Frequently Asked Questions: QuestSelect Lab Benefit updated October 20, 2016 1.
Who is eligible for the QuestSelect Lab Benefit? You are eligible for this benefit if you are enrolled in a Quest medical plan, with the exception of the Kaiser Consumer Chice plans and the Aetna Basic plan. Any enrolled dependents are also eligible for this benefit. The QuestSelect Lab Benefit varies among the three medical plan options. 2.
How does this benefit work for Consumer Choice Plan (except Kaiser) and Copay Select Plan members? The QuestSelect Lab Benefit is a voluntary program that allows you to obtain 100% coverage for your lab testing. When your physician requires lab testing, you can have your tests covered in full by directing your tests to a Quest Diagnostics business. The Consumer Choice Plan (except Kaiser) and the Copay Select Plan reimburse the cost of lab services according to the chart below. Quest Lab In‐Network Lab (non‐Quest) Out‐of‐Network Lab 3.
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Consumer Choice Plan 0% 50% after deductible 50% of the allowed amount after out‐of‐network deductible Copay Select Plan 0% 50% after deductible 100%; no out‐of‐network coverage Why am I not eligible for this benefit if I am enrolled in Kaiser? The Quest Diagnostics health plans run by Kaiser in Northern and Southern California are “premium‐based plans,” which means that the cost of laboratory services is already built into the rate that we pay. Since we are already paying for this service at those rates, it would be significantly overpaying for lab services if we continued to offer this benefit to employees in those plans. How does this benefit work for Basic Plan members? The Basic Plan is designed to be a lower‐cost option that meets or exceeds the requirements of Minimum Essential Coverage under the Affordable Care Act. The Basic Plan reimburses the cost of lab services according to the chart below. Quest Lab In‐Network Lab (non‐Quest) Out‐of‐Network Lab Basic Plan 25% after deductible 50% after deductible 100%; no out‐of‐network coverage 5.
What Quest Diagnostics businesses participate in the QuestSelect Lab Benefit?  AmeriPath  Dermpath Diagnostics  Associated Clinical Laboratories (ACL)  Diagnostic Laboratory of Oklahoma (DLO)  Athena Diagnostics  Mid America Clinical Laboratories (MACL)  Berkeley HeartLab  Quest Diagnostics  Sonora Quest  CompuNet Clinical Laboratories 6.
What tests are included under the QuestSelect Lab Benefit? The QuestSelect Lab Benefit includes all tests performed by Quest Diagnostics businesses, provided that the tests have been ordered by your physician and are preauthorized by the medical plan. If preauthorization is not approved, you will pay out‐of‐
pocket if you proceed with testing. The program includes, but is not limited to:  Blood testing (e.g., cholesterol, CBC)  Urine testing (e.g., urinalysis)  Cytology and pathology (e.g., Pap smears, biopsies)  Cultures (e.g., throat cultures)  Fluids (e.g., amnios)  Quest Diagnostics BRCAdvantage™ test (health plan authorization required) Page | 1 Some lab tests, such as BRCAvantage and certain pre‐natal tests, are very expensive to administer. In 2017, certain outpatient lab tests will only be covered at Quest labs. This means you will be responsible for the full cost of the test if you choose to use a non‐Quest lab. To determine if a non‐Quest lab test won’t be covered call the HealthyQuest Concierge or the Member Services phone number on your Medical ID card. When you use the QuestSelect Lab Benefit, Quest Diagnostics does not receive any payment from the insurance company, health plan, employee or any other party. For billing questions, contact the toll‐free number listed on the outstanding bill. 7. Will I be subject to the non‐Quest in‐network coinsurance if my physician completes the test for a throat culture for strep throat right in the office for an immediate result? We encourage employees to direct all their testing to Quest Diagnostics in order to receive the highest benefit level. However, we recognize that there are circumstances when that is not possible. As a result, there will be limited exceptions for members covered under the Aetna Consumer Choice Plan. Exceptions will include services received as an inpatient; services received in the emergency room or urgent care, or when immediate results are required in the office; where there is insufficient access; or when the Quest Diagnostics businesses do not perform the test. Employees, as always, have the right to appeal through our standard appeals process with Aetna. 