Health Insurance FAQs

How long does it take until my urologist receives the test results?

Once MDxHealth receives the samples the test will take approximately 7-10 business days until your urologist will receive the test results.

For more information and to inquire about having the ConfirmMDx for Prostate Cancer test performed, please talk to your doctor.

Where is ConfirmMDx performed?

Your urologist will submit your previously collected, prostate biopsy samples to MDxHealth for testing in its CAP and CLIA accredited laboratory in Irvine, CA.  The test results will be provided to your urologist.

For more information and to inquire about having the ConfirmMDx for Prostate Cancer test performed, please talk to your doctor.

Does ConfirmMDx require an additional office visit?

You do not need a repeat biopsy or office visit for this test.

For more information and to inquire about having the ConfirmMDx for Prostate Cancer test performed, please talk to your doctor.

When should I get ConfirmMDx?

If you had a negative prostate biopsy within the past 24 months, ask your urologist if ConfirmMDx is right for you. Your doctor can send the remaining tissue samples from your previous prostate biopsy for ConfirmMDx testing. You do not need a repeat biopsy or office visit for this test.

For more information and to inquire about having the ConfirmMDx for Prostate Cancer test performed, please talk to your doctor.

 

Why do I need ConfirmMDx?

If you have an elevated PSA test result and high risk factors you may have prostate cancer.  A prostate biopsy procedure is the best method for your urologist to determine if cancer is present.  Although 1 in 6 men are diagnosed with prostate cancer during their lifetime, the vast majority of men have a negative prostate biopsy result.

Unfortunately, today’s “gold standard” for diagnosis, the prostate biopsy procedure, only provides a limited evaluation by sampling less than 1% of your entire prostate. Prostate cancer may be present in one or more small tumors, and there is a risk the biopsy needle could have missed it.

Your urologist may have concerns about your risk for undetected prostate cancer and recommend ConfirmMDx to determine your need for a repeat biopsy.

For more information and to inquire about having the ConfirmMDx for Prostate Cancer test performed, please talk to your doctor.

What are my options if I do not have health care insurance?

MDxHealth offers a variety of financial assistance programs with options based on individual financial status. Some programs have certain eligibility requirements; please contact MDxHealth and one of our representatives will gladly assist you in determining the right program for you.

What if my insurance company does not cover the ConfirmMDx test?

In the unusual event that your insurance company denies coverage, MDxHealth will appeal the denial on your behalf. In most cases the appeals process, which may include a letter from you and/or your physician, will overturn the denial and the insurance company will agree to pay for the test. MDxHealth will strive to minimize your financial obligation. If the appeals process is unsuccessful, you may be eligible for a self-pay discount and a payment program tailored specifically for you.

Will I have any financial responsibility for the ConfirmMDx test?

The ConfirmMDx test falls under the Clinical Laboratory Fee Schedule, so there is no co-payment, co-insurance or deductible for patients covered under traditional Medicare. Patients covered by commercial insurance companies may be responsible for a co-payment, co-insurance, and/or deductible depending on the health insurance plan.The amount, if any, will depend on the specific level of benefits for your insurance plan. MDxHealth will gladly work with you should you need assistance and if any such payments are required.

How will I know if my insurance covered the ConfirmMDx test?

Once your claim has been processed; your insurance company may send you a statement called an Explanation of Benefits (EOB). An EOB from your insurance company is not a bill from MDxHealth.

What is an Assignment of Benefits form (AOB)?

An AOB form authorizes MDxHealth to provide the necessary information on your behalf to your insurance company for claims processing and for appeals purposes. A signed AOB form allows your insurance company to pay MDxHealth directly for your test and enables MDxHealth to accept that payment as payment in full.

Will my insurance cover the cost of ConfirmMDx for Prostate Cancer?

MDxHealth is billing Medicare and insurance companies on behaIf of patients. In most cases, insurance companies will cover the entire testing fee. MDxHealth will accept the payment from your insurance company as payment in full with a signed Assignment of Benefits form (AOB). MDxHealth will not bill you for the difference between the insurance payment and the retail price of the test.

For patients covered by traditional Medicare coverage, the ConfirmMDx test falls under the Clinical Laboratory Fee Schedule, so there will be no patient financial responsibility. For Medicare patients, an Advanced Beneficiary Notice (ABN) may be required.

For questions regarding your specific level of coverage, please contact MDxHealth and one of our representatives will gladly assist you.

Commitment to Patients
MDxHealth understands that the costs associated with the diagnosis, treatment and management of prostate cancer can impose a financial hardship that may affect your  decisions on  selecting  testing  and  treatment options. Regardless of your insurance coverage or financial status, MDxHealth's staff will assist you to obtain the testing you need. We can provide assistance with the filing of insurance claims and appeals, financial assistance, and payment programs.

For additional information:
MDxHealth's representatives are available to assist you with insurance and billing questions related to testing services and insurance coverage. For more information, we can be reached by phone at 866.259.5644 weekdays, 6:00AM to 5:00PM Pacific Standard Time, or by email at patient.first@mdxhealth.com.