Finding out about insurance coverage for a genetic test is important since many patients want this information as they go through the informed consent process. Health insurance often pays for the majority of the cost of genetic testing. Myriad assists in obtaining reimbursement for the genetic tests we offer. Our goal is to ensure that patients receive the appropriate coverage from their plan and are aware of their own financial obligations prior to testing.

Patients should choose a payment option by checking the appropriate box on Myriad's Test Request Form (pdf).* The Test Request Form is available in every test kit or by calling Myriad Customer Service at (800) 469-7423, option "0." Healthcare providers may also request a test kit using our online order form.

Professional society guidelines endorse the clinical utility of BRACAnalysis®, COLARIS®, COLARIS AP® and MELARIS® as the standard of care in assessing and managing hereditary cancer. Most insurers provide coverage for the tests. On average, a patient will pay only $300 out-of-pocket for a test.

Payment options are outlined below:

Option 1— Insurance Billing
For patients who choose Insurance Billing on the Test Request Form, Myriad will verify coverage and determine patient responsibility. If the patient’s coinsurance responsibility will exceed $375, prior to processing their specimen, we will contact the patient directly within three business days after sample receipt at Myriad to discuss the specifics of their case and options available to them. If coinsurance is NOT expected to exceed $375, the patient is not contacted and their specimen processing begins immediately.

Note: Although rare, some insurers may require a pre-authorization before the sample is submitted for testing, which may delay the start of the test. We will contact the healthcare provider if this is the case.

Patients must sign the Insurance Billing Patient/Responsible Party signature line on the Test Request Form and submit enlarged photocopies of the front and back of the their insurance card. Myriad will submit bills directly to insurance carriers and will appeal and resubmit claims on the patient’s behalf, with input from the patient’s authorized healthcare provider as needed. Coinsurance and unmet deductibles are the patient’s responsibility.

Option 2— Patient Payment
Patient pays for the testing service themselves. The patient may make this selection and provide credit card information on the Test Request Form or provide a check or money order payable to Myriad Genetic Laboratories, Inc. for the full amount of the test, which should be submitted with the Test Request Form. A patient may also contact Customer Service for installment payment options.

Letters of Medical Necessity (LMN)
Some insurance companies require that a letter of medical necessity (LMN) be submitted prior to granting pre-authorization. Guidelines for writing LMNs and example LMNs can be viewed by clicking here.

Medicare
Medicare pays for the test when specific criteria are met. Physicians should consult Medicare's web site to determine if the patient meets Medicare's testing criteria for genetic testing, and can obtain assistance in interpreting the criteria from Myriad's Medical Services 800-469-7423, option "2." ." 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, an Advance Beneficiary Notice (pdf) is also required 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 the patient. A summary of instructions and documentation requirements for Medicare patients is included on page one of the Advance Beneficiary Notice.

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:

• Application (pdf)*
  
• Medical Criteria (pdf)*
  

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

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