Billing and Insurance Forms

Financial Assistance Application and Income Eligibility Chart To enroll in the Athena Alliance Program, the Financial Assistance Application must be completed and returned in order to reduce the invoice to the patients qualified amount(not all patients will qualify for assistance) DOWNLOAD
Advanced Beneficiary Notice For non-covered tests, Medicare requires this form to be be completed and signed by the patient stating they understand Medicare will not cover the test and they will be financially responsible(they can apply for financial assistance) DOWNLOAD