Insurance Coverage
The cost of the PreDx Diabetes Risk Score (DRS) is reimbursed by private insurance carriers, as well as Medicare and Tricare plans. Tethys Bioscience, Inc., is your laboratory service provider for the PreDx DRS, and will bill your insurance provider directly for laboratory services.
Details of the billing policy for the PreDx DRS are as follows
- If you are a patient with PPO or POS insurance: Tethys will accept the amount paid by your insurance company as payment in full for your PreDx DRS unless your insurance policy or state law requires you to pay Tethys a “patient portion.”
- If you are a Medicare or Tricare patient: The entire cost of services performed by Tethys Clinical Laboratory for the PreDx DRS is covered when your physician determines that the test is “reasonable and necessary.” There is no out-of-pocket cost to you for your test from Tethys.
- If you are a patient with HMO or EPO insurance: The same policy applies as for patients with PPO insurance, except a prior authorization from your insurance plan is required. This authorization will be initiated by your physician.
Interpreting your Insurer's "Summary of Patient"
If you have PPO, POS, HMO or EPO insurance, you will receive a "summary of payment" notification from your provider. This summary may be called any of the following:
- Explanation of Benefits (EOB)
- Provider Claim Summary
- Remittance Advice
- Provider Explanation of Medical Payment
This summary of payment of your insurance claim is not a bill from Tethys
Instances when you might receive a bill for your PreDx DRS:
- Your health insurance provider has sent a reimbursement check for laboratory services directly to you instead of Tethys Inc., and you have not forwarded that check to Tethys as required.
- Your claim cannot be properly processed because of outdated, incomplete or inaccurate insurance information.
- Tethys is an "in-network" provider and you have not met your insurer-specified contributions (deductible and/or co-pay) for laboratory services.
- You are paying for your PreDx DRS directly, rather than submitting a claim to your insurance provider.
Need further information?
if you have any questions or concerns, please contact the
Tethys Billing Department
at 1-888-697-7339, Ext. 3