Because HIV resistance testing has become widely accepted as the standard of care for the selection of 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 GATEWAY LINE program [1-877-436-6243] for people with challenging reimbursement cases.
GATEWAY LINE
Monogram has established a toll-free number to assist patients who are seeking insurance pre-approval or reimbursement for use of testing from Monogram: 1-877-436-6243
By calling the toll-free Gateway Line, Monogram insurance advocates will:
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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 Monogram’s assays. 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 our tests, in hopes of continuing to increase physician and patient access to this important treatment tool.
Click here to email our Gateway Line with your reimbursement questions.
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