Billing
What is the GeneSight Promise?
We promise if your cost could be more than $330, we will call you prior to processing your test
What is SLC6A4 & its significance?
Serotonin Transporter Gene - SSRIs are the first line of defense for depression and anxiety.
67% of the population has a genetic variation at this site meaning 7/10 patients are less likely to respond to the first prescribed medication
What was the study design for GUIDED?
1167 patients + 60 sites
Participants were divided into two treatment arms : GeneSight guided and TAU
Patients/raters were blinded, clinicians were not
Using the HAM-D scale, participants were assessed by raters to evaluate progression in symptom improvement, response & remission
PATIENT Q:
"How do I get the GeneSight test?"
The GeneSight test must be administered by a clinician with prescriptive authority who is registered with our company to offer the test.
Once your clinician is registered, you can contact their office to schedule an appointment and discuss your interest in GeneSight testing.
What sets GeneSight apart from our competitors?
1. Our combinatorial approach (CPGx)
2. Our robust clinical studies (currently have 7 published, peer reviewed clinical studies).
Explain the billing process for a patient with United Healthcare.
A patient with United Healthcare may be responsible for a portion of the cost of the test. We promise to contact you prior to processing your test if your OOP could exceed $330.
We also offer financial assistance based on household AGI + number of people in the household
Any OOP $100 or greater is eligible for an interest free payment plan.
How many genes are included in our algorithm and which gene is included for informational purposes?
Why is this gene excluded from the algorithm?
14 & COMT
COMT is excluded from our algorithm because based on a review of past studies and a thorough evaluation of more recent data there is no association between COMT genetic variation and treatment outcomes with the medications found on the GeneSight report
What were three study limitations from GUIDED?
1. Mostly Caucasian
2. Treating clinicians not blinded
3. Study did not include patients with mild depression, may not be able to generalize to mild depression patients
HCP Q:
"How valid are the GeneSight results?"
GeneSight has been evaluated in multiple peer reviewed clinical studies, included the GUIDED study which is the largest pharmacogenomic clinical trial to date.
*briefly verbalize GUIDED and findings*
You have just collected all of the clinic/HCP information from the office necessary for the new account registration - verbalize next steps to the customer
Now that I have received all necessary information for the registration, I will send over the registration invite via email for you to review and complete at your first convenience. Once this is done, you will receive your welcome email to activate your account and establish a password within 24 hours. From here you will be able to access our secure web portal where orders are placed/results are viewed and collection materials will be shipped to your office to have on hand.
What three resources do we offer our customers to help address their billing questions?
1. Financial Information Sheet
2. Cost Calculator
3. Customer Service Team
If a medication is placed in the RED bin, does this mean the clinician cannot prescribe this drug to the patient?
If a medication is placed into the RED bin, this does not mean the clinician cannot select from this category. Rather, the clinician should review the clinical considerations that accompany the medication. GeneSight is a tool for the clinician to use in their medication management and the action each clinician takes based on the results is at his/her discretion.
Compare and verbalize GDI vs Congruency
Congruency data reviewed a subset of the initial study population from GUIDED who entered the GUIDED study on a RED bin medication (213).
Symptom Improvement = 59%
Response = 71%
Remission = 153%
GDI data reviewed a larger subset (in comparison to congruency) of the initial study population from GUIDED who entered the GUIDED study on a RED or YELLOW bin medication (787).
Symptom Improvement = 23%
Response = 42%
Patient Q:
"Should I call my insurance to see if this will be covered?"
GeneSight has an internal billing structure. We will submit the cost of the test in a claim to your insurance policy and once that claim is processed we will bill you for your portion of the test. We promise to contact you prior to processing your test if your OOP could exceed $330.
*Ask for their insurance type and elaborate on process for the patient*
What is the process for the clinic to order a GeneSight test for each scenario:
Collection in the clinic
DTP
Collection in the clinic:
Place the order in the secure web portal
Collect the patient's sample
Send kit (include sample, consent form & insurance) via FedEx
DTP:
Place the order in the secure web portal & select ship kit to patient
Once kit is delivered to patient, they will collect their sample and send along with their consent/insurance information via FedEx
Verbalize the billing process per each of the four payor types
1. Commercial/Private Insurance : GeneSight Promise applies - FAP - Payment Plans
2. Medicare Advantage : GeneSight Promise applies
3. Medicare part B : Zero OOP cost
4. Medicaid : Typically zero OOP cost
What is MTHFR?
The MTHFR panel measures a patients ability to convert folic acid and dietary folate into its active form, which is called l-methylfolate.
L-methylfolate plays an important role in making neurotransmitters, such as serotonin, dopamine, and norepinephrine, which help regulate mood
Verbalize our combinatorial approach
The patented GeneSight CPGx approach not only focuses on the primary pathway in which a drug metabolizes through but looks at the multiple pathways and weights them against each other based on significance.
HCP Q:
"All of my staff uses the same email address. Can we all register using the same email?"
"Can we just share our login information with each other?"
For security purposes, we register each user on the account with a unique email address.
Review Glidian
United Healthcare requires a prior authorization for GeneSight testing and to ensure this does not become a burden for your office when ordering GeneSight Psychotropic, we have partnered with a 3rd party company, Glidian, to handle the prior authorization work on your behalf.
Glidian is a one time enrollment and no cost to your office.
"I have received a bill for $5000?!"
Is the statement from your insurance company or GeneSight?
What you are looking at is an explanation of benefits (EOB) which is a summary of the claim we submitted to your insurance, what your insurance covered and what they assume to be your patient responsibility.
Your bill for GeneSight will come from our lab and will have the GeneSight logo displayed at the top. This amount will not exceed $330 (unless you were contacted by our team previously and agreed to proceed with the testing).
I can connect you with our billing team now so that they can provide an update on where we are at in the billing process.
What do the gray bin medications mean?
When a medication falls into the gray category, it means it does not currently have any clinically proven genetic markers that allow it to be categorized
Explain the Medication Switching analysis
A sub analysis which reviewed patients who entered GUIDED on a medication with GDIs at baseline and then had their medication switched.
Patients that had their treatment guided by GeneSight we switched to a green bin medication 66.4% of the time in comparison to 20% of the time for the TAU patient group.
Patient Q:
"Where do I receive my GeneSight results?"
Once we receive your sample in our lab the results are sent to your clinician within 36 hours to our secure web portal. From there you can schedule your follow up appointment with them to review and decide on next steps.
Verbalize the 3 report scenarios when ordering for a patient with Medicare?
1. Selection of medication or multiple medications with multiple GDIs will result in the GeneSight Psychotropic
2. Selection of medication or multiple medications with a single GDI will result in a single gene report
3. Selection of medication or multiple medications with no GDIs will require an ABN to be signed by the patient and the GeneSight Psychotropic report