PAYMENT AND BILLING POLICIES
For IGeneX, Inc.
August 2006

IGeneX Inc. is a privately owned laboratory focused on performing specialized testing for Lyme Disease and other related Tick Borne Diseases.

It is our intention to provide cost-savings for our patients as well as our clients. In doing so, IGeneX has not contracted with any insurance companies. Therefore, we DO NOT bill patients’ health insurance for any testing performed through IGeneX.

PAYMENT FOR TESTING

Prepayment
We require prepayment at the time the specimen is sent to IGeneX for processing. We accept Visa, Mastercard, Discover, American Express, Personal Checks or Money Orders. A statement will be mailed to you with information to send to your insurance company for reimbursement.

International Patients/Clients: Credit Card only

MEDICARE PATIENTS – PLEASE PROVIDE ALL INFORMATION REQUESTED BELOW

Medicare - Primary (Any deductible is patients’ responsibility.)
- Complete and sign Medicare Box on Test Request Form
- Send a copy of the front and back of your Medicare Card.
Medicare - Secondary
We will bill for your testing with the receipt of:
- Complete and sign Medicare Box on Test Request Form
- Send a copy of the front and back of your Primary Insurance Carrier.
- Send a copy of the front and back of your Medicare Card.
Medicare – HMO
We are not a provider with any HMO.
- Complete and sign Medicare Box on Test Request Form
- A copy of the front and back of your Medicare Card
- Send prepayment for testing. A statement will be sent to you so that you may submit it to your HMO.
Medicare –Senior Plans
We are not a provider with any Senior Plan (Direct, Advantage, or Choice PPO). We will bill for your testing with the receipt of:
- Complete and sign Medicare Box on Test Request Form
- A copy of the front and back of your Medicare Senior Plan Card
- A completed form (enclosed) “Advance Notice for Medicare Beneficiaries with Senior Plans”.

CANCELLATION POLICY

Only your physician is able to request, change, or cancel tests. Once the test results have been released, testing can not be cancelled.

IGeneX, Inc.
795 San Antonio Rd., Palo Alto, CA 94303 USA
Tel. 650.424.1191 / 800.832.3200 Fax. 650.424.1196