Reimbursement Guide for Commercial Insurance
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Athena Diagnostics is committed to assisting physicians and health care professionals provide the best possible care for patients. Athena will work with physicians and patients to manage the insurance reimbursement process.
Please review this helpful guide to find out how Athena can assist physicians and commercially insured patients.
In-Network Insurance Plans
Individuals who have an in-network insurance plan are not required to make any up-front payments to Athena. They would only be responsible for whatever payment is mandated by their insurance plan. Due to variability between insurance plans, we encourage patients and their health care providers to check with their insurance plan to determine what costs, if any, the patient would be responsible for.
Here is a helpful list of questions to ask the insurance company. You will need to know which test is being ordered when you contact the insurance company.
What is the patient responsibility for this test?
The insurance company will need to know the CPT codes for the test. These codes are available on Athena's website at www.AthenaDiagnostics.com or by calling our customer service department.
Do I have coverage for genetic testing?
Ask this question only if the test ordered is a genetic test. Even though your insurance company considers Athena in-network, your specific plan may exclude genetic testing.
Does my insurance plan require me to obtain a prior-authorization to have this test performed?
Most in-network plans do not require this. Contact your insurance provider to be sure.
Out-of-Network Plans
Athena Diagnostics accepts all types of commercial insurance, however, we are not in-network with all insurance plans.
For those individuals who have an out-of-network insurance plan, Athena will do the following:
- File claims directly with ths insurance company
- Regularly file appeals on behalf of the patient if coverage is denied
- Assist patients in resolving coverage issues
- Offer flexible payment options if patient must be billed
- Provide resources to help you obtain prior authorization from the insurance company
Here is a helpful list of questions to ask the insurance company. You will need to know which test is being ordered when you contact the insurance company.
Athena is out-of-network. Do I have out-of-network benefits on my plan, and if so, how much will you cover?
What is the patient responsibility for this test?
The insurance company will need to know the CPT codes for the test. These codes are available on Athena's website at www.AthenaDiagnostics.com or by calling our customer service department.
Do I have coverage for genetic testing?
Ask this question only if the test ordered is a genetic test. Even though your insurance company considers Athena in-network, your specific plan may exclude genetic testing.
Does my insurance plan require me to obtain a prior-authorization to have this test performed?
Letters of Medical Necessity and Appeal
Generic Letters
Letter | Appeal Letter
Complete CMT Evaluation, #404
Letter | Appeal Letter
Complete Ataxia Evaluation, #696
Letter | Appeal Letter
Febrile Seizures Evaluation, #548
Letter | Appeal Letter
Complete Paraneoplastic Evaluation, #467
Letter | Appeal Letter
SensoriMotor Neuropathy Profile - Complete, #287
Letter | Appeal Letter
Complete Limb Girdle Muscular Dystrophy Evaluation, #603
Letter | Appeal Letter
Monogenic Diabetes (MODY) Evaluation, #885
Letter | Appeal Letter
Complete PKD Evaluation, #761
Letter | Appeal Letter
Complete Alport Syndrome Evaluation, #759
Letter | Appeal Letter
Osteogenesis Imperfecta Evaluation, #860
Letter | Appeal Letter