We often hear from patients and physicians interested in learning more about the cost associated with the 4Kscore test, and whether the test is covered under Medicare, Medicaid or other health insurance plans. This is a confusing area and the answers always vary – because of different insurance carriers and plans.
Bridging the Gap Between PSA and Biopsies
With nearly 3 million men currently living with prostate cancer in the United States, early detection of the disease is paramount. Early detection of prostate cancer begins with screening the Prostate Specific Antigen (PSA) to assess the health of the prostate. If a PSA test result is high, often times a doctor may recommend a biopsy. However, because the PSA test cannot distinguish between aggressive prostate cancer and other less serious conditions, many men with a high PSA may be subjected to unnecessary prostate biopsies.
The 4Kscore is a simple blood test intended to help reduce the need for unnecessary biopsies. If the 4Kscore determines that a patient’s risk factor of having aggressive prostate cancer is low, the patient, in consultation with his physician, may decide not to have a prostate biopsy. The 4Kscore is helping many to avoid the cost of a biopsy, as well as reduce associated pain and complications, which can include: fever, bleeding, infection, and transient urinary difficulties.
The Cost of the 4Kscore Test
We are proud to offer 4Kscore tests at reasonable prices as part of our Patient Health Advocacy Program to increase access to comprehensive testing for patients who do not have health insurance or for those who choose not to submit a claim to their insurance company. If you would like to discuss your specific situation and our self-pay and payment plan options, please call our specialized billing hotline at 855-4KBILLING (855-452-4554) between the hours of 9am and 9pm EST, Monday-Friday.
Is It Covered By My Insurance?
Because all insurance plans are different, coverage for laboratory testing depends on your particular insurance company and plan. We like to personally address specific needs to determine if the cost of the 4Kscore is covered under your insurance plan. Please call our specialized billing hotline at 855-4KBILLING (855-452-4554) between the hours of 9am and 9pm EST, Monday-Friday to discuss insurance coverage.
Once a patient has undergone the 4Kscore test, if an insurance company does not pay the filed claim because the insurance company deems the test investigational, not a covered service or an out-of network service, we will file an appeal on the patient’s behalf. The patient will only be responsible for applicable copayment, coinsurance and/or deductible amounts, unless prior written arrangements have been made with the patient.
The Cost of Unnecessary Biopsies
Beyond the cost of the 4Kscore test, it is also important to consider the cost of undergoing unnecessary biopsy. As a result of rising coinsurance, copayments, and deductibles, in many cases, insurance companies do not fully reimburse for the cost of a biopsy. In addition to the cost of the procedure itself, prostate biopsies require resources in the Urologist’s practice and at the pathology lab, costs which are passed onto patients and insurance companies alike. The 4Kscore has the ability to reduce unnecessary biopsies and overtreatment of indolent prostate cancer saving the US healthcare system billions of dollars – that is some serious savings!
Still Have A Billing Question?
Insurance cost and coverage can be tricky to navigate, but we are always here to help to ensure the 4Kscore test is an affordable option for men at risk of developing prostate cancer. If you have more questions about the 4Kscore test, email us at 4KscoreInquiry@BioReference.com.