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BRACAnalysis Payment and Insurance

Testing for cancer risk is covered by most insurance companies. To learn more about payment, insurance, and your privacy rights, click on the links below.



Health Insurance Reimbursement

Testing for hereditary cancer risk is becoming more common, especially as healthcare provides new options for cancer risk reduction to physicians and patients. Most insurance carriers cover genetic testing services. In fact, although each situation is unique, the average patient pays only 10% of the test price out-of-pocket. Myriad assists in obtaining reimbursement for the genetic tests we offer. Our goal is to ensure that you receive the appropriate coverage from your plan and are aware of your own financial obligations prior to testing.

Your Healthcare provider documents certain key ancestry and personal history information and designates the appropriate test for you on Myriad's Test Request Form. On the same form, you choose a payment option by checking the appropriate box. If you choose Insurance Billing, your signature is also required in the Insurance billing section.

Payment Options

Option 1 - Insurance Billing

If you choose Insurance Billing option on the Test Request Form, Myriad will verify coverage and determine your financial responsibility. If your total financial responsibility will exceed $375 (or $15 per month when utilizing our interest-free 25-month payment plan) for any reason, including co-insurance, deductible, or non-covered services, we will contact you directly to discuss the specifics of the case and options available to you before proceeding with the testing process. If your total financial responsibility will NOT exceed $375, you will NOT be contacted, and sample processing will begin immediately.

Note: Some insurers may require a pre-authorization before testing is initiated, which may delay the start of the test. We will contact the healthcare provider if this is the case.

In order to proceed with the Insurance Billing option, the Patient/Responsible Party signature on the Test Request Form and enlarged photocopies of the front and back of the patient’s health insurance card(s) are required. Myriad will submit bills directly to your insurance carrier and will also appeal and resubmit claims on your behalf, with input from your authorized healthcare provider as needed.

Option 2 - Patient Payment

Pay for the testing service yourself. With your sample, you provide credit card information or a check or money order payable to Myriad Genetic Laboratories, Inc. for the full amount of the test. Contact Customer Service for installment payment options.

Canceling the Test

If you cancel a test before it is started, you will not be charged. Testing is usually started 24-48 hours after receipt at Myriad. Once your test is started, you are responsible for payment of the test.

Medicare

Medicare Patients should select Option 1. Medicare pays for the test when specific criteria are met. Your physician should consult Medicare's web site to determine if you meet Medicare's criteria for genetic testing, and can obtain assistance in interpreting the criteria from Myriad's Medical Services at 800-469-7423. For all Medicare patients, a copy of the signed informed consent is required before testing will begin. For patients who do not meet Medicare criteria, a signed Advance Beneficiary Notice (ABN) is also required to be received by Myriad before testing will begin. Because Medicare will likely not cover test costs for patients who do not meet Medicare criteria, test costs will be billed to you.

Myriad Financial Assistance Program

Myriad is able to offer testing at no charge to uninsured patients that meet specific financial and medical criteria. Patients who are recipients of government-funded programs (i.e. Medicaid, Medicare) or those that have any third-party insurance are not eligible to apply.

Qualification requirements and the submission instructions are provided on the Myriad Financial Assistance Program application:


To view the current HHS financial guidelines, please view the link below.
http://aspe.hhs.gov/poverty/index.shtml

Privacy Issues

It is Myriad's policy that test results are disclosed only to the requesting healthcare provider/designee and are not disclosed to anyone else (including insurance carriers) without the written permission of the patient.

Federal and state laws prohibit health insurance discrimination against patients who undergo genetic testing. In 1996, the federal government enacted the Health Insurance Portability and Accountability Act (HIPAA). Under this law, patients in group health insurance plans are protected from discrimination based on genetic information. In May 2008, the Genetic Information Nondiscrimination Act (GINA) was signed into law and will add to the legal protections that are in place on both the federal and state levels.

Studies have found no documented cases of health insurance discrimination on the basis of genetic testing for hereditary cancer syndromes. Most states have enacted laws further protecting patients from discrimination based on genetic information.

Privacy Links

Your genetic test results are strictly confidential, and will only be released to the doctor who ordered your test, unless you provide written consent specifying otherwise. Even when your insurance company pays for your genetic test, the company does not receive your results.

Here are some helpful Web sites that will give you more information on your privacy rights:

National Conference of State Legislatures
www.ncsl.org

United States Department of Health and Human Services, Office for Civil Rights
www.hhs.gov/ocr

National Human Genome Institute—The Ethical, Legal and Social Implications (ELSI) Research Program
www.nhgri.nih.gov/ELSI

National Institutes of Health—Office of Legislative Policy and Analysis
http://olpa.od.nih.gov

The Library of Congress—THOMAS
http://thomas.loc.gov/home/thomas.html

American Civil Liberties Union
www.aclu.org

Georgetown University Health Policy Institute
www.healthinsuranceinfo.net

Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA), enacted by Congress in 1996, required the Department of Health and Human Services to establish national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers. In addition, HIPAA also contains provisions that address the security and privacy of health data and information.

Myriad is dedicated to offering high-quality laboratory services in the area of predictive medicine and is committed to ensuring patient privacy through compliance with HIPAA. We have an active privacy program that ensures your confidentiality and is fully compliant with the HIPAA Privacy Rule.

As mandated by the Privacy Rule, Myriad requires that all employees undergo privacy awareness training and has implemented administrative and technical safeguards that are focused on protecting patient privacy. Myriad is also committed to compliance with the HIPAA Security and the Transactions and Code Sets regulations.

Notice of Privacy Practices

The HIPAA Privacy Rule gives you the right to be informed of our privacy practices and your privacy rights where they concern your personal health information. You can download our Notice of Privacy Practices in PDF format here [PDF–Size: 92KB]. If you prefer to receive a copy by mail, call the Customer Service Department at (800) 469-7423.

Questions
Please direct general questions about Myriad services to our Customer Service Department at (800) 469-7423.

Complaints
Please direct complaints concerning privacy or confidentiality to our Quality and Compliance Department, Privacy Office at (800) 883-3263, or by email at quality@myriad.com.

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