Is the Perthera Report covered by commercial insurance?
Perthera will work directly with your health insurance provider to coordinate payment for the Perthera Report, regardless of Perthera’s in-network or out-of-network status.
The Perthera Report is evaluated for coverage by insurers on a case-by-case basis for medical necessity. It is up to your healthcare provider to determine whether they believe the Perthera Report is medically necessary, and your health insurance plan will determine whether you meet coverage requirements.
The Perthera Report is new and represents the potential for great innovation to the oncology community. Perthera is actively pursuing coverage for the Perthera Report from commercial insurers; however, this process takes time.
Does Medicare cover the Perthera Report?
For Medicare beneficiaries and Medicare Advantage enrollees, the Perthera Report is evaluated for coverage by Medicare on a case-by-case basis for medical necessity. It is up to your healthcare provider to determine whether they believe the Perthera Report is medically necessary, and your Medicare or Medicare Advantage health insurance plan will determine whether you meet coverage requirements.
Does Medicaid cover the Perthera Report?
For Medicaid recipients and managed Medicaid enrollees, Perthera does not accept Medicaid (or managed Medicaid) insurance for the Perthera Report. Perthera is actively working on becoming a credentialed Medicaid provider with all 50 states.
Is Perthera an In-Network provider?
Perthera is currently an out-of-network provider.
How is my insurance deductible applied to the Perthera Report?
An insurance deductible is the amount that you must pay out-of-pocket each year before your insurance plan will start to cover the cost of your care. If you have a deductible that must be paid (or met) for either in-network or out-of-network provider services, and you have not yet met your deductible, the amount you pay out-of-pocket for your Perthera Report will be applied to your deductible. If you have met your deductible for the year, you will only be responsible for co-insurance amounts (i.e., the percentage of costs that you are responsible to pay pursuant to your insurance policy).
What if my insurance company denies coverage/payment for the Perthera Report?
Insurers, and not Perthera, may have their own criteria for when they will pay for the cost of medical services/products, including the Perthera Report. To the extent that a claim for a Perthera Report is denied, Perthera will assist with appealing this decision. If the claim is denied after Perthera’s appeal, Perthera will send you a Patient Statement for the cost of the Perthera Report.
How can I get the Perthera Report covered by my health insurer?
There are ways you may be able to reimburse yourself for the costs of the Perthera Report in a tax-advantaged way if your oncologist orders the Perthera Report and documents that request and you have either a Flexible Spending Account (FSA) or Health Savings Account (HSA), regardless of whether the services are reimbursable under your health insurance coverage.
You may also inquire about Perthera’s Patient Assistance Program. If you have a patient financial responsibility and/or a financial hardship, you may be eligible for the Perthera Patient Assistance Program. Please call (703) 344-0828 or email Perthera Patient Services for more information at perthera@marshallbilling.com
I received an Explanation of Benefits (EOB) from my insurance company, what does this mean?
You may receive an Explanation of Benefits (EOB) from your insurance company in the mail. This is not a bill. The EOB is generated by your health insurer whenever Perthera submits a claim to your insurer for the Perthera Report you received. An EOB describes what costs your insurance company will cover for medical care or products you’ve received.
The insurance company sends you, the patient, an EOB to help make clear the cost of the care you received and any out-of-pocket/patient responsibility medical expenses you may be responsible for, including in-network/out-of-network deductibles, co-insurance, and/or cost share/copays. In most cases, Perthera will also receive this letter and will handle any necessary appeals. If your insurance company does not send the EOB to Perthera, we may request that you send a copy of the EOB to Perthera.
Will I get a bill from Perthera for the Perthera Report?
If there is an outstanding balance due for a deductible to be met, then you will receive a Patient Responsibility Statement from Perthera along with instructions on how to pay. Patients will receive a Patient Responsibility Statement from Perthera by mail and/or email to the address provided on the Perthera Report order requisition form that your healthcare provider completed.
Do you offer flexible payment plans?
If you have a Patient Responsibility owed to Perthera, you can set up a monthly payment plan that breaks the total amount into equal payments over an agreed period of time.
Do you offer discounts?
Not at this time.
Who can I contact if I have billing related questions?
Please contact Perthera Patient Services by phone at (703) 344-0828 or email at perthera@marshallbilling.com
Who can I contact if I have questions about the Perthera Report (non-billing related)?
If you have general questions about Perthera or the Perthera Report, please contact the main number at (703) 286-0780.