Download Patient Notice of Financial Responsibility for Non

Patient Notice of Financial Responsibility for Non-Covered Testing
NeoGenomics Laboratories is a medical laboratory that specializes in cancer genetics testing. Your physician
has recommended a test be ordered that will provide clinical value to your personalized patient management
plan. Unfortunately, certain tests are not covered and will be the responsibility of the patient.
Here are the steps that take place when a test is ordered from NeoGenomics:
1. A physician orders a test from NeoGenomics that he / she believes will provide clinical value to the
personalized patient management plan.
2. NeoGenomics will perform the testing and deliver the results back to the ordering physician.
3. NeoGenomics will bill the medical coverage provider of the patient and wait for a reply in the form of
payment or denial. At the same time, the medical coverage provider will send an Explanation of Benefits to
the patient that will explain the coverage decision. This is not a bill from NeoGenomics.
4. The medical coverage provider may deny coverage, leaving the patient with the financial responsibility. The
medical coverage provider may pay a portion of the billed charges, leaving the patient to pay only the
appropriate co-payment, co-insurance, or deductible for testing services. NeoGenomics will send a bill to the
patient with details on payment options.
NeoGenomics makes patient billing as flexible as possible when coverage is denied. We offer several payment
options, including check, money order, credit / debit card, and payment plans Estimated patient responsibility
amounts can be found on the second page. Please call our Billing Team to find out more at 866-776-5907.
Rev. 011516
NeoTYPE Cancer Profiles
Price
Patient Estimated Responsibility
NeoTYPE™ Myeloid Disorders Profile
$2,600
$2,600
NeoTYPE™ Precision Profile for Solid Tumors
$2,600
$2,600
$60
$60
Panels
Price
Patient Estimated Responsibility
BTK Inhibitor Acquired Resistance Panel
$780
$780
BTK Inhibitor Primary Susceptibility Panel
$1,560
$1,560
Molecular Pathology Interpretation for NeoTYPE Cancer Profiles
Other & Individual Tests
Price
Patient Estimated
Responsibility
AKT1
$390
ALK
Other & Individual Tests
Price
Patient Estimated
Responsibility
$390
IKZF1
$390
$390
$390
$390
JAK3
$390
$390
APC
$390
$390
KDM6A
$390
$390
ASXL1
$600
$600
KDR
$390
$390
ATM
$390
$390
KRAS Exon 4
$675
$675
ATRX
$390
$390
MET
$450
$450
BCOR
$390
$390
MLL
$390
$390
BCORL1
$390
$390
MYD88
$390
$390
BTK
$390
$390
NeoARRAY SNP/Cytogenetic Profile $1,950
$1,950
CALR
$390
$390
NOTCH1
$1,200
$1,200
CARD11
$390
$390
PHF6
$390
$390
CBL
$600
$600
PLC-Gamma-2
$390
$390
CBLB
$390
$390
PTPN11
$425
$425
CBLC
$390
$390
RAD21
$390
$390
CD79B
$450
$450
RB1
$390
$390
CDH1
$390
$390
RET
$390
$390
CDKN2A
$390
$390
SETBP1
$175
$175
CSF1R
$390
$390
SF3B1
$461
$461
CSF3R
$644
$644
SMAD4
$390
$390
CTNNB1
$390
$390
SMARCB1
$390
$390
CUX1
$390
$390
SMC1A
$390
$390
CXCR4
$390
$390
SMC3
$390
$390
DNMT3A
$450
$450
SMO
$390
$390
ERBB2
$390
$390
SRC
$390
$390
ERBB4
$390
$390
SRSF2
$517
$517
ETV6
$616
$616
STAG2
$390
$390
EZH2
$750
$750
STAT3
$644
$644
FBXW7
$390
$390
STK11
$390
$390
FGFR1
$390
$390
TET2
$900
$900
FGFR2
$390
$390
TP53
$1,479
$1,479
FGFR3
$390
$390
U2AF1
$562
$562
GATA1
$390
$390
UGT1A1
$100
$100
GATA2
$390
$390
VHL
$390
$390
GNA11
$390
$390
WT1
$600
$600
ZRSR2
$600
$600
GNAQ
$390
$390
GNAS
$1134
$1134
HNF1A
$390
$390
HOXB13
$220
$220
HRAS
$500
$500
Note: Patient responsibility amounts may vary depending on a variety of factors including the patient’s condition, diagnosis codes provided, medications, frequency of testing
and results of previously ordered tests. Patient responsibility amounts are an estimate and may vary on a claim by claim basis.
Rev. 011516