Ordering & Billing

There are several ordering and billing options available to meet the specific needs of every medical practice. Use the following information to determine the best option for you and your patients. Ordering options are largely dependent upon your preferred billing method. Athena’s billing options are outlined below.

Billing Options

1. Direct Bill. Athena bills Hospitals, Laboratories or Clinics directly.
2. Commercial Insurance. Athena bills the patient’s commercial insurance.
3. Medicare. Athena will bill Medicare for most outpatient testing.
4. Medicaid. Athena offers substantial discounts to patients with Medicaid.

Direct Bill

Athena Diagnostics, where possible, will directly bill a Hospital, Reference Laboratory, and/or a Clinic for all services performed for a patient (with the exception of certain Medicare or Medicaid testing). Patients can have their blood drawn at a local hospital lab or reference lab. Athena provides free Specimen Collection Kits which include a prepaid air bills.

Athena will not direct bill a physician unless an Authorization of Financial Liability form (available from Reimbursement Services) has been completed by the physician.

Commercial Insurance¹

Athena will directly bill an insurance company for those commercially insured patients with plans covering diagnostic testing, including genetic testing when a gene test is ordered from Athena. The easiest way to order for this billing method is through our Access Athena program. Simply fax the Access Athena Commercial Insurance Requisition to 866-223-1247 and Athena will begin the process of setting your patient up with a convenient home draw. The home draw service is free of charge.² A home draw is the fastest, most direct way to get a sample to Athena. However, patients who do not wish to have a home draw may go to a hospital lab, or other reference lab to have their blood drawn and then sent directly to Athena using our prepaid shipping kits.

Patients with a commercial insurance plan for which Athena is a contracted provider

Patients with a commercial insurance plan for which Athena is a contracted provider are subject to the deductible and co-insurance obligations of their plan. For these patients, Athena will bill insurance directly for all of our services and there will be no up-front charges paid to Athena by the patient. Athena will forward the appropriate notification of obligation to the patient as specified by the Explanation of Benefits (EOB). In all instances, Athena will adhere to the terms of the patient’s individual policy insofar as payments for services are concerned. Patients should check with their local provider for pre-authorization and coverage questions related to our services.

Patients with a commercial insurance plan for which Athena is not a contracted provider

Because insurance companies do not always cover the full cost of diagnostic testing, Athena has established the Patient Protection Plan for patients covered by commercial insurance for which Athena is not a contracted provider.³ Ordinarily, any charge not covered by an insurance plan for which Athena is not a contracted provider would be billed by Athena directly to the patient, and any disputes about the amount covered would be appealed directly to the insurance company by the patient. However, Athena will assist the patient in managing this process through its Patient Protection Plan.

Patient Protection Plan³  Athena's unique Patient Protection Plan limits a patient's out-of-pocket expense to no more than 20% of billed charges or $500, whichever is less.  Click here  for more information on this program. 

To ensure claims are properly submitted in a timely manner to a patient's insurance company, the following will be requested:

• Patient Name
• Patient Address
• Patient Date of Birth
• Copy of the front and back of the insurance card
• Claims Address
• Policy Number
• Subscriber Name and Address
• ICD-9 Code
• Requesting Physician
• Payment Information (Credit card number and expiration date or personal check)

1. Commercial insurance does not include Federal health care programs such as Medicare, Medicare HMO, Medicare PPO, Medicaid, and Tricare/Champus, programs for which there is a specific government-mandated billing process.  Patients should verify coverage with their individual provider prior to testing.
2. Certain statutes and regulations prohibit participation in Athena's blood draw program.  Those affected by such statutes and regulations will be identified by Athena's  specimen collection concierge service and separate arrangements will need to be made.
3. Due to State laws, the Patient Protection Plan is not available in Delaware, Florida, Maryland, Massachusetts, New Jersey, New York, Ohio, Rhode Island, and Texas.