8. Will urgent care facilities be included as an exception for the QuestSelect Lab Benefit? Aetna has a network of urgent care facilities that you can locate on Aetna Navigator or by calling the HealthyQuest Concierge. We encourage you to be prepared for possible urgent care needs and become familiar with what is available in your area. Don’t wait until you have an emergency. We recognize, however, that once you are in the emergency room, urgent care or walk‐in facility, you are limited in directing your lab tests. As a result, you will not be subject to the non‐Quest in‐network lab coinsurance in those circumstances if your tests do not go to a Quest Diagnostics business. 9. Is it my responsibility to ensure that my covered spouse and other dependents direct their lab tests to Quest? Yes, we encourage you to share the details of the QuestSelect Lab Benefit with your family. The deductible or coinsurance will apply to services for your dependents as well as for you if a Quest Diagnostics business is not used. 10. What will happen if my physician does not have an account with Quest Diagnostics? More than half of all physicians do indeed have accounts with Quest Diagnostics. If your doctor does not have an account with us we encourage you to talk to your physician about your lab benefits. The doctor may establish an account with us or arrange for specimen pick‐up, or you may use a Patient Service Center or other contracted draw sites. 11. I have been a patient of one physician for over 15 years. During my last visit, I asked if he would use Quest Diagnostics labs for my lab tests. However, the physician is affiliated with a hospital that handles all the lab work. What should I do? Physicians may provide you with an order on a prescription pad to have most samples taken at a Patient Service Center or contracted draw site. We suggest that you advise your physician of your lab benefit. If your physician is still unwilling to send your specimens to a Quest Diagnostics business, you may still take advantage of the QuestSelect Lab Benefit by using a Patient Service Center or contracted draw site. For the occasions when it is not possible to have the specimen taken in that manner, you will be subject to the non‐Quest in‐network lab coinsurance if the tests are performed by a non‐Quest lab. Out‐of‐network coverage is only covered at 50% of the allowed amount of the out‐of‐network deductible for Consumer Choice Plan members and is not covered for Copay Select Plan members. 12. What if my doctor has an in‐house lab to perform his/her own lab testing? How will it be handled if I have point‐of‐care testing, or if I have my blood checked every three weeks at the doctor’s office via a finger stick? We encourage you to use a Quest Diagnostics business for your lab testing. In fact, a significant portion of our non‐Quest Diagnostics lab spend is for in‐office testing. As a result, we strongly suggest that you make every effort to direct your lab testing to a Quest Diagnostics business and request a requisition that you can take to a Patient Service Center or contracted draw site if your physician will not send it to Quest Diagnostics. We do recognize, however, that there are times when it is most appropriate to have your testing done in the physician’s office. If the testing is done in the physician’s office, you will not be subject to the non‐Quest in‐network lab coinsurance. If the sample is taken in the physician’s office and the testing is performed elsewhere, you will be subject to the non‐Quest in‐network lab coinsurance. Page | 2 13. What happens if I my doctor agrees to send lab work to a Quest lab, but ends up not doing so? As a general rule, you will be subject to the non‐Quest in‐network lab coinsurance. We encourage you to consider using a Patient Service Center or contracted draw site where you have better assurance that your specimen is being routed as you have directed. 14. What will happen if my oncologist will not send my biopsy to a Quest Diagnostics business? 15.
