INSURANCE BILLING PATIENT PROTECTION PLAN BLOOD DRAW SERVICE QUESTIONS & ANSWERS GLOSSARY ABOUT ATHENA CONTACT US
Insurance Billing
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Insurance Billing - Commercial Insurance

Athena Diagnostics is a specialized commercial reference lab that your physician uses to aid in the diagnosis of certain medical conditions.  We are an in-network provider with most Blue Cross Blue Shield insurance plans.  We do file claims with all commercial insurance plans on behalf of the patient.

Because insurance billing can be complicated, we have done our best to eliminate many of the complexities and hassles associated with insurance billing. Athena performs the following services on behalf of the patient:

  • We will file all insurance claims. This way the patient and the physician’s office won’t bear the burden of collecting reimbursement from the insurance company.
  • We will exhaust all appeals efforts. If the insurance company denies payment or doesn’t pay the full amount, we will submit an appeal on the patient’s behalf to maximize insurance reimbursement when appropriate to do so.
  • We will offer flexible payment options. In instances where the insurance company doesn’t pay the full amount, we will work with the patient to find a payment option that is suitable.

Helpful Tips
We’ve learned that when the healthcare provider and the patient take certain steps before testing, the reimbursement process is much easier.  Some steps may even result in more complete reimbursement from the insurance company, and a lower patient financial responsibility. Here’s what you can do to help minimize a balance bill.

  • Obtain a pre-authorization. By doing this, you’re notifying your insurance company that you’re in need of this testing, you’re explaining why it’s medically necessary. This may reduce the amount you have to pay.  A pre-authorization is not a guarantee of payment.  Insurance plans do not always require a pre-authorization, so check with your individual provider to determine if one is required.
  • Check with your insurance plan to see if Athena is a contracted provider. If Athena is a contracted provider, you would only be liable for whatever co-pay, co-insurance, deductible, or non-covered service that is indicated by your plan. If Athena is not a contracted provider with your insurance plan you may be eligible for the Patient Protection Plan which limits your out-of-pocket expense to no more than 20% of the amount billed to your insurance.  Athena is a contracted provider with most Blue Cross Blue Shield plans.

Questions to Ask Your Insurance Company
In our experience, we have found that the following questions should be asked of your insurance company when determining if and how much they will cover a particular test.

  • I am having a test performed at Athena Diagnostics. Could you tell me if you cover the following CPT Codes and how much you pay on them?
    Athena can provide you with the CPT codes of the test you are having performed.
  • Do I have coverage for genetic testing?
    Ask this question if the test ordered is a genetic test.
  • Do I need pre-authorization to have this test performed?
  • Athena is out-of-network. Do I have out-of-network benefits on my plan, and if so, how much will you cover?
    Blue Cross Blue Shield PPO, POS, Indemnity, and HMO of New England and MA are in-network
  • What would be my deductible for this test?
  • What would be my co-insurance or co-pay on my plan for this test?

For patients with a Blue Cross Blue Shield contracted plan, the following questions may be helpful when speaking with your insurance provider.

  • Is Athena considered in-network for my policy? Their provider number is 041369 and their NPI number is 1023063062.
  • Do I have coverage for genetic testing?
    Only ask if the test is a genetic test.
  • What might be my financial responsibility for this test?
  • Is a pre-authorization required or recommended?

Remember, if your insurance company tells you that you may be financially responsible for any amount, we do offer the Patient Protection Plan to eligible patients, and we offer flexible payment options. To find out more details on payment options, contact our Reimbursement Specialists at 800-394-4493, option 1 or E-Mail us. A representative will get back to you within three business days.