Federal Healthcare Programs

Testing for hospital inpatients or outpatients with Medicare must be billed by the drawing institution. For all other patients, Athena Diagnostics will submit claims to Medicare (in Massachusetts) for most of our tests. If your test is covered by Medicare, you are not responsible for any payment. Unfortunately, certain tests remain uncovered at this time. For such testing, the patient must read and sign the Advance Beneficiary Notice provided by Athena on the Medicare Test Requisition. The patient must also provide a personal check or credit card information for the full cost of the test prior to testing. Athena will not cash the check or process the credit card until it has received a denial from Medicare. Medicare beneficiaries are not eligible to participate in the Patient Protection Plan.  Athena does not accept credit card information via E-Mail.

Athena also requires the client to provide an ICD-9 code and a physician UPIN to avoid a delay in testing.

Medicaid

Athena Diagnostics is not a participating provider in any Medicaid program, but Athena offers Medicaid patients a substantial discount off its regular price for clinical laboratory services through its Financial Assistance Program.

To request a discount, a Medicaid patient must submit a completed Financial Assistance Program Application, appropriate documentation including proof of Medicaid eligibility, and payment. Completed applications will be reviewed and testing will be completed if the application is approved. Please visit www.AthenaDiagnostics.com/FAP to download the Financial Assistance Program Application.

NOTICE: Orders received that are not in compliance with our billing policy may result in delayed turnaround time. If you have any questions about our billing policy, please contact a Reimbursement Representative at 800-394-4493; when prompted, select option 4.

Information for Your Patients - Frequently Asked Questions

Why does my doctor want me to have this test?
The information gathered by your doctor about your symptoms, family history and/or the results of other routine testing has led him/her to suspect that a specific disorder may be the cause of your symptoms. The results of diagnostic tests will provide you and your doctor important new information to assist in your care.

Why do I need a special test?
Because many diseases share similar symptoms, your doctor has determined that you should have a diagnostic test provided by Athena to help identify the cause of your symptoms. Some companies, like Athena, provide testing services to help determine a specific diagnosis.

How do I get tested?
Your test must be ordered by a healthcare provider.  You may have your blood drawn at home through Athena's free home draw service² or at a partner hospital or reference laboratory.  Once the test is complete, Athena will send the result report to the ordering healthcare provider.

Do I pay Athena Diagnostics for performing my test? How?
Athena Diagnostics will file claims directly with your insurance company.  Athena will also file appeals when appropriate.  In some cases, Athena may be required to bill you for the amount not paid for by your insurance company.  This varies from state to state so we encourage you to contact our reimbursement department for specific details.

Will my insurance pay for this test?
Most commercial insurance companies pay at least a part of the charges for a particular test and may pay in full. As part of Athena's Patient Protection Plan, Athena will bill your insurance company for the cost of testing and file all appropriate appeals. Also, regardless of the amount paid by your insurance company, Athena will limit your out-of-pocket costs to 20% of the amount billed. (If your insurance company ultimately pays more than 80% of the charge for the test, Athena will refund the excess amount to you.) The Patient Protection Plan is not available to individuals with a commercial insurance plan with which Athena is a contracted provider.  Other restrictions may apply.

Will Medicare pay for the test?
For tests covered by Medicare, Athena will bill the Medicare program directly. However, depending upon the circumstances, you may be asked to provide payment in advance for some tests because Medicare does not always cover the cost of testing. In this situation, you will be asked to read and sign an Advance Beneficiary Notice, which will be given to you by your doctor, authorize payment to Athena, and provide a valid credit card number or personal check at the time the test is ordered.  Athena does not accept credit card information via E-Mail.

Can you tell me more about the company that does this test?
Athena Diagnostics, Inc. is the largest company in the United States focused exclusively on providing specialized testing to physicians in the areas of neurology, endocrinology, and nephrology. Athena works with leading researchers to provide innovative tests that will help provide awareness for you and your physician regarding your illness.

Any questions?
Call Athena's toll free number: 1-800-394-4493 and ask to speak to Reimbursement Services.

Ordering

Athena has made it easy for you to order the testing you need. There are two methods that can be used to order from us outlined below.