Frequently Asked Questions about Health Insurance Coverage for MammaPrint^®

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Agendia is billing insurance companies on behalf of insured patients in the USA. Some insurance companies will pay the entire charge while others may pay a portion of the charge based on patient benefit levels. Agendia will accept the insurance payment as payment in full with a signed Assignment of Benefits form (AOB). For questions regarding a patient’s specific level of coverage, please contact Agendia’s Customer Care team and one of our specialists will be happy to provide further assistance.

In the unusual event an insurance company denies coverage, we will gladly work with the health insurance provider to appeal the denial. In most cases the appeals process, which may include a letter from you and/or your patient, will overturn the denial and the insurance company will agree to pay for the testing services.

Agendia will do its best to minimize the patient’s financial burden. If their insurance company denies payment for their MammaPrint test, and the appeals process is unsuccessful, Agendia’s Customer Care team can assist them with eligibility for a discounted payment program tailored specifically for their circumstances.  Please contact the Agendia Customer Care team and one of our specialists will be happy to help your patient further.

Agendia’s AOB form is a standard agreement that authorizes Agendia to provide the necessary billing information, on a patient’s behalf, to their health insurance plan for claims processing purposes and to appeal for payment when necessary.  It authorizes the health insurance plan to pay Agendia for the MammaPrint test and allows Agendia to accept that payment as payment in full; eliminating balance bills for the difference between the retail charges and the amount the insurance company pays.

At the time your patient decides to have the MammaPrint test performed, you can provide your patient the Agendia AOB form for completion and submission along with the test requisition form.  If you do not have this form on hand, please contact your local representaive or Agendia Customer Care and we will provide you and your patient with an AOB by email, fax or mail.

If the patient’s tissue sample arrives at Agendia without a signed AOB form and they have health insurance, we will make every effort to contact the patient, send them the form and allow them to fax or mail the signed form directly to us. We are here to assist every step of the way.

Agendia will bill the patient’s health insurance plan directly on their behalf.  Agendia will accept the insurance company payment as payment in full with a signed AOB form. Depending on the patient’s health insurance plan benefits, she may be responsible for any applicable co-payment, deductible or co-insurance as required by the insurance company. These costs vary by patient benefit level and insurance company.

Agendia is a compassionate company offering a wide range of financial assistance programs based on individual financial ability. If the patient’s insurance provider denies Agendia’s appeals, please ask them to contact Agendia’s Customer Care team and one of our specialists will gladly discuss these programs and determine their eligibility.

Once their claim is processed; many insurance companies send patients a statement called an Explanation of Benefits (EOB). This statement informs patients of services billed, charges and the amount payable according to the plan and patient benefit levels. EOB’s may include information pertaining to appeals or patient financial responsibility such as co-pays, co-insurance and/or deductibles. Please note that EOB’s are not bills. They are a statement of information for patients. Actual information provided on an EOB may vary by insurance company.

If you have any questions regarding a patient’s EOB from pertaining to MammaPrint and/or Agendia, please contact our Customer Care team and one of our specialists will help explain their claim status.

Agendia offers a variety of financial assistance programs with options based upon individual financial ability. Some programs have certain eligibility requirements, so please contact Agendia's Customer Care team and a specialist will gladly assist you to determine the right program for your patient.

Yes, they can pay over time and can make payments using credit cards. Please contact Agendia’s Customer Care specialists to discuss the right payment plan for your patient.

Agendia’s Customer Care specialists are available to provide assistance with any insurance and billing questions related to MammaPrint and other Agenida assays.  Please contact your local representative, or Agendia Customer Care and we will galdy assist you with your questions.