The Great Plains Laboratory will file insurance claims as a courtesy to our United States clients and will help the patient receive maximum benefits. However, please keep in mind that the insurance policy is a contract between the patient and the insurance company. The laboratory cannot become involved in disputes between the patient and the insurance company regarding deductibles, co-payments, covered charges, secondary insurance, or any other issue beyond supplying factual information as necessary. The laboratory will not bill insurance after the test has been paid by cash or credit card. In these cases, the laboratory will mail a reimbursement form to the patient which can be submitted to the insurance company for reimbursement.
If the laboratory has not received payment from the insurance company within 60 days, the patient will be billed for the test.
Payment is due from you at that time. If payment is received from the insurance company after the patient has already paid for a test, the laboratory will return the insurance payment directly to the patient.
Insurance Plans Filed
Blue Cross and Blue Shield*
The Great Plains Laboratory, Inc. is contracted locally with Blue Cross and Blue Shield (BCBS) of Kansas City and is contracted nationally with BCBS PPO members through the Blue Card program. Blue Card members are recognized in one of two ways. The member’s BCBS insurance card will display a suitcase logo on the front with the letters PPO inside or will have a map of the United States on it. Tests are filed by The Great Plains Laboratory as "in network" for patients who carry these policies. We require a copy of the front and back of the patient’s card to be sent with the test specimen. Please contact our billing department for additional information.
*It is important to understand that being contracted does not mean that BCBS will pay for all of your testing. Being contracted means that our laboratory can only bill the patient the allowable charges for co-insurance, deductibles, co-payments, or non-covered services. If the patient’s deductible has not been met for year, or services are deemed “not medically necessary”, the patient may owe a significant balance.
Tricare
The Great Plains Laboratory, Inc. is contracted with Tricare in every region of the United States. Patients should include a copy of the front and back of the insurance card and the member’s social security number.
Medicare
The Great Plains Laboratory, Inc. is contracted with Medicare. Most of our tests are covered by Medicare. Please see the Advanced Beneficiary Notice (ABN) for a list of non-covered tests. All patients who have Medicare must sign and return the ABN form with the specimen. This form is included in the test kits. We require a copy of the front and back of the patient’s card to be sent with the test specimen. If the patient has chosen to enroll in a Medicare Advantage program, then the laboratory will need to receive a copy of the Medicare Advantage program card. The Medicare Advantage program card is not the same as a Medicare card. Please contact the billing department with any questions concerning coverage.
All Other Carriers
The Great Plains Laboratory is considered “out of network” for all insurance carriers other than those listed above. The laboratory will file "out of network" insurance on behalf of the patient, provided that the patient includes 20% prepayment along with the insurance information on the test requisition form. PPO insurance policies will usually cover our services once the patient’s deductible has been met. The patient will be responsible for any co-insurance, co-payments, and any services denied as “not medically necessary”. However, some “out of network” insurance policies will pay in full for the test performed at The Great Plains Laboratory, Inc. The laboratory will require 20% prepayment for all out of network claims even when insurance states that full reimbursement will be made. Should the insurance pay for more than the patient balance, a reimbursement check will automatically be mailed to the patient by the end of the following month.
Insurance Plans Not Filed
The Great Plains Laboratory cannot bill any state run programs, Medicaid plans, or HMO's. If the patient has any of these insurance policies, the patient must pay in full by check or credit card. A receipt will be sent to the patient.
Claim Processing is as Follows
The patient must photocopy their membership card (both sides) and submit it with the Test Requisition Form.
The appropriate ICD-9 diagnosis code(s) and signature must be provided by a physician for the laboratory to process a claim.
The physician does not need to be a provider of any insurance. However, some policies will require that the physician have specific credentials to authorize testing.
20% pre-payment of the list price is required for all patients filing "out of network" benefits. The laboratory will not accept any payment in advance of service for patients with BCBS, Tricare, or Medicare with a few exceptions (see below).
Exceptions BCBS: Some BCBS plans do not cover the IgG Food Allergy Test. We recommend that you call your insurance company to verify if you have coverage for this test. The CPT code is 86001. Medicare: Payment in full (patient cash price) is required for the Comprehensive Fatty Acids Test, Gluten/Casein Peptides Test, IgE Allergy Advanced Combined Test, IgE Allergy Food Allergy Tests, IgE Inhalant Allergy Tests, IgG Food Allergy Test, Metals Fecal Test, Metals Hair Test, Metals Red Blood Cell Test, Metals Urine Test, Metals Whole Blood Test, and the Vitamin D Test by Medicare patients. These tests are not eligible to be filed with Medicare.
Once the laboratory receives payment information from the insurance company, the patient will be responsible for any deductible and/or co-insurance.
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.
The laboratory will not process the patient's lab results without proper forms and signatures.
CPT Codes are also known as procedure codes and is how insurance will determine the nature of the test. Click here to download a PDF of the CPT Codes. Please note that certain tests are only available as part of a panel and not individually.
