After Pathway Genomics files a claim, your insurance company may pull funds directly from your health account to pay Pathway Genomics. It is recommended, if you have one of these accounts that you opt out of automatic payment prior to submitting a sample for testing.
Some insurance plans will make the patient responsible for any non-covered charges and pull funds directly from the HSA/FSA/HRA. Pathway Genomics only bills patients for “Allowed” charges, which are applied to Deductible, Co-Insurance and/or Copayments.
If a patient is enrolled in an FSA, HSA, HRA or other type of medical spending account, Pathway Genomics is not responsible or liable for any medical spending account automatic deduction. Pathway Genomics recommends, to prevent this, consider removing any automatic deductions prior to submitting a sample for testing. If not, the patient’s account may be debited automatically by the patients Insurance company to pay Pathway Genomics. This automatic payment may be a vastly different amount than the final patient responsibility as determined by Pathway Genomics.
Pathway Genomics does not have the ability to reverse or refund these payments or other reimbursed amounts. Contacting any insurance carrier or employer in advance of services regarding coordination of benefits issues that may impact such an account is solely the responsibility of the patient.
How does Pathway Genomic determine my Patient Responsibility?
Patients will be responsible for their Deductible, Co-Insurance and Copayment, as determined by their insurance company.
Deductible: The amount a patient must pay prior to having benefits paid by insurance. Deductibles may be required for both in-network and out-of-network services.
Co-Insurance: A patient’s share of the cost of a service, often a percentage of the Allowed Amount. Co-Insurance begins after the Deductible amount has been met.
Copayments: A fixed amount (e.g. $20) required from a patient when seeking services from a provider.
Allowed Amount: The amount determined by the insurance company, also known as an “eligible expense” or “negotiated rate”. Insurance will use that price to determine a patient’s benefits. There is often a difference between the Allowed Amount and the “Billed Amount” which is the amount a medical provider charges for a service (e.g. a doctor may bill $20 for a flu shot, however, the insurance Allowed Amount is $15. The insurance will apply the member’s benefits to $15). Pathway Genomics does not bill the difference between the Allowed Amount and the Billed Amount to the patients.
We understand that there are a variety of financial needs and we would be happy to work with you to provide some options.
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