MicroGenDX Patient Assistance | MicroGen Diagnostics

Questions about billing?

1-855-208-0019 Option 2
Available hours: Mon-Fri 9AM - 5PM CST

BILLING QUESTIONS

MicroGenDX is a laboratory service that provides physicians a diagnostic tool to identify bacteria and fungal microbes, which can be causing an infection. Before making a treatment decision or prescribing an antibiotic your physician needs to know the type of microorganism at the site of infection.

MicroGenDX is a molecular laboratory that uses the latest technology to identify the microbes by their DNA. Just as you have your own unique DNA, every species of bacteria or fungus has its own unique DNA. We now have a database with the DNA of over 50,000 species of microbes! By knowing the DNA of thousands of species of bacteria and fungus, we can extract the DNA from your sample and match it to this database!

Scientists have used DNA to identify microbes for many years and believe the technology is the Gold Standard for identifying microbes. In the past the technology was too expensive and took too long to use in human medicine, until now. MicroGenDX is the world leader in using Next Generation Sequencing to detect and identify microorganisms.

Your doctor could have used another diagnostic tool for identifying bacteria or fungus and that tool is likely a traditional culture. Your insurance carrier may have covered the cost of a traditional culture but you should understand the differences between a culture and DNA sampling.

Culture means to grow. The traditional culture has been the primary diagnostic tool for detecting microbes since its discovery in 1870. Less than 1% of microbes will grow in culture! Your samples also needs to be at the culture lab in 2 hours and kept at room temperature. (If not, it will not grow) When you see the lab boxes sitting outside of your physician office, that is where your sample will often sit for hours before being picked up! (DNA samples are not as sensitive to time and temperature).

This means that DNA technology used by MicroGenDX is more accurate than culture in detecting the bacteria and fungus causing your symptoms. Now your doctor has better information to prescribe the right treatment. It could mean the difference in you feeling better faster. It will also be lower cost to you from not having to pay for repeat office visits and repeated courses of antibiotics can be the result of a culture being wrong.

Our Commitment to Supporting your Office

It’s our priority to make use of our test as easy as possible for your office staff and will show them what the patient needs to sign and why. (If Patients have Aetna or one of the BC plans and/or have no insurance coverage) We are focused on our testing service being covered by more of these BC plans and will continue to update you as we add more states.

If the patient who has Aetna or one of the BC plans does not agree to sign the patient letter please do not send that patients sample to MicroGenDX. Our policy with all other private plans has not changed with the exception that if the patients plan does not cover the cost of our test. They will receive an EOB (Explanation of Benefits) from their insurance provider and they will receive one invoice from MicroGenDX Laboratories.

Patient Billing Information

Dear Patient,
Your Doctor has requested testing by MicroGenDX Laboratory out of medical necessity. MicroGenDX a national laboratory that provides Molecular Diagnostic Testing. The DNA technology that MicroGenDX provides is the “gold standard” of microbial diagnostics.

After providing test results to your physician, MicroGenDX will bill most insurance companies for the testing. The insurance company will review the claim and determine your responsibility for deductible amounts and uncovered portions of the bill for each sample sent to the laboratory.

Please be advised, if contracted with MicroGenDX, your insurance will provide us the amount to bill you for the services rendered. This amount could vary depending on your plan deductible, coinsurance and/or copay, and may be higher than our discount offered to uninsured (self-pay) patients. If you have questions or concerns regarding your coverage, please contact your insurance company. We offer a discounted cash price of $199 for those patients whose insurance is not contracted with MicroGenDX. MicroGenDX is committed to insuring that all physicians and patients have a thorough understanding of our billing policies and have all necessary information. Our Customer Service Center is available for you to contact with any questions or concerns regarding your MicroGenDX bill.

MicroGenDX Customer Service:
1-855-208-0019, option 1

Billing Process for MicroGenDX Services

What to Expect:

Upon Receiving the patient sample MicroGenDX (a Division of Southwest Regional Laboratories) verifies insurance information, completes testing and bills patient insurance plan.
Insurance Providers will mail patients an Explanation of Benefits. Please Note an EOB (Explanation of Benefits) is NOT a bill from MicroGenDX.
Please call the phone number on the back of your insurance card for information on coverage of this test.
MicroGenDX offers a Patient Assistance Program which allows patients to pay in monthly installments until their balance is paid in full. Contact Customer Service at 1-855-208-0019 option #1 with additional questions or to begin a payment plan.

