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.
- 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.
- 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)
- 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.