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We encourage you to explain the QuestSelect Lab Benefit to your physician and direct your biopsy to Quest Diagnostics. We do recognize that there will be times when this is not possible. As a result, you will not be subject to the coinsurance if a tissue sample is not sent to a Quest Diagnostics business. Please note, however, that depending on how the claim is submitted, you may be required to file an appeal. Is use of the QuestSelect Lab Benefit mandatory? While the use of Quest labs is a voluntary, patient‐driven benefit, you must be aware that if you do not choose to use a Quest lab, you will have additional out‐of‐pocket costs for lab tests. If a Quest Diagnostics lab runs my test, how will my results be sent to my record? Will there be an electronic record if there isn’t an interface with the physician? Physicians will receive results electronically if they are using Care360. Otherwise, as a general rule, the results will be faxed to the physician’s office. Will the phlebotomist know that I am a Quest Diagnostics employee? There is no special process in the Patient Services Centers for Quest Diagnostics employees. You will be treated like any other patient and will be required to show your medical ID card to receive services. Is it possible my own lab work could be in a batch of tests I need to run? If your sample is included in a batch of tests you are assigned to run, you may run your own test. Each sample is assigned an accession number and you may not even know that your sample is included in the batch of tests you are running until the results are being reviewed. If it is a single test, such as a Pap test, and you are assigned your specific sample, you may process it as you would any other patient sample. In either case, if you are uncomfortable running your own sample, consult with your supervisor to see if that batch or test can be assigned to another employee running the same test. What is Quest Diagnostics doing to ensure that my privacy and that of my family is maintained? We work hard on a daily basis to ensure that every patient’s information is safeguarded as defined by the HIPAA regulations and our robust privacy program. All employees are required to attend compliance training that includes the privacy of Protected Health Information (PHI) to ensure that they understand the laboratory’s responsibility to safeguard the information and test results of patients entrusting their samples to Quest Diagnostics. Testing for our employees and their family members happens on a regular basis. Employees that violate requirements of privacy and release of test results are subject to corrective action up to and including termination. Your privacy will be protected as it is for all patients having testing done by Quest Diagnostics. How will the QuestSelect Lab Benefit prepare us for the “Cadillac Tax” in 2018? Under Health Care Reform, beginning in 2018 healthcare benefit plans that are considered “too costly” will incur an excise tax. The QuestSelect Lab Benefit allows us to help control these costs early on by offering free testing to employees when using our own services, as lab benefits from other providers are very costly to our health plan. Why am I not eligible for this benefit if I am enrolled in my spouse’s health insurance? Your lab costs are covered under your health plan and therefore Quest would be paying for services already built in to the rate you are paying for coverage. I have insurance under my spouse’s plan, which does not include Quest Diagnostics as a participating provider. Can I still use Quest Diagnostics for my lab testing? We encourage all our employees and dependents to utilize the services that we provide whenever possible and suggest that you check the available benefits under your plan to determine if it is meeting your needs. Page | 3 23. What is BRCA? BRCA1 and BRCA2 are genes with known mutations responsible for increasing the risk of hereditary breast and ovarian cancer and associated cancers in women, and for prostate and breast cancer among men. Individuals who carry these mutations are at a higher risk for developing certain types of cancer, such as breast or ovarian cancer. Having a mutation does not mean you have cancer, only that you are at a higher risk for developing cancer. Knowing if you have a mutation allows you and your healthcare provider to take proactive steps to reduce your chances of developing cancer. 24. Who should get tested? The following quiz will help you find out if you might be at risk for these hereditary cancers. If you answer yes to any of these questions, talk with your doctor or genetic counselor about the Quest Diagnostics BRCAvantage™ test. If you answer no to all of these questions, please consult with your physician about the appropriateness of the BRCA test for you. Quiz for Women Quiz for Men 1. Does at least 1 of your blood relatives have a BRCA1 or BRCA2 1. Does at least 1 of your blood relatives have a BRCA1 or BRCA2 mutation? mutation? 2. Have you had breast cancer? 2. Have you had breast cancer at age 50 or younger? 3. Have you had ovarian, fallopian tube or peritoneal cancer? 3. Have you had pancreatic or aggressive prostate cancer and 2 or 4. Have you had “triple negative” (ER/PR/HER2 negative) breast more close blood relatives* with breast, ovarian, pancreatic or cancer at age 60 or younger? aggressive prostate cancer? 5. Are you an Ashkenazi Jew who has had breast cancer? 