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VitaGraftTM Kidney Billing Guidelines

Oncocyte is committed to increasing access to personalized testing for all kidney transplant patients.

We realize that each patient’s situation is unique and are here to support you throughout the insurance claim and billing process. We believe every patient who could benefit from VitaGraft Kidney testing should have access to our test and are committed to helping you manage related out-of-pocket expenses.

Patients with Medicare coverage​

VitaGraft Kidney is medically necessary and covered by Medicare when specific criteria are met. Patients with Medicare Advantage may have an out-of-pocket expense based on their plan. Oncocyte will bill Medicare directly.​


Questions? Contact us anytime.

Oncocyte Customer Service Team
Phone: 1-844-621-8880
Email: customer.service@oncocyte.com

Oncocyte Billing Specialists
Phone: 1-844-679-6600

Patients with commercial insurance

We accept all patients with any insurance plans and will bill the patient's insurance directly as an out-of-network provider. Coverage may differ depending on the patient's insurance plan, and all denied claims will be appealed. Additional information may be needed from you to support the appeal process. The appeal process is time-sensitive and prompt attention to related requests you may receive from us will be needed.

Financial Assistance Program

Patients who meet specific criteria may be eligible for financial assistance to reduce the cost of testing. Oncocyte will conduct an individual assessment to evaluate your eligibility for the program upon completion of the Financial Assistance Application.

FAQs

Currently, all health insurance plans are accepted.

We are a participating provider with Medicare. At this time, all other insurance plans are out-of-network.

We accept all patients with any insurance plan(s) and will bill the patient’s insurance provider directly as an out-of-network provider. Coverage may differ depending on the patient’s insurance plan, and all denied claims will be appealed, the success of which will depend on your particular policy. Additional information may be needed from the patient to support the appeal process. The appeal process is time-sensitive and prompt attention to related requests the patient may receive from us will be needed.

Currently, no state Medicaid programs have coverage for VitaGraft Kidney.  However, tests for VitaGraft Kidney for patients with Medicaid will be accepted. 

VitaGraft Kidney is a blood-based transplant monitoring test that quantifies the concentration of donor-derived cell-free DNA following kidney transplantation. The test is considered medically necessary by CMS if the following criteria are met:

  1. The patient has had a kidney transplant.
  2. The patient has clinical suspicion of rejection at least 12 days post-transplant.

No, patients will be billed for the deductibles and copay/co-insurance amounts only. 

No, patients will be billed for the deductibles and copay/co-insurance amounts as adjudicated by the patient’s insurance plan. Patients have the ability to apply for our Financial Assistance Program if the amount billed creates a financial hardship. The Financial Assistance Application is available through our website.  Please refer to “How does the Financial Assistance program work?” below for more information. 

Oncocyte will not be actively pursuing prior authorizations as needed. If a patient’s insurance plan requires prior authorization, we will work with the ordering provider and the insurance plan to obtain the authorization. 

Denied claims will be appealed on the patient’s behalf.  The patient will be asked to sign an Authorization of Representation if his or her insurance plan requires it. If an appeal is denied, the patient will be billed for the patient responsibility amount as determined by the insurance plan. Financial Assistance and no-interest payment plans will be available to the patient based on eligibility.

The Financial Assistance program is based on the current year’s Federal Poverty guidelines. The patient’s previous year’s income (Line 22 of IRS form 1040) as well as the number of people in the patient’s household are taken into consideration. Financial Assistance is not available for anyone with governmental insurance (Medicare, Medicaid, VA). The application is available on this webpage.

Payment plans for 3-, 6- or 12-month installments will be available. Payment installment amounts will be based on the balance due and the number of months. There will be no interest charged on the balance due. Statements will be sent to the patient every 30 days until the balance is zero. 

Mastercard, VISA, and Discover credit cards will be accepted. 

The patient is responsible for submitting to Oncocyte any insurance payments received directly by the patient from his or her insurance provider. If requested by the patient, Oncocyte will work with the patient and/or policyholder on how to submit the payment directly to Oncocyte. The amounts associated with these payments are not eligible for reduction through the Financial Assistance program (only amounts associated with patient responsibility are eligible for consideration under the Financial Assistance program). Once Oncocyte is made aware of a payment made to a patient directly from his or her insurance provider, a statement for such amount will be sent to the patient. If the amount of this payment is not known at the time, a statement for the full amount of the applicable test cost will be sent to the patient.  This statement will include a request that the patient forward to Oncocyte an explanation of benefits from the patient’s insurance provider. Once Oncocyte receives the explanation of benefits, the statement amount owed will be adjusted to reflect the amount paid to the patient by his or her insurance provider plus any deductible or copay/co-insurance owed.

An EOB is a statement from the patient’s health insurance plan describing what costs it will cover for medical care or products he or she has received. It is not a bill.

Patient should call Customer Service at 1-844-621-8880, email customer.service@oncocyte.com, or call Oncocyte’s Billing Specialists at 1-844-679-6600.

© 2024 Oncocyte, Inc. All Rights Reserved. The VitaGraft Kidney Test has been developed and its performance characteristics determined by Oncocyte. The VitaGraft Kidney Test has not been cleared or approved by the US Food and Drug Administration (FDA). Oncocyte's laboratory offering the VitaGraft Kidney Test is CAP-accredited and CLIA-certified.

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