OneOme’s mission is to provide the most cost-effective, pharmacogenomic testing and tools for providers across the globe to use in everyday patient care. In order to achieve this goal, we offer multiple billing options.
At OneOme, our goal is to provide every provider and their patients with access to pharmacogenomic testing. That’s why we’ve created a billing process that supports different payment options, depending on how the test is ordered, including:
Our client services team is available to work with you to find the best billing option for your scenario. CONTACT US for more information.
Patient self-pay (U.S. only)
For tests ordered by a patient’s provider, patients may pay for the test directly at the time the provider submits the order, or OneOme can contact the patient to collect payment after the provider submits the order. OneOme accepts payments from all major credit cards, HSA accounts, and PayPal. In addition, we offer interest-free payment plans when needed. Please CONTACT US for more information about interest-free payment plans.
Please note that the sample will not be processed until payment is collected or a payment plan has been established.
For RightMed Tests ordered through the independent provider network, OneOme accepts payment from credit cards, HSA accounts, and PayPal (insurance billing is not available for this option).
We will bill institutions directly at our current list price without a contract. Discounted pricing is available with a contract. Testing is not invoiced until a report has been delivered. We offer a variety of payment options including check, credit card, or wire transfer. Please CONTACT US for more information.
Our goal is to provide patients the lowest cost option available to them. Depending on a patient’s insurance, their maximum out-of-pocket cost may vary.
Medicare, Medicaid, and TRICARE
For government-funded insurance programs, such as Medicare, Medicaid, Managed Medicaid Plans, or TRICARE, a patient’s out-of-pocket cost will be $0. Medicare Advantage plans may have a copayment or deductible requirement.
For RightMed Tests ordered by a patient’s provider where insurance billing is selected, OneOme will determine if insurance is likely to contribute and if the patient qualifies for our Financial Assistance Program (FAP). Please note, OneOme will only submit insurance claims to insurers that are likely to contribute to the cost of the test based on the plan’s coverage policies for pharmacogenomic testing.
OneOme Financial Assistance Program (FAP)
OneOme offers financial assistance to reduce out-of-pocket costs for qualified patients in the U.S. to $299 or less. To be eligible patients must have private insurance and meet income requirements (pre-tax household income up to 600 percent of the Federal poverty level). Use the calculator below to predict your out-of-pocket cost of the RightMed Test based on household size and income.
Calculate your predicted out-of-pocket cost
Insurance billing process
- OneOme reviews the patient’s insurance information to make sure it is complete and accurate and to determine whether the insurer is likely to contribute to the cost of the RightMed Test, based on the plan’s policies.
- OneOme will pre-qualify the patient for financial assistance.
- Patients eligible for financial assistance: The FAP-qualified amount is the maximum out of pocket cost the patient can expect regardless of whether their insurance will contribute to the cost of the test. If OneOme opts to bill a patient’s insurance, they may receive a balance bill for up to the FAP-qualified amount once insurance billing is completed. If a patient’s insurance is unlikely to cover the test, we will contact the patient and request payment at the FAP-qualified amount up front.
- Patients ineligible for financial assistance: The patient self pay rate will likely be the lowest cost option, regardless of insurance contribution. OneOme will contact the patient to offer our self pay option.
- If OneOme determines that the patient’s insurance meets billing requirements and the patient qualifies for FAP, OneOme submits the insurance claim directly to patient’s insurance company once the test results are ready.
- If a claim is submitted, the patient will receive an explanation of benefits (EOB) from their insurance company in the mail. The EOB is NOT a bill, but an explanation of what was covered.
- If coverage is denied or only part of the test is covered, OneOme may appeal the decision on behalf of the patient.
- After a final coverage decision from insurance is made, a patient may receive an invoice from OneOme for any deductibles, coinsurance, copayments, and for services deemed non-covered or ineligible under their insurance policy. When applicable OneOme will reduce this remaining balance up to their FAP-qualified price.
It is the responsibility of the submitting party to determine the correct billing codes to use when filing billing claims to third-party insurance. Below is a list of relevant codes.
|GENE||CPT code||CPT code description|
|CYP1A2||81479||Unlisted molecular pathology procedure|
|CYP2B6||81479||Unlisted molecular pathology procedure|
|CYP2C19||81225||Cyp2c19 gene common variants|
|CYP2C9||81227||Cyp2c9 gene common variants|
|CYP2D6||81226||Cyp2d6 gene common variants|
|CYP3A4||81230||Cyp3a4 gene common variants|
|CYP3A5||81231||Cyp3a5 gene common variants|
|SLCO1B1||81328||Slco1b1 gene common variants|
|NUDT15||81479||Unlisted molecular pathology procedure|
|OPRM1||81479||Unlisted molecular pathology procedure|
|COMT||81479||Unlisted molecular pathology procedure|
|DRD2||81479||Unlisted molecular pathology procedure|
|HTR2C||81479||Unlisted molecular pathology procedure|
|HTR2A||81479||Unlisted molecular pathology procedure|
|DPYD||81232||Dpyd gene common variants|
|GRIK4||81479||Unlisted molecular pathology procedure|
|IL28B (IFNL4)||81283||Ifnl4 gene|
|TPMT||81335||Tpmt gene common variants|
|SLC6A4||81479||Unlisted molecular pathology procedure|
|CYP2C Cluster||81479||Unlisted molecular pathology procedure|
|CYP4F2||81479||Unlisted molecular pathology procedure|
|HLAA||81381||Hla i typing 1 allele hr|
|HLAB||81381||Hla i typing 1 allele hr|
|MTHFR||81291||Mthfr gene com variants|
OneOme’s tests were developed and their performance characteristics have been determined by OneOme, LLC, a clinical laboratory located at 807 Broadway Street NE, Suite 100 Minneapolis, MN 55413. They have not been cleared or approved by the U.S. Food and Drug Administration. OneOme is regulated under CLIA-88 as qualified to perform high-complexity testing. These tests are used for clinical purposes and should not be regarded as investigational or for research.
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- The RightMed Test must be ordered by a physician.
- The RightMed Test, as with all genomic testing, has limitations. Always discuss the test with a healthcare provider knowledgeable about the test and to see if it's right for you.
- RightMed Test results are not a substitute for medical advice and should only be used in consultation with a medical professional.
- The RightMed Test does not determine the best medication for the patient; it is a tool to provide additional information to the patient’s healthcare provider. The healthcare provider should take other factors into consideration regardless of genotype.
- Independent healthcare providers available through OneOme's service will not have all of your health history, which may cause the test results to be subject to a different interpretation than by your personal physician.
- DO NOT MAKE ANY CHANGES TO YOUR CURRENT MEDICATIONS OR DOSING WITHOUT CONSULTING YOUR HEALTHCARE PROVIDER.