Signature Genomic Laboratories, a Spokane, Wash.-based firm that offers an array comparative genomic hybridization-based cytogenetic testing service, last week said it has launched an in-house program designed to help patients obtain insurance coverage for its tests.
“This program has been brought on board so that we can better communicate with patients about what level of coverage they have for this test, and they know ahead of time what their responsibilities are once testing is complete,” said Catherine Kashork, Signature’s director of operations.
Signature first began offering its cytogenetics service in 2004 and currently offers testing for adult and pediatric patients, as well as a prenatal screening service. Kashork told BioArray News last week that before creating the program, which launched in March, “physicians’ offices and genetic counselors would take the insurance information, and would file for pre-authorizations [for the tests], if necessary.”
She said that Signature is “trying to eliminate the burden to them and at the same time provide the patient with an opportunity to know what is out there in terms of coverage for patient testing.”
To develop the so-called “patient advocacy” program, Kashork said the firm has added personnel to work with patients and healthcare providers to provide maximum coverage for Signature’s tests, which she said typically cost between $1,500 and $2,000.
According to Kashork, the program will now encourage authorized healthcare providers to request a benefits investigation directly. She said the investigation may include a pre-authorization if one is required by the insurance carrier, and the patient and healthcare provider are contacted in regards to their benefits and responsibilities. If the customers proceed with testing, Signature then files a claim with the insurance carrier. It can also work on the patient’s behalf through an appeals process if necessary, she said.
“We basically launched this program in March and we are just now getting our feet wet in terms of what [patients] need and what can we provide” to them, she said, adding that Signature “in general has not had a real significant problem with insurance coverage.” The firm has had to deal with appeals from carriers in the past, though, and Kashork said that although it relies on a relatively new technology for its service, Signature has successfully won coverage from providers.
“Any testing inevitably goes through a certain level of appeals process in the insurance industry,” she said. “We have used scientific literature from other researchers and institutions that have supported the utility of this assay to help a patient with their claims process.”
Mostly, though, Kashork said that Signature has received a “positive response” from health-insurance companies and that Signature basically want to enable their patients to get as much coverage from carriers as possible. The company also offers patients the option of adopting a payment plan to cover the remainder of the service’s costs.
‘A Tremendous Area of Need’
While Kashork described Signature’s experience of negotiating with insurance carriers in mostly positive terms, other companies that offer similar services said they are aware of patients being denied coverage for CGH-based diagnostic services.
Mansoor Mohammed, CEO of CombiMatrix Molecular Diagnostics, which like Signature also offers adult, pediatric, and prenatal CGH-based screens for genetic abnormalities, told BioArray News that the firm has been involved since its inception in helping patients obtain insurance coverage for its tests, and that such a program is “entrenched in [our] business model.”
“In general, we have not had a real significant problem with insurance coverage.”
“We don’t have a patient-advocacy team, we have a patient advocacy company,” said Robert Embree, vice president of operations at CMDX. “Everyone here at CMDX from our CEO to the young lady that answers the phone to the supervisor in our clinical laboratory ... is charged with being a patient advocate [and is] expected to work with the patient and genetic counselor to ensure they receive the best possible service at the most reasonable costs.”
In general, Embree said that CMDX does not ask for any upfront payment or commitment from patients and works with them to obtain pre-authorization when necessary. The company offers direct bill pricing to give the referring physician the ability to have a decision in the payment process and to help reduce costs to the patient, he said. CMDX also has a “financial hardship” program to work out alternative payment plans.
Embree said that CMDX also accepts state Medicaid cases “even though reimbursement may be at a reduced rate,” and works with its “referring physicians to secure pre-authorization from insurance companies in regards to individual patient cases.” Additionally, the company “will assist referring physicians and patients in filing appeals in regards to matters when coverage is reduced or denied.”
Another array-CGH company is Buffalo, NY-based Empire Genomics, which sells a chip called Accuarray that can be used in laboratory-developed tests in a CLIA-approved setting to identify chromosomal abnormalities.
“We ... believe that this is a tremendous area of need and one in which we too are committed to helping resolve,” said Empire CEO Anthony Johnson. “While we do not have a formal program in place, we do frequently hear of insurance companies not willing to reimburse, not being well versed on the benefits of this type of testing, and therefore patients not having access to this test when desired.
“This is an important issue, though needless to say as ultimately patients will need to be able to receive this test and know that reimbursement will be covered at sufficient levels,” Johnson added.
Embree said that one reason why patient advocacy has become a “hot topic” recently could be that a National Legal Symposium on Medicare and patient advocacy will be held in Washington, DC, this week. The seminar is hosted by the Patient Advocate Foundation and the George Washington University.
According to the event website, the symposium is being held to offer “in-depth insight into Medicare” as well as to “discuss the techniques and challenges of representing Medicare beneficiaries whose claims for treatment have been denied or delayed or whose quality of care has been adversely affected.”