Billing and Insurance

The cost for the Cunningham Panel™ is $925. We have found that about half of our patients have some health insurance coverage for our test. The following video addresses insurance questions and provides tips for working with your carrier.

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The most common question our billing department receives is, “Will my insurance pay for The Cunningham Panel?”  We put this short video together to help answer that very important question.  This video takes a few minutes to review.  We hope it will be helpful to you.

The answer to the question, “will my insurance pay for The Cunningham Panel?” is not as easy as a “yes,” or “no” answer.  It’s more like “it depends.”

Our experience is that about half of our patients have some insurance payment for our test.  Some insurance plans pay the whole charge; others pay only a little.  Most payments are somewhere in between.

I’ll talk more about the specifics of insurance coverage as we go on.

The most important advice we can give you is to call your insurance company before having the test specimen collected.  This way you’ll have at least some idea of how much you may have to pay for The Cunningham Panel.  We have a very helpful tool on our website that will walk you through the process of talking to your insurance company.  The link to that tool is found under the Parent & Patient Resources tab, and it’s called Insurance Checklist.

Let me give you a quick overview of insurance coverage issues in general:

There are three important factors that will help determine if your insurance plan may provide coverage for The Cunningham Panel:

  • The primary factor is the level of benefits purchased by your employer group or, if you pay for an individual plan, what you purchased as individual or family coverage. If the policy has richer benefits, it may be more likely to cover the test.
  • Secondly, you’ll need to know if your insurance plan has any out-of-network benefits.  If you’re covered through an HMO, POS, or EPO plan, you may not have any out-of-network benefits at all, OR your insurance company may require you or your primary care provider to obtain preauthorization for The Cunningham Panel. If your test was ordered by someone other than your primary care provider, your insurance company may not be willing to pay for the test.
  • Third factor:  If you do have out-of-network benefits, has your out-of-network deductible been met this year? Most insurance plans have two separate deductibles; an in-network deductible and an out-of-network. Because Moleculera Labs is not contracted with any insurance plans, our charges will often fall to your out- of-network deductible. You will want to check how much your out-of-network deductible is and how much you may have met this year.  Out of network deductibles are usually higher than in-network deductibles.

Patient families also want to know if we can tell them how much their out-of-pocket cost will be – in other words, how much will they personally have to pay.  This is a little trickier than determining if the insurance company will consider The Cunningham Panel a covered expense.  The answer to this question has to do with something called an “allowable.”

What’s an allowable?  Insurance “allowables” are dollar values the company assigns to each procedure code used to bill any medical service.  Usually the “allowable values” are considerably less than the billed charges.  What this means for you is that even if your insurance company tells you that they will cover The Cunningham Panel at “100%”, they likely mean “100% of their allowed charges,” – in other words, less than what we charge for the test.  Moleculera Labs isn’t able to accept the insurance allowables assigned to our charges.  This means you’ll be responsible to pay the difference between the insurance company allowable and our total charge.

This is a lot of information, isn’t it?  Just a couple more things to think about:

  • This is really important:  just because the insurance plan representative told you that The Cunningham Panel would be “covered” doesn’t necessarily mean that the insurance company will make a payment.  Covered services can be applied to your out-of-network deductible.
  • Also – many people aren’t aware that every insurance company offers hundreds of different plans with significantly different levels of benefits.  If your neighbor has the same ‘brand name’ insurance company you do, you may have completely different benefits.  Just because a friend or neighbor’s plan covered The Cunningham Panel, it doesn’t mean that your plan will.
  • If your insurance company makes a payment to us for The Cunningham Panel and  that payment creates a credit balance on your account – we will refund that credit balance to you, not the insurance company.

As we close this video, we again want to urge you to call your insurance company.  Use our Insurance Checklist tool, found on the Moleculera Labs website, under the Parent and Patient Resources tab.  The checklist should help you get the specific answers you need.

If you have other questions I didn’t address in this video, please feel free to call us at 405-239-5250 for more information.