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Sponsored by:
This HIV Drug Resistance Resource Center is provided to The Body by Monogram Biosciences, which is solely responsible for the information provided here. Neither The Body nor its publisher, Body Health Resources Corporation, endorses or opposes any particular product, service or treatment option. Instead, you are encouraged to discuss your options with a healthcare provider who specializes in treating HIV. |
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Reimbursement Support |
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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 HIV assays from Monogram, including PhenoSense GT™, PhenoSense™ HIV, and GeneSeq™ HIV. Reimbursement is available nationally from Medicare and Medicaid (except in Mississippi), and is available in most states from private payers and ADAP.
If you have questions about your insurance coverage for HIV resistance tests, click here to email Monogram's PhenoAid Hotline or call 1-87-PHENOAID (1-877-436-6243).
You can also turn to the following sources for assistance:
Your Healthcare Provider
This is a good place to start. Your healthcare provider can contact your insurance company to find out what coverage you have for HIV resistance testing, whether you will have a co-pay and how much it will be. Your healthcare provider can also help you obtain required pre-authorizations and inform you about government assistance programs for which you may be eligible.
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Your Insurance Company
Although your healthcare provider will work with your insurance company to coordinate coverage and payment for your HIV resistance test, you also have the option to contact your insurance carrier directly. In addition to explaining your coverage and co-payments, your insurance company can point you to "in-network" lab services.
Click here for questions that can help you start a conversation with your healthcare provider or insurance company about reimbursement.
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PhenoAID
Monogram offers reimbursement support through its PhenoAID service, which you can access toll-free at: 1-87-PHENOAID (1-877-436-6243). Please have your insurance card and Social Security number handy when you call.
When you use 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 pre-authorization 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
- Maintain your privacy by keeping your personal and insurance information secure
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 e-mail our PhenoAID Hotline with your reimbursement questions.
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| Is an HIV drug resistance test right for you? If so, which kind? Click here |
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