*If insurance provider sends check to the patient.*
PLEASE NOTE: Several BCBS and GHI Plans may send the check to the patient. Please write “Pay to the Order of MicroGenDX” and send that check directly to Southwest Regional PCR at 2002 W. Loop 289, Suite 116, Lubbock TX 79407.

Billing FAQs

General Questions

1Why have I received an invoice from MicroGenDX?

The invoice you received is for laboratory services provided by MicroGenDX, which were ordered by your physician. This invoice is for laboratory testing fees only and is separate from any bill you may have received from your physician and/or paid at your physicians office. Please refer to the message on your MicroGenDX invoice or the Explanation of Benefits (EOB) from your insurance carrier for more specific information about why you received an invoice. A few reasons you may have received an invoice include, but are not limited to, the following:

Insurance information was not received or the wrong insurance information was received on your test order
The insurance carrier processed the claim and denied payment
The insurance carrier processed the claim and applied the balance to your co-pay or deductible
The insurance carrier did not respond to the claim

2I don’t understand some aspects of my invoice. Who can help me to understand it?

If you would like further assistance, please call the Customer Care phone number listed on your invoice or click here for our Customer Care or call 806-793-8869. You can also contact our online Customer Service by emailing your question at [email protected]

3Why does an invoice for my testing sometimes get mailed to my home addressed to my spouse?

The policyholder is responsible for payment of co-insurance, co-payments and or deductibles incurred for covered services provided to you as a covered dependent. If the invoice is addressed to your spouse, it is likely your spouse is the insurance policyholder.

4I received an invoice requesting additional information. What should I do?

Please send the requested information to the address or fax number listed on your invoice. You can also call the Customer Service phone number listed on your invoice, or contact our online Custoner Care. If the message on your invoice indicates that your insurance carrier needs more information from you in order to process your claim, please contact your insurance carrier directly.

5Where does MicroGenDX obtain the diagnosis information related to my claim?

MicroGenDX obtains diagnosis information from the ordering physicians office. If your insurance carrier denied your claim due to the diagnosis code, please contact your physicians office.

Payment

1Can I pay my invoice online?

You can pay your invoice directly from this website by clicking here. This will take you to our online payment center.

2Is my payment information secure?

Yes. All of us are concerned about web privacy and the security of the information we transmit over the Internet. When paying your bill online through the MicroGenDX hosted bill payment application, be assured that your information is secure, both during transmission over the Internet and within the application itself. This application uses industry standard SSL encryption on EVERY page in the system. This is the same encryption and validation technology used by banks and brokerages to safeguard your financial information. To verify this system is delivered over a secure SSL connection, look for the SSL padlock in your browser:

If you’re using Internet Explorer 7.0 or later, the padlock is located at the top of your browser window, immediately to the right of the address bar.
If you’re using Internet Explorer 6.0 or earlier, the padlock is located at the bottom right of your browser window, immediately to the left of the word "Internet".
If you’re using Firefox 4.0 or later, you will not see padlock at all. Instead, the Site Identification Button is displayed on the left end of the address bar. If you’re using Firefox 3.0 or earlier, the padlock is located at the bottom right of your browser window.
If you’re using Safari, the padlock is located at the top right of your browser window.

For more information, see our privacy policy.

3How do I pay my invoice by mail?

To pay your invoice by mail, send your payment to the "Send Payments To" address listed on your invoice. Please send the Payment Coupon(s), attached to your invoice, along with your payment and write your invoice number(s) on your check or money order to ensure proper credit is applied.

4Why do I have a different invoice number each time I have services performed? How does this affect making payments online?

Our billing system generates transactional specific invoices. Due to patient privacy issues, our system does not store information regarding the patient from transaction to transaction. Each transaction generates a new invoice number. Therefore, if paying online, the online invoice number must match the actual paper invoice so the payment can be applied to the correct invoice.

5Am I required to pay for past due balances to get future services?

A payment may be required at the time of service for all past due balances. MicroGenDX reserves the right to refuse laboratory services for failure to pay for past services.

Insurance

1How can I find out if MicroGenDX is a participating provider with my insurance?

It is the patients responsibility to verify benefits before services are performed. Any questions regarding coverage should be directed to your insurance carrier.

2How do I submit secondary insurance information?

In select geographic areas, MicroGenDX will file eligible claims to a secondary insurance carrier as a one-time courtesy. To check availability of this courtesy service and to submit your secondary insurance information, please call the Customer Service phone number listed on your invoice or click here for our Customer Service phone numbers by area. You can also contact our online Customer Service.

