Questions & Answers

Who is Athena Diagnostics?
Athena Diagnostics is a leading reference laboratory that performs highly specialized diagnostic testing. Your healthcare provider relies on us to provide diagnostic information to help in his/her diagnosis and treatment options.

Is the test covered by my insurance?
It may be. Athena is an in-network provider with all Blue Cross Blue Shield PPO, POS,  Indemnity and HMO of MA & New England insurance plans as well as other managed care plans. A list of these plans is available here. If Athena is not contracted with your plan, you can always contact your insurance company to find out if the testing would be covered and if you need a prior authorization. Patients with a commercial insurance plan not contracted with Athena could benefit from the Patient Protection Plan if eligible.

What is the Patient Protection Plan?
The Patient Protection Plan is Athena’s unique program designed to limit your financial exposure to no more than 20% of billed charges or $500, whichever is less.  It is only available to patients with a commercial insurance plan not contracted with Athena. Click here or call 800-394-4493 for more information.

How do I enroll in the Patient Protection Plan?
If you are eligible for the plan, a packet will be sent to you shortly after we receive your specimen and physician order. You will simply need to fill out the enrollment forms and send them back to us with the payment within 21 days of our receipt of your specimen. That’s all. Click here for eligibility details.

Do I need a prior authorization?
Athena does not require a prior authorization to perform testing, however you should determine if your insurance company requires you to obtain a prior authorization prior to testing.  Athena will not delay testing in the absence of a prior authorization.   

Will Athena obtain a prior-authorization if my insurance requires one?
No. Athena is not your primary care provider. If your insurance company requires you to obtain a prior authorization, you may need to work with your physician’s office to obtain one.  Athena is glad to help by providing CPT codes and technical information on the test requested.

Do you offer a payment plan?
We do work with individuals on a case-by-case basis to provide flexible payment options. For details, please call 800-394-4493, option 1.

Is there a chance that I would get a bill even if my insurance tells me the test is covered?
Yes. That’s why it is important to verify coverage and to enroll in the Patient Protection Plan if you’re eligible. Often times an insurance company will indicate that a test is covered at 100%. They are likely referring to what’s called the “usual and customary” amounts associated with the procedure codes. Our prices may differ from those amounts, and therefore, not covered at 100%.  Individuals who participate in the Patient Protection Plan will not receive a balance bill.

How do I get my specimen drawn?
If you are having a blood test, your physician can fax the Access Athena Requisition Form to (866) 223-1247 to initiate a free home blood draw. A licensed partner phlebotomy service will contact you to set up the draw. This service is available to patients age 16 and older. Alternatively, your physician may ask you to go to a hospital laboratory or reference laboratory to have the specimen drawn and sent to Athena.

If the test is not covered, what are my options?
In most states, patients with a commercial insurance plan are eligible for the Patient Protection Plan. We also offer flexible payment options to those who are required to make remittance to Athena.  Athena is glad to help by providing CPT codes and technical information on the test requested

Can I cancel the test?
If you want to cancel your test, we encourage you to promptly discuss this with your physician.  If the decision is made that the test should be cancelled, your physciain should immediately fax a written request to Athena to cancel the test.  Based upon your request, the physician may cancel the test at any time before specimen testing is complete.

If you still have questions, please email us using this contact form.