MicroGenDX Patient Assistance

Patient Billing Information

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. Most MicroGenDX tests are covered by Medicare, select Medicaid, and private insurance.

Please be advised that, 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 in advance. We offer a discounted cash price for those patients whose insurance is not contracted with MicroGenDX.

MicroGenDX is committed to ensuring that all physicians and patients have a complete understanding of our billing policies and receive all necessary information to make an informed decision. Our Billing Department is available for any questions or concerns regarding your MicroGenDX bill at at 1-855-208-0019 option #2. The Billing Department is open 8AM to 5PM CST Monday through Friday.

Billing Process for MicroGenDX Services

Please call the phone number on the back of your insurance card for information on coverage of any MicroGenDX test.
Upon Receiving the patient sample, MicroGenDX verifies insurance information, completes testing, and bills your insurance plan.
Insurance providers will then mail patients an Explanation of Benefits (EOB). Please Note an EOB is NOT a bill from MicroGenDX.
MicroGenDX offers a Patient Assistance Program which allows patients to pay in monthly installments until their balance is paid in full. Contact the Billing Department at 1-855-208-0019 option #2 with additional questions or to begin a payment plan.

If Insurance Provider Sends A Check to You Instead of MicroGenDX

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 our offices 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 for our Billing Department call 855-208-0019 option #2. You can also contact our Billing Department by emailing your question to [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 our Billing Department at 855-208-0019 option #2. 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.

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 our Billing Department at 855-208-0019 option #2.

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 calling our Billing Department at 855-208-0019 option #2. 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 uniform 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).

10What can I do if my MicroGenDX test is not covered by my insurance?

MicroGenDX strongly encourages you to file an Appeal for Coverage to your insurance company. In order to accomplish this please follow the below instructions:

1. On a web browser search “[Insurance Company Name] appeal insurance coverage” Most companies will have a page detailing what steps you should take to ask for coverage.

2. Follow the instructions on that website.

3. If that does not work you can look for an email address or physical address and send them the following letter:

To Whom It May Concern,

I would like to appeal coverage for my recent MicroGenDX test. MicroGenDX is a laboratory providing a unique test that is not available through another lab currently in-network. MicroGenDX’s qPCR+NGS test is backed by over 70 peer review publications and is vital when culture tests fail to find the causative microbe in the infection. MicroGenDX tests for over 50,000 species of bacteria and fungi. MicroGenDX testing can help me get the antimicrobials I need to cure my life threating/chronic infection. My infection has been affecting my quality of life and the currently covered testing is not providing the answers I need to get better. I would like you to review this company again and agree to cover this testing.

Thank you,

Patient Name

4. We also suggest you call your insurance company and verbally state to them the above letter.

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 always 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.