GET MORE INFORMATION ON THE NO SURPRISES ACT
The CareDx Reimbursement Team will make every attempt to support coverage and reimbursement for our health services. Our Reimbursement Hotline staff can address questions regarding:
To better understand the coverage and reimbursement process, we’ve outlined what occurs once we receive the test order from your doctor.
Your doctor orders a CareDx test.
Once testing is complete, CareDx bills your insurance, and we confirm insurance coverage.
Your health plan will process a claim for your diagnostic test. The notice you receive from your insurance is called an Explanation of Benefits (EOB). This is a notification your claim has been processed. THIS IS NOT A BILL, AND YOU WILL NOT MAKE A PAYMENT.
If your insurance denies the claim, they will notify you and CareDx. With your permission, CareDx will work on your behalf to appeal with your insurance provider for your health care services. Appeals may take several months, and you may be notified of each appeal with another EOB or letter from your health plan. This is standard practice when appealing your claim.
In the event you have financial responsibility, CareDx will reach out to you before issuing a bill to review your financial assistance options. CareDx will send you an invoice—like the one shown above—for any patient responsibility. Do not make payment until you receive this invoice.
Financial assistance is available for patients who meet the eligibility criteria to qualify for reduced financial responsibility for CareDx services. For more information on the eligibility criteria and to apply, contact the CareDx Reimbursement Team.
Under the No Surprises Act, patients who don’t have insurance or who are not using insurance may request a good faith estimate of expected charges for CareDx services.
This good faith estimate shows the costs of CareDx services that are reasonably expected for your health care needs. The estimate is based on information known to CareDx at the time the estimate was created.
If you received a good faith estimate from CareDx and you are billed substantially in excess of the amount in the good faith estimate, you have certain rights under the law. Find out more by reviewing our No Surprise Act disclosures.
The CareDx Patient Financial Assistance Program helps patients gain access to necessary testing. The program is available to qualifying patients, whether they are uninsured or underinsured.
Yes, patients with insurance through Medicare, Medicare Advantage or Medicaid may be eligible for the program if the test is not covered by their payer.
You may be eligible if you have no insurance, provided you meet the FAP eligibility criteria. The program was designed, in part, for patients with no insurance coverage. Patients who don’t have insurance or who are not using insurance have the right to receive a good faith estimate of the bill for CareDx services upon request.
You may be eligible if you have commercial coverage, provided you meet the FAP eligibility criteria and:
No, to qualify, you must apply for the program and the CareDx Reimbursement Team will determine if you meet the eligibility criteria.
No, CareDx does not charge a fee to apply to the program.
You may receive an EOB from your insurance company after your CareDx test. If you receive an EOB and are concerned about your patient responsibility, please contact the CareDx Reimbursement Team.
Please contact the CareDx Reimbursement Team. We may assist you through the claims process with your insurance company, including (with your permission) help with appeals for any denial of coverage (depending upon the policies of your insurance carrier).
CareDx may work with you on appeals to your insurance provider. In the event your insurance company does not cover the cost of testing, you may apply for assistance through the Financial Assistance Program to see if you qualify.
The following CareDx products are covered benefits for Medicare beneficiaries. Patients who meet clinical criteria for coverage have zero financial responsibility.
AlloSure Kidney assesses the probability of acute rejection in kidney transplant recipients with clinical suspicion of rejection and informs clinical decision-making about the necessity of renal biopsy in such patients at least 2 weeks post-transplant in conjunction with standard clinical assessment.
AlloSure Heart is only covered when used in conjunction with AlloMap Heart to assess the probability of allograft rejection in heart transplant recipients with clinical suspicion of rejection and to inform clinical decision-making about the necessity of a heart biopsy in such patients at least 55 days post- transplant in conjunction with standard clinical assessment.
AlloMap Heart is intended to aid in the identification of heart transplant recipients with stable allograft function who have a low probability of moderate/severe acute rejection in conjunction with standard clinical assessment at least 2 months (55 days) since transplantation.
View more information on the Local Coverage Determination, including billing and coding guidelines.