Billing and Reimbursement
NantHealth accepts most insurance plans, including Medicare, but is currently not an in-network laboratory with a majority of individual insurance providers**. We will perform the services ordered and deemed medically necessary for all patients whose physicians consider the test to be medically necessary regardless of our network status. We are committed to assisting physicians and their patients by streamlining the insurance billing process and limiting patient out-of-pocket expenditures, when appropriate through the NantAccess Program for underinsured and uninsured patients. Please contact the GPS Care Center for more information regarding reimbursement.
Upon request, we will work with insurance companies on your patients’ behalf to determine estimated out-of-pocket responsibility and/or complete any prior authorization requirements, as many insurers will consider reimbursement on a patient-by-patient basis. We will submit claims, and if a claim is denied, NantHealth will manage the appeal. The appeals process may require additional information from the patient or a family member and from the healthcare provider. This may include gaining access to patient records or a Letter of Medical Necessity. Our goal is to keep such requests to an absolute minimum.
After appeals have been exhausted and pending financial assistance status, we are required by law to bill the patient for the amount indicated by the patient’s contracted health plan, according to the terms of the respective benefits. Should an insurer deny or only partially cover a claim, we will help determine the patient’s responsibility. For uninsured or underinsured patients or those experiencing financial hardship, NantHealth offers comprehensive financial assistance, based on financial eligibility.
Our representatives are available to answer patient financial and insurance questions before, during, and after the testing process. Patients can call 1-844-MY-OMICS for assistance.
**Insurance Coverage of GPS Cancer
GPS Cancer is the first multiomic testing platform in the nation to receive insurance coverage. GPS Cancer testing will be covered and eligible for reimbursement consideration by Independence Blue Cross of Pennsylvania commercial plans only. (Note: GPS Cancer testing is not covered for MediAdvantage and Medicaid plans). Additionally, coverage restrictions exclude the following conditions:
- Cancers of unknown primary
- Rare cancers (i.e., less than one percent of cancers) with metastases, and for which there are only documented case reports and limited treatment experience
- Metastatic cancer that has progressed after treatment with a regimen of chemotherapy and for which additional chemotherapy is indicated
- Primary brain cancer
- Pediatric cancers
- Triple negative breast cancer
- Virally infected tumors
- Metastatic non-small cell lung cancer that has progressed after treatment with two different regimens of chemotherapy and for which additional chemotherapy is indicated
- Individuals eligible for cancer immunotherapy