Billing

Athena's Billing Policy
There are four main types of billing procedures carried out by Athena Diagnostics. In order to help manage this process, we need different types of information from our customers.

Direct Client Billing: Direct Billing to Hospitals, Laboratories or Clinics

Athena Diagnostics, where possiblef, will directly bill a Hospital, Reference Laboratory, and/or a Clinic for all sefrvices performed for a patient (with the exception of certain Medicare or Medicaid testing). Direct billing helps to avoid delays in processing orders since it simplifies the ordering process.

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

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.

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.² 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.

What is the Patient Protection Plan?

• The Patient Protection Plan is Athena’s unique program designed to protect patients from having to pay the balance of their bill not covered by insurance. It is available to commercially insured patients with plans covering diagnostic testing, including genetic testing when a gene test is ordered from Athena. The Patient Protection Plan is not available to patients in all states. Please contact Athena to verify whether patients in your state may participate in the Patient Protection Plan.

How does the Patient Protection Plan work?

• The Patient Protection Plan limits an eligible, enrolled patient’s liability to 20% of the cost of the test, even if the patient’s insurance plan pays nothing. Patients enroll in the program by signing the enrollment form and paying 20% of the cost of the test within 21 days of the test order.
• Athena handles all the billing to the insurance company including the appeals process when applicable. Our appeals experience can help save time and frustration in dealing with the insurance company. Certain insurance plans require the patient to appeal. In these cases, we will supply documentation to the patient to appeal directly to their insurance. We may also ask the physician for medical records and/or a letter of medical necessity when needed as part of the appeal process.
• For patients enrolled in the Patient Protection Plan, any amount collected from the insurance company in excess of 80% of the amount billed will be refunded to the patient. The “if” and “how much” a patient may receive is solely dependent on how much the insurance company pays Athena Diagnostics. Regardless of the amount ultimately paid by the insurance company, Athena will limit an eligible, enrolled patient’s out-of-pocket costs to 20% of the amount billed.

I am a patient. What can I do to be sure I am in the Patient Protection Plan and protected from a balance bill?

• You must enroll in the program in order to be protected.
• Athena will send you a letter inviting you to participate in the Patient Protection Plan. – Fill out the information and fax it back to Athena at the fax number provided in the letter. There is a 21-day enrollment period, which begins on the date your specimen is received by Athena. If the signed enrollment form and payment are not received within this 21-day period, you may be financially responsible for any remaining balance after your insurance company has made their payment.³
• You can always call Athena at (800) 394-4493 for more information about the Patient Protection Plan. We can even take your 20% payment over the phone if you pay by credit card.  Athena Diagnostics does not accept credit card information via E-mail.

I am a patient. What if I don’t participate in the Patient Protection Plan?

• If you do not choose to participate in the Patient Protection Plan, Athena will run your test but you will be financially responsible for the entire portion of your bill not reimbursed by your insurance company.²

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 certain Medicare, Medicare HMO, Medicare PPO, Medicaid, or 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. Due to State laws, the Patient Protection Plan is not available in all States including Florida and Maryland. Please contact Athena to help determine whether the Patient Protection Plan is available in your state.
3. Due to State laws, patients in some states may not receive a balance bill.

Medicare/Medicare HMOs

Testing for Medicare hospital inpatients or outpatients must be billed to 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 Diagnostics 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 doctor or a laboratory will collect from you a small sample (usually blood) that will be sent to Athena. Athena performs many tests like the one that has been ordered for you. Athena provides not only high quality testing services but also ongoing consultation with your doctor, who will discuss your test results with you.

Do I pay Athena Diagnostics for performing my test? How?
You will be responsible for paying for any tests, unless a third party provides payment or reimbursement, as discussed below.

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.)

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 fcredit card number orf personal check at the time the test is ordered.

Can you tell me more about the company that does this test?
Athena 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.