When Will Your Patients Receive a Bill From DRUGSCAN®?
Excessive Testing Policies The following insurances have excessive testing policies regarding Presumptive and Definitive Drug testing where services will not be reimbursed if thresholds are met. Please take note of these policies to assist in your patient’s treatment and service.
SITUATION
DEFINITION
Self pay/Uninsured
If a patient is uninsured, DRUGSCAN ® will bill at our current self pay rate.
INSURANCE PAYER
PROCEDURE
POLICY
Aetna
Presumptive and Definitive Drug Testing
The frequency limit for each (presumptive and definitive) is 8 times per 365 days, from the time of service is first rendered.
Drug testing is not a covered benefit under the patient’s plan.
DRUGSCAN ® will bill at our current self pay rate.
Presumptive screening up to 24 times per year, beginning at the start of treatment, as part of a routine monitoring program. Definitive urine drug testing is considered medically necessary when all the following criteria are met: The presumptive urine drug testing was done for a medically necessary reason; and The presumptive test was negative for prescribed medications, positive for a prescription drug with abuse potential which was not prescribed, or positive for an illegal drug (for example, but not limited to methamphetamine or cocaine), and; The specific definitive test(s) ordered are supported by documentation specifying the rationale for each quantitative test ordered; and Clinical documentation reflects how the results of the test(s) will be used to guide clinical care.
Amerigroup of IA
Presumptive and Definitive
DRUGSCAN ® is contracted with the patient’s insurance plan.
DRUGSCAN ® will bill per the EOB (explanation of benefits).
Drug Testing
Patient lives outside of NY, FL, CO, ID, SD and does not have Harvard Pilgrim: DRUGSCAN ® will bill at our reduced out of network rate, if applicable. Patient lives in NY, FL, CO, ID, SD or has Harvard Pilgrim: DRUGSCAN ® will bill per the EOB, if applicable as required by state law or plan requirements. Patient lives outside of NY, FL, CO, ID, SD: DRUGSCAN ® will bill the total amount of the insurance check plus any patient responsibility but at our reduced out of network rate, if applicable. Patient lives in NY, FL, CO, ID, SD: DRUGSCAN ® will bill the total amount of the insurance check plus any patient responsibility applied per the EOB, if applicable as required by state law or plan requirements. Note: If the insurance check or balance of the insurance check is not sent to DRUGSCAN ® by the patient, further collection efforts may be taken.
DRUGSCAN ® is not contracted with the patient’s commercial insurance plan and has not received a check for our services.
DRUGSCAN ® is not contracted with the patient’s commercial insurance plan and patient has received a check for DRUGSCAN ® ’s services.
BCBS of NC
Definitive Drug Testing
G0480 (1 – 7 drug classes) is the only covered panel code. G0481 and up is not covered.
Patient has a Medicare/ Medicaid Managed care plan and a Copay/Deductible/Co- insurance is applied.
DRUGSCAN ® will bill per the EOB (explanation of benefits).
DRUGSCAN ® will bill at our current self pay rate.
Insurance provided by client is termed/ineligible
Page 1 of 6
For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
For questions call billing customer service at 844.345.1821 or email patient.billing @ DRUGSCAN.com
36
37
Made with FlippingBook Digital Proposal Creator