3Why have I received an invoice when I have insurance that covers my laboratory testing?

A few reasons you may have received an invoice include, but are not limited to, the following:

Insurance information was not received or the wrong insurance information was received on your test order;
The insurance carrier processed the claim and denied payment;
The insurance carrier processed the claim and applied the balance to your co-pay or deductible;
The insurance carrier did not respond to the claim.

Please refer to the message on your MicroGenDX invoice or the Explanation of Benefits (EOB) from your insurance carrier for more specific information about why you received an invoice. If you have additional questions or concerns, please contact your insurance carrier directly. If your insurance carrier was not billed or was billed with incorrect information, you can submit your correct insurance information here and we will resubmit a claim to your insurance carrier. It is helpful to have your insurance card in front of you when providing this information.

4My insurance information has changed. How do I correct it?

You can provide your insurance information directly to MicroGenDX by clicking here to contact Customer Service or here to manage your account. Please be sure that the information provided is accurate and complete. Inaccurate or incomplete information may result in a delay or denial of payment by your insurance carrier. You can also mail or fax a copy of the front and back of your insurance card to the correspondence address or fax number listed on your invoice.

5Why was my invoice billed with incorrect insurance information?

Your insurance carrier is billed based on the information provided to us on the original test order from your physician, also called a requisition. Sometimes the information provided on the requisition is incorrect. To ensure your insurance is billed properly, please present your insurance card at each physicians office or Patient Service Center (PSC) visit. Please also make sure your physicians office or the PSC, has your most current insurance and billing information, including your current address, contact information, and correct date of birth. Some physicians offices have a separate laboratory test ordering system, MicroGenDX Customer Care, so you can also check with your physicians office or the PSC to verify that your insurance information is correct in this system as well.

6Why do I have to give my insurance information each time I visit my physician or Patient Service Center?

Individual insurance coverage plans typically change on an annual basis. It is important to provide your most current insurance policy information at each visit to ensure proper billing.

7I received information from my insurance carrier about my benefits and I do not understand all of the information. Can you help me?

For information regarding coverage and benefits from your insurance carrier, please contact your insurance carrier directly. Information about how a specific claim is processed should be provided to you from your insurance carrier on an Explanation of Benefits (EOB) form. These forms usually differ with each insurance carrier. You can click here for a glossary of terms, which may help you interpret the information provided by your insurance carrier.

8The "Explanation of Benefits" I received from my insurance carrier is different from the information on my MicroGenDX invoice. What should I do?

If you received an Explanation of Benefits (EOB) from your insurance carrier that differs from what is indicated on your MicroGenDX invoice, please write your invoice number on the EOB and mail a copy or fax it to MicroGenDX. Please refer to your invoice for the correspondence mailing address and fax number. MicroGenDX will contact your insurance carrier to research and resolve the discrepancy.

9How long will it take to receive a response from my insurance carrier?

It typically takes about four to six weeks for your insurance carrier to process your claim and send you and Explanation of Benefits (EOB).

Coverage

1Is MicroGenDX able to tell me if I am covered for testing?

No, MicroGenDX does not know each individual patients insurance coverage. It is the patients responsibility to verify benefits before services are performed. Any questions regarding coverage should be directed to your insurance carrier.

2Does Medicare cover this testing?

Yes. Nationwide.

3Does Blue Cross cover this testing?

Yes, in some states and levels. It is your responsibility to contact your provider to find out if they cover this test.

Pricing

1Can MicroGenDX tell me how much I can expect to pay for my tests?

The price you pay for tests performed by MicroGenDX may be dependent on several variables, such as:

If you have insurance or not;
Your insurance plan coverage of laboratory tests;
Your age: if you are 65+, Medicare will not pay for some tests that your physician considers important; and
Your healthcare providers agreement with MicroGenDX.

Medicare

1How can I have Medicare send my invoice to my secondary insurance carrier?

Medicare provides a "crossover" program that automatically forwards patients claims to their secondary insurance carrier for coordination of benefits. To take advantage of this program, please contact Medicare directly to notify them of your secondary insurance coverage.

Test Results

1Can I receive a copy of my test results?

Ask your doctor’s office for a copy of your results.

Patient Assistance Programs

1Does MicroGenDX have a program for patients experiencing financial hardship and/or patients who do not have insurance?

MicroGenDX offers payment plans which allows patients to pay in monthly installments until their balance is paid in full. We also offer Financial Assistance, which provides free or reduced-fee laboratory services, to those who qualify based on U.S. Department of Health and Human Service poverty guidelines.