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Reimbursement for Monogram's HIV Assays
Because resistance testing has become widely accepted as the standard of care for the selection of antiretroviral therapy, federal payers
and private insurance companies have established reimbursement policies for Monogram's HIV assays, including PhenoSense GT™,
PhenoSense™ HIV, and GeneSeq™ HIV. Reimbursement is available nationally from Medicare, and is available in most states from private payers,
Medicaid, and ADAP. Monogram offers coverage assistance through its PHENOAID program
[1-87-PHENOAID (1-877-436-6243)] for people with
challenging reimbursement cases.
PHENOAID —
Monogram has established a toll-free number to assist patients who are seeking insurance preapproval or reimbursement for use of drug
resistance testing from Monogram: 1-87-PHENOAID (1-877-436-6243).
By calling this toll-free line, Monogram insurance advocates will:
- Assist you in your efforts to obtain prior authorization for resistance testing
- Verify whether your insurance includes a benefit that covers the testing
- Work on your behalf if preauthorization or insurance reimbursement is denied
- Assist with any appeals of insurance denials
- Assist physicians in completing the necessary medical documents
- Coordinate efforts with the billing entity to increase the likelihood of insurance coverage for the testing
Monogram is also actively involved in negotiations with private insurers, state Medicaid and ADAP programs to increase access to HIV drug
resistance testing. Working in partnership with physicians, advocates, and people living with HIV/AIDS, Monogram is collecting data and
providing insurers with the most up-to-date information on the benefits of drug resistance testing, in hopes of continuing to increase
physician and patient access to this important treatment tool.
Click here to download an information sheet on our PhenoAID service.
Click here to email our PhenoAID Hotline with your reimbursement questions. |
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