Payment Options and Health Insurance Reimbursement

Testing for hereditary cancer risk is becoming more common, especially as newer and more effective options for cancer risk reduction have become available. Most insurance carriers cover genetic testing services for hereditary cancer. In fact, although each situation is unique, the average patient pays coinsurance of less than 10% of the test price. Myriad assists in obtaining reimbursement for the genetic tests we offer. Our goal is to ensure that you receive the appropriate coverage from your plan and are aware of your own financial obligations prior to testing.

To order a test, your healthcare provider documents certain key personal and family history information and designates the appropriate 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 in the Insurance billing section.

Payment options are outlined below (click on option to expand):

Option 1—Insurance Billing

If you choose Insurance Billing on the Test Request Form, Myriad will verify coverage and determine your responsibility. If your coinsurance responsibility (after deductibles) will exceed $375, we will contact you directly within 3 business days after we receive your sample to discuss the specifics of your case and options available to you before proceeding with the testing process. If coinsurance is NOT expected to exceed $375, you will not be not contacted, and your specimen processing will begin immediately.

Note: Although rare, some insurers may require a pre-authorization before the sample is submitted for testing, which may delay the start of the test. We will contact the healthcare provider if this is the case.

You must sign the Insurance Billing Patient/Responsible Party signature line on the Test Request Form and submit enlarged photocopies of the front and back of your insurance card. Myriad will submit bills directly to insurance carriers and will appeal and resubmit claims on your behalf, with input from your authorized healthcare provider as needed. Coinsurance and unmet deductibles are 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 for installment payment options.

Cancelling a Test

If you cancel a test before it is started, you will not be charged. Testing is usually started 24 to 48 hours after receipt at Myriad. Once your test is started, you are responsible for payment of the test.

Medicare

Medicare patients should select Option 1. Medicare pays for the test when specific criteria are met. Your physician should consult Medicare's Web site to determine if you meet Medicare's criteria for genetic testing and can obtain assistance in interpreting the criteria from Myriad's Medical Services at 800-469-7423. For all Medicare patients, a copy of the signed informed consent is required before testing will begin. For patients who do not meet Medicare criteria, a signed Advance Beneficiary Notice of Noncoverage (ABN) is also required to be received by Myriad before testing will begin. Because Medicare will likely not cover test costs for patients who do not meet Medicare criteria, test costs are your responsibility.

Myriad Financial Assistance Program

Myriad is able to offer testing at no charge to uninsured patients that meet specific financial and medical criteria. Due to regulatory limitations, patients who are recipients of governmentfunded programs (ie, Medicaid, Medicare) or those that have any third-party insurance are not eligible to apply.

Qualification requirements and the submission instructions are provided below:

Application (PDF)*            En Espanol (PDF)*

Medical Criteria (PDF)*

Financial Criteria (PDF)*

To view the current HHS financial guidelines, please view the link below.
http://aspe.hhs.gov/poverty/index.shtml

*To view PDF files, you need the free Adobe Acrobat Reader software.

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