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Health System Policy for Genetic/Molecular/High-Cost Laboratory Tests in the Outpatient Setting

Effective Date: July 16, 2018

Purpose: As knowledge of the Human Genome expands and Laboratory Technology advances, more esoteric testing, including genetic and molecular tests, is available to clinicians and patients. Many of these tests are very high cost (relative to routine laboratory testing) and are of undetermined or unproven clinical value; therefore these tests are not always covered by health insurance plans. Many insurance companies consider these types of tests as Non-Covered services or require special approval prior to determining the coverage decision.

In an effort to raise patient awareness of insurance coverage and the potential for patient financial responsibility for non-covered charges, Huntsville Hospital Health System has set forth the following requirements prior to requesting a Genetic or High-Cost Test in the Outpatient Setting.

1. Insurance coverage must be determined prior to submitting samples for testing or referring patients to the lab for blood draw. Many insurance companies have forms on their website for the Pre-Approval/Pre-Determination process. Please refer to your patient’s insurance for specific requirements. Obtain the Reference number of the call to insurance and/or the PreAuth number. Include this information on paperwork submitted to Huntsville Hospital Lab.
   
   
2. The physician or office staff will retrieve the appropriate Advance Beneficiary Notice (ABN) form at the link below to educate the patient on their potential financial responsibility. For assistance with the determination of costs to be listed on the ABN, contact Monique Thatch at (256) 265-2522. Links to the ABN forms are listed below. 
   
   Advance Beneficiary Notice (ABN's)
   • Blue Cross Blue Shield of Alabama Billing for Noncovered Services
   • Medicare Advance Beneficiary Notice of Noncoverage (ABN)
   • Tricare noncovered services waiver
     
     
3. Fax the order and the signed ABN to (256) 265-6785, Attn: Monique Thatch. Arrangements will be made for prepayment of the patient’s responsibility followed by the scheduling of sample collection.

Click to view frequently asked questions about genetic, molecular and high-cost laboratory testing. 

Huntsville Hospital offers the MAKOplasty® joint replacement system. The procedures are less invasive than traditional joint replacement surgery and are performed using RIO®, a highly advanced, surgeon-controlled robotic arm system. The RIO® system provides a 3-D image of the patient's hips or knees based on a previous CT scan. Using the 3-D model, the surgeon can plan the most favorable size and position of the implant, which is critical for proper joint reconstruction.

The system offers different advantages for knee and hip replacement patients. As an alternative to total knee replacement, Partial Knee Resurfacing is designed to relieve pain caused by joint degeneration due to osteoarthritis. The robotic arm gives the surgeon the ability to target a specific compartment of the knee while sparing the healthy bone and ligaments surrounding it. Since healthy bone is preserved with the partial replacement, a patient who undergoes this procedure may be a future candidate for a total knee replacement procedure. MAKOplasty® Total Hip Arthroplasty is another option for a total hip replacement procedure designed for patients who suffer from non-inflammatory or inflammatory degenerative joint disease. MAKOplasty® Hip assists surgeons in achieving accurate alignment and positioning of implants, restore patient confidence in their mobility, and help them return to an active lifestyle.

Speak with your physician if you would like to learn more about this option.

The da Vinci robot is one of the most advanced surgical technologies in health care and can be used by physicians across many specialties. The unique design of the robot combines endoscopic surgery, high-definition microscopic viewing and a 540-degree rotation of surgical instruments.

Huntsville Hospital has four da Vinci robotic systems, including a latest-generation Xi model used primarily for colorectal and thoracic procedures. The da Vinci system is also widely used in many other specialties including urology, gynecology, general surgery and oncology.

How it works

The surgeon makes small incisions to insert an advanced microscope attached to a high-definition camera that delivers a 3-D image. With superior visualization, the surgeon can perform meticulous dissections via the robotic arms of the da Vinci. The surgeon’s hands literally guide the robot’s arms in the area of the surgery. Tiny, hard to reach areas in the body become more reachable using this technology. With high-definition clarity, the da Vinci uses 540-degree rotational capacity to surpass the ability of the human wrist.

For the patient, the value of this technology is simple: smaller incision, less bleeding, less scarring and less pain. It is used in multiple specialties including urology, gynecology, general surgery and oncology. Speak with your physician if you would like to learn more about robotic-assisted surgery.