American Esoteric Laboratories (AEL) will work with our patients and their ordering providers to obtain prior authorization according to their insurance carrier's coverage requirements.
When your healthcare provider orders certain molecular or genetic tests, AEL will contact your insurance carrier to verify coverage requirements before proceeding with the test. Your insurance carrier may request clinical information and patient history to evaluate medical necessity and coverage criteria. Once this information is received, your insurance carrier will either approve or deny the test. In the event of a denial, AEL will communicate with you or your provider to explain the result and explore testing alternatives and financial responsibility. Approval of a prior authorization signifies that your insurance carrier will cover the costs based on your policy, but does not relieve the patient of financial responsibility, if applicable.
Important Note: AEL does not obtain prior authorization for every laboratory test. If you have any questions regarding your coverage, it is essential that you carefully review the test information on your laboratory order with your insurance carrier's customer service before any testing is conducted.
Prior Authorization FAQs
How can I determine coverage for specific services as well as my financial responsibility?
You may have received a card or other document as proof of health insurance. All cards vary, but should have the same type of information as the example shown below.
Before going for any lab tests, it is a good idea to check the test details on your lab order with your insurance company's customer service to understand your plan's coverage. You can ask them the following questions:
- Are the test(s) mentioned covered by my policy?
- What are the costs for the test(s) that I'm responsible for, including deductibles and copays?
- What are the medical conditions that need to be met for the testing to be covered?
- Does this test require pre-authorization before I can get the services?
How is prior authorization obtained?
When your healthcare provider orders specific molecular or genetic tests, AEL will reach out to your insurance carrier to initiate the process of obtaining prior authorization. AEL will work together with your physician to obtain any necessary supporting documentation that your insurance carrier may require for the prior authorization review.
What do I do if the prior authorization for my test is denied or the test is not a covered benefit under my policy?
If your insurance carrier denies prior authorization, or if your insurance plan does not cover the test, you can still opt to proceed with testing. However, you will be responsible for covering the cost of the test(s). You may qualify for our Financial Assistance or Self-Pay Program, which can help lessen the financial impact of these laboratory costs.
Please reach out to a AEL Care Specialist at 901.432.8602 for more information on these programs or assistance with the prior authorization process. We are available Monday-Friday, 8 AM to 5 PM central time, closed Noon to 1 PM for lunch.