Billing Summary

Rosetta Genomics believes every patient who needs our tests should be able to receive them. We provide high-quality, medically necessary tests based on established medical guidelines.

The information in the following sections addresses commonly asked health plan and billing questions. If you would like more information, please contact:
Rosetta Member Services
1-888-522-7971
Monday-Friday 7 am – 7:00 pm EST

WHAT TO
EXPECT
FREQUENTLY ASKED
QUESTIONS
FINANCIAL
ASSISTANCE PLAN
MEDICARE
INFORMATION

What to Expect

  1. Rosetta Genomics accepts third-party assignment and will submit a claim to your primary health plan.
  2. You will receive an Explanation of Benefits (EOB) from your health plan and a welcome letter from Rosetta Genomics that includes a statement of services rendered and submitted to your health plan.
  3. Appeals can take 30-180 days or more depending on the timely collection of the information needed to file an appropriate appeal. Rosetta will submit primary and secondary appeals before billing the final amount specified by your health plan as patient financial responsibility.
  4. Rosetta Genomics will send the patient an invoice for any co-pays, deductibles, or co-insurances, as determined by your health plan. Payment is due upon receipt.
  5. Customer Service Associates are available to discuss the claims, appeals and billing process, and the options available to you to reduce your out-of-pocket expenses and optimize your eligible benefits.
  6. All Rosetta Genomics patients are eligible to apply for our Financial Assistance Program.

Glossary of Health Plan Terms Found on Most EOBs
An EOB is a document provided by your health plan that explains how your claim was processed and paid. Most health plans use a unique format for their EOBs so it is important to know and understand your company's format. If you have questions, please contact your health plan directly.

TERM DESCRIPTION
Account Number A number assigned to each bill by Rosetta Genomics.
Amount Paid The portion of the total bill that has been paid by your health plan.
Allowed Charges The amount the health plan approved for processing.
Claim Number The number assigned by your health plan to the Rosetta Genomics claim.
Co-insurance The portion of the allowed charges (usually a certain percentage) that is the patient’s financial responsibility. This amount can differ based on in-network or out-of-network determinations.
Contract Adjustment The portion of the total bill that is NOT owed to Rosetta Genomics by either the health plan or the patient due to a contractual agreement between the health plan and Rosetta Genomics.
Coordination of Benefits The amount owed by another health plan when the patient has secondary coverage.
Co-pay The amount required to be paid by the patient per visit or encounter.
Date of Service The date on which the laboratory testing was reported to your physician.
Deductible A specific annual dollar limit that must be paid by the patient before the patient’s insurance will begin reimbursing for covered services.
Excess Charges Any portion of the total charges that that the health plan determines is greater than the allowed charges; this amount may be based on the contractual agreement between the health plan and Rosetta Genomics or may be an amount limiting the "UCR" charge amount (usual, customary, and reasonable).
Explanation of Payment The section of an EOB that uses reason and denial codes to explain the payments made.
IPA Independent Practice Association: a group of allied physicians and/or health professionals who coordinate care usually under a capitated or pre-paid arrangement.
Non-covered A service that is excluded from your benefit plan which is considered non-payable by your health plan. The patient may be responsible for this amount.
Patient Information Information including patient name, patient ID number, responsible party, subscriber, insured’s name, and employee’s group number.
Patient Responsibility The amount your health plan has determined the patient owes Rosetta Genomics. This includes co-pay, co-insurance, deductibles, and any percentage of balance, if payment is less than 100% of the billed amount.
Provider Information Rosetta Genomics name, provider ID, and mailing address.
Service Code A CPT Code or other HCPCS code representing the service provided.
Submitted Charges The amount billed by Rosetta Genomics.
Units The number of items included in the service.
UCR The usual, customary, and reasonable fee for services. Often referred to as the list price.
  • How do I make a payment?

    How do I make a payment?
    If you receive a Rosetta Genomics statement, there are several options for payment:

    Check or money order:
    Please make it payable to Rosetta Genomics and mail it to the address below:


    Credit or debit card:
    You may complete the form on your invoice or to pay by phone, please call us at the number below. A receipt can be mailed to you upon request.

