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The patient must photocopy their membership card (both sides) and submit it with the Test Requisition Form. |

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The appropriate ICD-9 diagnosis code(s) and signature must be provided by a physician for the laboratory to process a claim. |

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20% pre-payment of the list price is required for all patients filing "out of network" benefits. The laboratory does not require any payment in advance of service for patients with BCBS, Tricare, or Medicare with a few exceptions. |

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Once the laboratory receives payment information from the insurance company, the patient will be responsible for any deductible and/or co-insurance. |

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If for any reason the insurance company deems the lab work as non-covered or medically unnecessary, the patient will be responsible for the charges in full. |

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The laboratory will not process the patient's lab results without proper forms and signatures. |
Please contact The Great Plains Laboratory billing/insurance department at 913-754-0459 if you have questions.