When ordering testing, your healthcare provider documents certain medical history information and orders the TheraGuide 5-FU™ test for you on Myriad's Test Request Form. On the same form, you choose a payment option by checking the appropriate box. If you choose Insurance Billing, your signature is also required.
Option 1 - Insurance Billing
Myriad will bill the insurer for services rendered. Testing will begin upon receipt of the blood sample, completed Test Request Form (with your signature), and legible photocopies of the front and back of your insurance card.
Myriad will submit bills directly to insurance carriers and will appeal and resubmit claims if necessary. Some insurance companies pay up to "usual and customary" amounts. These amounts vary and may or may not cover the entire charge for the test. Any difference between the total charge and the insurance payment will be your responsibility.
Option 2 - Patient Payment
Pay for the testing service yourself. With your sample, you provide credit card information or a check or money order payable to Myriad Genetic Laboratories, Inc. for the full amount of the test. Contact Customer Service at 1-800-469-7423 for installment payment options.
TheraGuide 5-FU™ Patient Protection Program
For a limited time, Myriad Genetic Laboratories will be offering a TheraGuide 5-FU™ Patient Protection Program. The Patient Protection Program was developed to protect patients undergoing chemotherapy from unexpected financial burden due to limited insurance coverage during the introduction of TheraGuide 5-FU™.
Qualifying patients* for whom TheraGuide 5-FU™ has been performed may be eligible for the program. You will continue to be responsible for applicable deductible and copayment amounts according to your health plan. However, your out-of-pocket costs will be limited to the greater of: the patient's applicable deductible and/or copayment OR 20% of Myriad's billed charges.
Eligibility:
To participate, qualifying patients* who opted for Insurance Billing as described above may, after receiving a billing invoice from Myriad, contact Myriad's Billing Department at the toll-free number that appears on the invoice (1-800-725-2722) to complete a program application. In the case of an insurance denial, you must agree to cooperate with Myriad's appeal to the insurance company for coverage.
*A qualifying patient is one that is being considered for, or is currently receiving, 5-FU or capecitabine therapy as a result of a cancer diagnosis, is a member of a private health insurance program, and resides in a jurisdiction where such a program is not prohibited by law. Patients covered under Medicare, Medicaid, or other government program or reside in Florida, Massachusetts, Texas, Minnesota, Rhode Island, or other states where such a program is prohibited are not eligible for the Patient Protection Program.
Medicare
Medicare has not established a coverage policy for this test. A signed Advance Beneficiary Notice (ABN) is required before the test can be started. Because Medicare will likely not cover test costs until policy has been established, test costs will be billed to you.
Privacy Issues
It is Myriad's policy that test results are disclosed only to the requesting healthcare provider/designee and are not disclosed to anyone else (including insurance carriers) without the written permission of the patient.
Federal and state laws prohibit health insurance discrimination against patients who undergo genetic testing. In 1996, the federal government enacted the Health Insurance Portability and Accountability Act (HIPAA). Under this law, patients in group health insurance plans are protected from discrimination based on genetic information.
Studies have found no documented cases of health insurance discrimination on the basis of genetic testing for hereditary cancer syndromes. Most states have enacted laws further protecting patients from discrimination based on genetic information.