    Please mail your payment to the address on your statement. We also accept PayPal payments. Please contact Rosetta Genomics Customer Service to make payment.

  • Did you bill my primary health plan for these charges?

    Rosetta Genomics accepts third-party assignment for all health plans and will bill your health plan directly. We require full and accurate health plan information from you and your provider. If the health plan information we receive is incorrect or missing information, we may not be able to file a claim with your health plan.

  • My bill shows a claim was filed with my health plan. Why am I receiving a bill for the full amount?

    You may receive a bill for the full amount if:

    1. Your health plan information is incorrect or outdated in our system
    2. Your health plan didn't reply to our claim in a timely manner
    3. Your health plan denied payment for some or all of our services

    Contact your health plan at the customer service phone number on the back of your member card. If they received our claim, ask them why payment has been delayed. If they did not receive the claim, make sure we have your updated health plan information

  • Why do I have a balance left over after my insurance has paid?

    1. You have non-government insurance and are responsible for a co-payment, co-insurance, deductible, and/or non-covered services.
    2. You have Medicare and are responsible for 20% of the amount Medicare has set as the cost of the test.
    3. You have Medicare and have signed an ABN (advanced beneficiary notice). In this case, you may owe the difference between what Medicare paid and what they have set as the cost of the test.

    Most health plans today have deductibles, co-insurance, or required co-payment amounts you must pay. If you believe this portion of your bill is your health plan's responsibility, contact them using the customer service phone number on the back of your insurance card.

  • Do you offer payment plans?

    In some cases, yes. Contact Rosetta Genomics Customer service to determine your eligibility.

  • My name, address, or other personal information changed. Who should I notify?

    Please contact Customer Service and we will be happy to update your information and submit a corrected claim when appropriate.

  • Why have I received an invoice from Rosetta Genomics?

    You may not be aware your physician has sent your specimen to Rosetta Genomics for testing. Some of the high complexity tests we provide are only available through Rosetta Genomics. The statement you receive is for medically necessary testing ordered by your physician and provided by a Rosetta Genomics laboratory. The statement is for laboratory testing fees only, and is separate from any bill you may have received from your physician and/or paid at your physician's office.

    Please refer to the message on your Rosetta Genomics statement or the Explanation of Benefits (EOB) from your health plan for more specific information about why you received a statement.

    You may receive a bill for some or all of the billed amount because:
    1. Your health plan information was not received or the wrong health plan information was received with your test request.
    2. Your health plan processed the claim and denied payment (see your EOB for explanation).
    3. Your health plan processed the claim and applied the balance to your health plan co-pay, co-insurance, or deductible requirement.
    4. The insurance carrier did not respond to the claim.

  • Am I required to pay past due balances to obtain future services?

    Your payments are due upon receipt. A payment for all past due balances is required at the time of service. Rosetta Genomics reserves the right to refuse laboratory services for failure to pay for past services.

  • Can Rosetta Genomics tell me how much I can expect to pay for my tests?

    The price you pay for Rosetta Genomics testing depends on several variables:
    1. If you have valid health plan coverage for the services ordered by your physician.
    2. Rosetta Genomics is or is not a participating provider in your health plan network.
    3. Your health plan or Medicare does not pay for some or all of the tests ordered by your physician because they do not consider the tests medically necessary.
    4. Your healthcare provider or physician has an agreement with Rosetta Genomics.

  • How can I have Medicare send my invoice to my secondary health plan/carrier?

    Medicare automatically forwards or “crosses over” your claim to your secondary health plan or insurance carrier when Medicare or your Medicare Advantage Health Plan are aware you have secondary coverage (sometimes referred to as Medi-Gap coverage). You must inform Medicare directly of your secondary insurance coverage.

  • How do I submit secondary health plan or insurance carrier information?

