Billing information

Financial Assistance Program

OneOme offers a Financial Assistance Program (FAP) to provide access to the RightMed Test for patients in financial need.

Insurance Overview

More and more insurance plans now include coverage for pharmacogenomic testing. However, it’s important to understand that when an insurance company indicates that they have “approved” a prior authorization or consider this testing a “covered service,” it does not guarantee that they will fully cover the cost of the test. In such cases, the patient may still be responsible for certain expenses, such as deductibles, copays, or coinsurance, depending on the specific policy terms. To ensure you have a clear understanding of your potential out-of-pocket expenses, we recommend that patients reach out to their insurance company. You can do this by contacting the member services number on the back of their insurance card. OneOme can provide you with the appropriate billing code(s) (e.g., CPT® PLA Code(s)) to communicate with your insurance company. This will help you better understand their coverage policies and get an estimate of the expected out-of-pocket costs for the RightMed Test.

Financial Assistance Program

The FAP offers predictable out-of-pocket costs and helps provide access to medically necessary tests to patients who may not otherwise be able to afford it. We encourage patients to apply for the Financial Assistance Program prior to ordering the test to determine eligibility.

To qualify for OneOme’s Financial Assistance Program, the following criteria must be met:

• The RightMed test is ordered by your healthcare provider
• You have medical insurance coverage but are underinsured (e.g., high deductible plan);
• You do not have insurance coverage through Medicare, Medicaid, Medicare Advantage, TRICARE, or any other federal health care program; and
• You meet certain income limits for your household.

Patients who qualify for OneOme's Financial Assistance Program will have a maximum out of pocket cost of $199 for the RightMed Test. Patients who are not eligible may choose OneOme’s self-pay option for $349.

These financial assistance tiers are based on household income and size, relative to Federal Poverty Levels for 2023. For additional information on Federal Poverty Levels, please visit: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines

2023 Tiers effective February 1st, 2023 are as follows:

These tiers are for informational purposes only and subject to change at any time.

To check eligibility for Financial Assistance before an order is placed, please complete this application.

Patients are encouraged to apply for financial assistance before submitting a sample for testing, and to follow up with OneOme's Client Services Team as soon as possible with any payment questions. We can be reached by phone Monday-Friday from 7 AM - 5 PM Central Time by calling 844-663-6635 or by emailing support@oneome.com

If a patient is eligible for our FAP, they will be mailed a letter confirming they qualified for the FAP and details of the program. If a patient is not eligible for the FAP, OneOme will contact the patient by phone or email to let them know they did not qualify, or that more information is needed to determine eligibility.

Please note that during the insurance claims process, the patient may receive an Explanation of Benefits (EOB) from their insurance. This is not a final bill. The final bill will come from OneOme.

CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

Federal No Surprises Act

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have these protections:

• You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
• Generally, your health plan must:
  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, contact OneOme's Client Services at 1-844-663-6635

The federal phone number for information and complaints is: 1-800-985-3059.

Visit such as www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

Minnesota: For more information about your rights under Minnesota state laws Visit https://www.health.state.mn.us/facilities/insurance/managedcare/faq/nosurprisesact.html. If you’ve received a surprise bill and you believe your health plan is not following the new law, you can file an appeal with your health plan or ask for an external review of its decision. You can also file a complaint with the Minnesota Department of Health or The Minnesota Department of Commerce.

Michigan:

Emergency Services: In general, an out-of-network provider may not charge you more than the in-network coinsurance, copayment, or deductible for emergency services provided at either an in-network or out-of-network facility, so long as your health benefit plan covers the emergency services provided.

Non-Emergency Services: In general, an out-of-network provider may not charge you more than the in-network coinsurance, copayment, or deductible for non-emergency services provided at an in-network facility. This billing restriction applies when your plan otherwise covers the non-emergency services provided, and you either do not have the ability or opportunity to choose an in-network provider or you were not provided with a proper disclosure of the provider’s out-of-network status prior to the services.

The Department of Insurance and Financial Services (DIFS) can help you with health insurance questions and complaints and can provide general information about Michigan’s surprise medical billing law. Contact DIFS Monday through Friday from 8 a.m. to 5 p.m. at 877-999-6442 or visit the DIFS website to file a complaint at Michigan.gov/DIFScomplaints.

You may make complaints against medical providers by contacting the Michigan Department of Licensing and Regulatory Affairs (LARA), Bureau of Professional Licensing. You can find information about LARA’s complaint process on its website at Michigan.gov/LARA/Bureau-List/BPL/Complaint.