Reimbursement

Guidance at your fingertips

Monogram Biosciences® believes strongly that access to their virology assays should be available to all patients who would benefit from them. Gateway is just one more example of Monogram's commitment to advancing individualized medicine.

With a dedicated staff that is familiar with reimbursement logistics across the nation, Gateway can help you:

• Verify test coverage
• Obtain prior authorization
• Work on patient's behalf if prior authorization or insurance reimbursement is denied
• Prepare appeals for insurance denials
• Complete necessary medical documents
• Coordinate submissions to increase likelihood of test coverage

Gateway makes reimbursement assistance as easy as 1-2-3

Gateway has created a simple 3-step process for reimbursement assistance.

	Call Gateway at 1-877-436-6243.
	Complete appropriate forms
	Receive notification from Gateway within 24 to 48 hours.

In the event that verification/coverage cannot be established, Gateway will manage the patient's case and/or research alternative coverage. Call Gateway, 1-877-436-6243

Information well need

When applying for support through Gateway, we’ll need the following information on the application:

Provider Information	Patient Information
Provider Name	Patient Name
Address of contact person	Social security number
Telephone number of contact person	Date of birth
Fax number of contact person	Patient Confidentiality Release Form
Provider NPI number	Annual family income of patient
Type of test requested	Number of dependents
Patient diagnosis code	Insurance information for all insurance plans including state and federal programs in which the patient participates
Order of test on a legal prescription pad	Financial documents to support annual family income stated above

Questions to Consider

When you contact your healthcare provider or insurance company about reimbursement for HIV resistance tests, you may want to address the following questions:

• Is this HIV resistance test covered by my insurance?
• Will I have a co-payment? If so, how much will it be?
• Do I need to obtain pre-authorization?
• Is the HIV resistance test considered an "in-network" lab service? If not, is there an alternative lab that is in my network?