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 possible, 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
Athena Diagnostics accepts all commercial insurance, however we do not have contracts with all commercial insurance plans. We will file claims and appeals with a patient's insurance plan. 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.
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.
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.
Athena also requires the client to provide an ICD-9 code and a physician UPIN to avoid a delay in testing.
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?
It is not possible for Athena Diagnostics to know how much an insurance plan will pay for the testing ordered by your physician. Certain variables such as your dedictible, co-pays and other elements of your specific benefit are unknown to us. We recommend contacting your insurance company to find out how much they will pay for the testing ordered. You may contact Athena directly for specific information that your insurance company will need to answer your questions.
Will Medicare pay for the test?
Testing for Medicare hospital inpatients or outpatients must be billed to the drawing institution. Patients with Medicare Part B will not have any financial responsibility.
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.
- Home Blood Draw. A free service that provides a simple way for patients to get their blood drawn and sent directly to Athena using one of our contracted phlebotomy services.2 Simply fill out an AccessAthena Commercial Insurance Requisition Form, and fax it to 866-223-1247. This method guarantees that your specimen will not be routed to another lab, preserving sample integrity and ensuring Athena’s quality.
- Partner Hospital/Lab Draw. Patients may have their blood drawn at a local partner hospital laboratory or reference lab.
International ordering is also available. Please click here
Call Athena's toll free number: 1-800-394-4493 and ask to speak to Reimbursement Services.