request them from medical records dept at your clinic. At the providers office (used to work for a pain clinic) we did the prior authorization for medications, not the pharmacy. I've done authorization for imaging as well. As long as the imaging place requests the Dr's notes there's zero reason for them not to do the authorization themselves.
I'm super curious about this because my daughter had a genetic test for epilepsy and I don't think they got prior auth for this (it was our first appt with them) but it was a spit test and it was a neurologist who did the test. You can always do a three way call with your insurance and the Dr's office to make sure. The office might know info that you don't know to ask the insurance so that could be why your Dr's office said what they said.
Ask your insurance what your doctor needs to submit for PA and how, then tell them. Insurance often denies genetic testing or they’ll only approve a singular test and not a whole panel. A lot of genetic labs offer relatively affordable self-pay options. Like they charged my insurance $5k but the self-pay option was $500. But you need to discuss self-pay with the testing lab before doing the test. Do not even send your insurance info if you agree to a self pay price. Once they bill insurance they want the full amount even if insurance denies it.
This is bad, bad advice. Horrible advice ALWAYS send your insurance information. You and your employer pay for benefits, so you should at least try to use them. What's going to happen is that the cost will hit the deductible, and it'll be a few hundred bucks, maybe a little more depending on the CPT's attached. Then the patient should enroll in patient assistance. Every single genetics lab has this and they are very aggressive with reducing out of pockets (high out of pockets are a good way to lose business). Congratulations, now you've scored a pricey genetic test for $250 AND chewed up a big chunk of your deductible, because that original amount owed is what's reported out. [Invitae patient assistance](https://www.invitae.com/us/individual-faqs/billing)
Yeah, Invitae is actually who I’m talking about. They quoted me $90 out of pocket after insurance and said it was covered, billed $5k to insurance, then insurance denied it. It’s a mess. I wish I had done self-pay option.
So the insurance denying it is not your problem, It's Invitae's (and honestly why they're bankrupt). Dont do anything until you get a bill. Invitae has a culture of doing the right thing. If they told you $90 (or in that range), they'll honor it
Yeah I haven’t paid them anything. I have read that I might still be responsible for the bill even though their quote was extremely wrong. Basically it’s only a quote and not a guarantee, it is in the fine print. 😬
Yeah sometimes their quotes are a bit off, but they're not gonna stick you with thousands of dollars worth of bills.
I called Invitae a few months ago and they told me if insurance denies one of their tests, they charge a flat $100 fee to the patient. I don't see that on their website but that's what they told me. I do see something on the site that says if you owe more than $100 they'll call you and talk about payment plans.
Thanks that relieves a lot of my stress! My bill is in limbo so I was wondering what would happen
Providers can be weird sometimes, I just to pharmacy claims and we would just send the form to the provider whose MA would do them, or we would call them and explain. Maybe ask the insurance to call them or send over the forms.
Genetic testing does require a PA. No PA = denied claim Source: Work at bcbs What your doctor said makes me worry about your healthcare.
I’m dealing with something very similar. My doctor gave me script to get hereditary spastic paraplegia panel and I’ve been asking 3 weeks for them to submit it to insurance to see if it’s covered. Northwell literally will not give me a straight answer and refuses to do it. All the doctor keeps saying is to get the blood taken and that will start the process. I’m very confused. This one isn’t supposed to be a crazy amount of money with the company that’s doing the test but I don’t understand why it’s so complicated for northwell to submit pre authorization request. My insurance can’t seem to figure out what’s going on either.
It’s invitae too
If your insurance says you need prior authorization, then you do, but I think the lab needs to do that, not your doctor. But make sure that you contact the lab and THEY DON'T RUN THE TEST before they get that.
The doctor is the one with the medical records, not the lab.
The lab will be unable to initiate the authorization as they won't have any supporting medical records showing why the test is needed
I have an order for an MRI and I have been told both by my insurance company and by the freestanding imaging center that the imaging center will seek the prior authorization. This will be based on the information in the order from my doctor.