4. Do you have a family history of breast or ovarian cancer? You 6. Have you had breast cancer, and have a family history if: a. 1 or more close blood relative* with breast cancer at age 50 a. Your mother, sister, daughter, grandmother, aunt, niece or or younger? granddaughter can answer yes to any question in the Quiz b. 2 or more close blood relatives* with breast cancer at any for Women. age? b. Your father, brother, son, grandfather, uncle, nephew or c. 1 or more close blood relative* with ovarian cancer? grandson can answer yes to any of the above questions in d. 2 or more close blood relatives* with pancreatic or aggressive the Quiz for Men. prostate cancer? c. Your first cousin, great‐grandparent or great‐grandchild had e. A close male blood relative with breast cancer? breast or ovarian cancer and 2 or more close blood relatives 7. Have you had pancreatic cancer and 2 or more close blood with breast cancer (at least 1 with breast cancer at age 50 relatives* with breast, ovarian, pancreatic or aggressive prostate or younger) and/or ovarian cancer. cancer? 8. Do you have a family history of breast or ovarian cancer? You have a family history if: a. Your mother, sister, daughter, grandmother, aunt, niece or granddaughter can answer yes to any of the above questions in the Quiz for Women. b. Your father, brother, son, grandfather, uncle, nephew or grandson can answer yes to any of the questions in the Quiz for Men. c. Your first cousin, great‐grandparent or great‐grandchild had breast or ovarian cancer and 2 or more close blood relatives with breast cancer (at least 1 with breast cancer at age 50 or younger) and/or ovarian cancer. *Close blood relatives include: first‐degree relatives: mother, father, sister, brother or child; second‐degree relatives: grandparent, aunt, uncle, niece, nephew, grandchild on same side of the family; third‐degree relatives: first cousin, great‐grandparent, great‐grandchildren on same side of the family. 25. My family and I are covered by a Quest Diagnostics medical plan. Is the Quest Diagnostics BRCAvantage™ test a covered expense? Yes, but only if you are preauthorized by your medical plan. If preauthorization is not approved, you will be required to self‐pay if you decide to proceed with the testing. Quest Diagnostics offers a concierge insurance preauthorization service that will contact your medical plan on your behalf to determine if the BRCA testing will be covered. For information on preauthorization services, please call 866.GENE.INFO. Page | 4 There are two scenarios depending on your medical plan: For employees and dependents enrolled in a medical plan that is part of the QuestSelect Lab Benefit (Consumer Choice Plan (except Kaiser) and Copay Select): The QuestSelect Lab Benefit covers all tests performed by Quest Diagnostics businesses, provided that the test has been ordered by your physician. Note that the BRCA test requires preauthorization by your health plan to be considered eligible for coverage under the QuestSelect Lab Benefit. Consult with your health plan about specific preauthorization procedures. For employees and dependents enrolled in any other Quest Diagnostics medical plan, not part of the QuestSelect Lab Benefit, The testing is covered by the individual health plan subject to its normal plan coverage guidelines and requirements. Please consult with your health plan for specific requirements. If preauthorization is not approved, you will be required to self‐
pay if you decide to proceed with the testing. 26. My family and I have medical insurance that is not offered through Quest Diagnostics. How can I find out if the Quest Diagnostics BRCAvantage™ test is a covered expense under my medical plan? Quest Diagnostics offers a concierge insurance preauthorization service prior to testing. Many insurance plans have established specific criteria in order to cover and reimburse the cost of BRCA testing. Quest Diagnostics will contact your health plan on your behalf to determine if the test will be covered. If preauthorization is not approved, you will be required to self‐pay if you decide to proceed with the testing. For information on preauthorization services, please call 866.GENE.INFO. 27. What if my health plan denies my preauthorization for coverage? Your health plan will notify you directly of a denial, and the plan also will reach out to your physician with this information. Your physician may submit additional information to the health plan for consideration and/or you and your physician may contact the health plan to initiate an appeal. If the health plan denial does not change, you may call Quest Diagnostics at (866) GENE‐
INFO for information on authorizing self‐payment for the test. This applies to all patients, including Quest Diagnostics employees covered by a health plan that is part of the QuestSelect Lab Benefit. 28. If I self‐pay for the test, is this expense eligible for reimbursement under a Health Care Flexible Spending Account (FSA)? All Health Care FSA expenses must be qualified medical, vision, pharmacy or dental benefit expenses, as defined in Section 213(d) of the Internal Revenue Code. Laboratory fees are eligible medical expenses. You must submit documentation to the FSA administrator with a receipt for your payment and the claim form certification that the fees were not reimbursed by your health plan or covered by the QuestSelect Lab Benefit. 29. What if I am interested in tests for other types of cancer? Please reach out to your personal physician to discuss your specific risk factors and testing available. For additional information, please visit BRCAvantage.com or call 866.GENE.INFO. Page | 5