    Rosetta Genomics will file eligible claims to a secondary health plan or insurance carrier when it is provided by the patient or responsible party. To submit your secondary insurance information, please call Rosetta Genomics Customer Service.

  • Does Rosetta Genomics have a program for patients experiencing financial hardship and/or patients who do not have insurance?

    Rosetta Genomics offers payment plans in monthly installments until your balance is paid in full. We also offer The Rosetta Genomics Financial Assistance Plan which provides free or reduced-fee laboratory services, to those who qualify based on U.S. Department of Health and Human Service poverty guidelines.

  • Are Rosetta Genomics services eligible for Flexible Spending Accounts (“FSA”) or Health Reimbursement Account (“HRA”)?

    Yes. You will need to contact your FSA or HRA administrator for instructions on filing requirements.

  • How can I find out if Rosetta Genomics is a participating provider with my health plan?

    Rosetta Genomics is a participating provider with a growing list of health plans covering more than 235 million lives in the United States. However, it is the patients’ responsibility to verify benefits before services are performed. Any questions regarding coverage should be directed to your health plan.

  • I don’t understand why my testing wasn’t paid by my health plan?

    Please refer to the messages and reason/denial codes on your health plan EOB and your Rosetta Genomics statement for more specific information about why you received a statement. If you have additional questions or concerns, please contact your health plan first.

  • Why was my health plan billed with incorrect insurance information?

    Your health plan is billed using the information provided to us on the original test order from your physician, also called a test requisition. Sometimes the information provided on the requisition is incorrect. To ensure your health plan is billed properly, please present your insurance card at each physician's office. Please also make sure your physician's office has your most current health plan and billing information, including your current address, contact information, and correct date of birth.

  • Why do I have to give my insurance information each time I visit my physician?

    Americans change their health plan coverage frequently, on average every three years. Open enrollment occurs annually. It is important to provide your most current health plan information at each visit to ensure you receive your eligible benefits.

  • I received information from my health plan about my benefits and I do not understand all of the information. Can you help me?

    Please contact your health plan directly. Information about how a specific claim is processed should be provided to you from your health plan with their Explanation of Benefits (EOB). You can also review the Glossary of Health Plan terms provided on this website which may help you interpret the information provided by your health plan.

  • Can Rosetta Genomics tell me if my testing is covered by my health plan?

    No, Rosetta Genomics does not know each individual patient’s health plan coverage. It is the patient's responsibility to verify benefits before services are performed. Any questions regarding coverage should be directed to your health plan.

  • Why does my Rosetta Genomics statement include charges for additional tests that were not on my physician's original order?

    Your physician may have requested additional testing after the order was submitted or your physician ordered a test that includes a "reflex" test. Reflex testing is performed when the results of your original test require more detailed information about the findings of the initial test.

  • Where does Rosetta Genomics obtain the diagnosis information related to my claim?

    Rosetta Genomics obtains diagnosis information from your ordering physician’s office. If your health plan denied your claim due to the diagnosis code, please contact your physician's office and ask them to call Rosetta Genomics Customer Service to update the diagnosis code.

  • I received a statement from Rosetta Genomics requesting additional information. What should I do?

    Please send the requested information to the address or fax number listed on your statement. You can also call the Customer Service phone number listed on your statement.

    If the message on your statement indicates that your health plan needs more information from you in order to process your claim, please contact your health plan directly.

  • What happens if I cannot afford to pay my bill?

    Rosetta Genomics has a Financial Assistance Plan for uninsured and under insured patients or those who may not be able to afford their associated out-of-pocket costs. (Limits and conditions apply.) Contact Customer Service for more information on these programs.

Financial Assistance Plan
Rosetta Genomics offers testing at reduced or no cost to uninsured or underinsured patients in the U.S. who meet specific financial criteria. Only U.S. patients are eligible. Due to regulatory limitations, patients who are recipients of U.S. government funded programs such as Medicaid, Medicare, and TriCare are not eligible to apply.

Financial Assistance Criteria
A separate Rosetta Genomics Financial Assistance Program Application is required. Download here. The financial criteria below are for informational purposes only. Financial assistance program applications submitted with specimens without prior approval from Rosetta Genomics will not be deemed to be qualified applications.

Note: The financial criteria above are based upon the 2016 United States Department of Health & Human Services (HHS) Poverty Guidelines (multiplied x 4) and are subject to change. If the patient does NOT qualify for financial assistance, Rosetta Genomics offers payment plans in which the patient can make monthly payments over 3, 6, or 12 months. Rosetta Genomics reserves the right to terminate or modify its Financial Assistance Program at any time without notice. Patients’ choosing to self-pay or pre-pay for Rosetta Genomics testing are not eligible for the Rosetta Genomics Financial Assistance Plan.  For international orders, the patient prepay option does not include shipping.

Third-party Billing Information
Rosetta Genomics is a participating provider with Medicare and covers more than 234 million Americans through various managed care agreements. Third-party payers request the information listed below be provided in order to process a claim:

  • Patient’s complete name
  • Patient’s date of birth
  • Patient’s gender
  • Patient’s address
  • Patient’s telephone number
  • Patient’s status: inpatient, outpatient, or non-patient
  • Subscriber’s name if other than patient
  • Subscriber’s date of birth
  • Complete mailing address of patient or subscriber
  • Patient’s relationship to subscriber, identified as: Self, Spouse, Child, and Other
  • Ordering physician’s last and first name
  • Treating physician’s last and first name
  • Specimen collection date and time
  • List all applicable ICD-9-CM diagnosis codes to their highest level of specificity
  • Copy of card (front & back)
  • Private Insurance: complete name and full address of the insurance company
  • Medicare, Medicaid, or insured’s ID member number as it appears on the insurance card
  • Group/policy number as it appears on the insurance card
  • Employer’s name

Medicare BIlling
Medicare reimburses Rosetta Genomics differently depending on the test provided. For tests reimbursed based on the Medicare Physician Fee Schedule, Medicare will reimburse at 80% of the fee schedule amount and the patient is billed for the remaining 20% co-insurance and any deductible amounts. For tests reimbursed based on the Medicare Clinical Laboratory Fee Schedule, Medicare typically reimburses Rosetta Genomics at 100% of the allowable amount.

Completing a Medicare Billing Request
Indicate with a mark the “Medicare” billing option on the test request form:

  • Complete patient demographics
  • Full name, address, telephone number, date of birth, and gender
  • Medicare number as it appears on the Medicare card
  • Specimen collection date and time or date of surgery and time
  • Patient’s place of service status: inpatient, outpatient, or non-patient
  • Ordering physician’s first and last name and NPI number
  • Treating physician’s first and last name and NPI number
  • All applicable ICD-10-CM diagnosis codes to their highest level of specificity
  • Secondary health plan or insurance carrier (Medi-Gap) information if applicable
  • Advance Beneficiary Notice (ABN) (if required)

Medicaid Billing
Rosetta Genomics does not participate with any Medicaid plans. However, Rosetta Genomics will provide testing services to Medicaid enrollees who are willing to pay in advance or have applied and been certified with our Financial Assistance Plan.

Completing a Medicaid Billing Request:
Indicate with a mark the “Medicaid” billing option on the test request form. Medicaid claim filing requirements vary by State and health plan but generally require:

  • Patient’s complete name, address, telephone number, and date of birth
  • Complete Medicaid member number and the State as it appears on the Medicaid card
  • Indicate primary or secondary information
  • Specimen collection date and time
  • Patient’s place of service status: inpatient, outpatient, or nonpatient
  • Ordering physician’s first and last name
  • Ordering physician’s signature; necessary only in states where required
  • Treating/PCP/PMP/clinician’s first and last name
  • Provider/authorization number—where required
  • List all applicable ICD-10-CM diagnosis codes to their highest level of specificity

Note: If Medicaid denies payment for non-covered services or eligibility reasons, the patient may be responsible for the payment.