shopping cart
facebook icontwitter iconslinkedin icongoogle icon

Blue Cross Blue Shield Coverage for Metametrix Tests

GI Effects Profile

For PPO members, participating providers within the Blue Cross Blue Shield (BCBS) networks* now classify the Metametrix tests listed below as potentially diagnostic and possibly eligible for coverage. When processing these claims, NO PAYMENT IS DUE at the time of filing.

GI Effects Profiles Potentially Eligible for Coverage:

  • 2100 Complete Profile – Stool
  • 2105 Microbial Ecology Profile – Stool
  • 2110 Mycology Profile – Stool
  • 2115 Parasitology Profile – Stool
  • 2120 Chemistries Profile – Stool

 

*Click here to check our growing list of participating BCBS - PPO networks

All Other Test Profiles

For in-network PPO members, our remaining test profiles may also be eligible for coverage. However, coverage for those claims will be processed at the discretion of BCBS. To have Metametrix file a BCBS claim on your behalf, we will need a copy of your valid insurance card (front and back) in order to proceed.

HMO Members

Metametrix is not a BCBS HMO provider and is considered out-of-network. However, you can take advantage of our "PrePay Advantage" program, which we will submit insurance claims as a courtesy once you submit full payment at the Patient Prepay price at the time of specimen submission. Click here to learn more about our PrePay Advantage program. For additional questions, please contact our Billing Department.

POS, EPO, HSA and All Other BCBS Members (including out-of-network PPO)

For POS, EPO, HSA and all other BCBS members (including out-of-network PPO), we will still file a claim on your behalf. However, those claims will be subject to the following price structure/options:

  • A partial payment for Metametrix GI Effects tests at the following rates:
    • $250 for 2100 (Complete Profile – Stool) and 2105 (Microbial Ecology Profile – Stool)
    • $75 for 2110 (Mycology), 2115 (Parasitology), and 2120 (Chemistries)

For all other tests, payment (20% of the test’s list price) is due at the time of specimen submission. Payments made that exceed the list price of any particular test will be properly applied, and the excess will be reimbursed accordingly. Also, please note that claims that are classified as out-of-network are your financial responsibility.

What to Do Now

For In-Network PPO members:

  • Prior to testing, you are advised to click here to check our growing list of participating BCBS - PPO networks. Claims that are classified as out-of-network are your financial responsibility.
  • You must sign and complete the Test Requisition Form (TRF) found within the contents of your test kit.
  • There is no payment due at the time of specimen submission for any of our tests if you are an in-network PPO member.
  • The following items must be submitted according to the kit instructions:

    MISSING ITEMS WILL DELAY THE RELEASE OF TEST RESULTS

    • Completed and signed TRF
    • Copy of your valid insurance card (front and back)
    • Your collected specimen(s)
  • Once we receive each completed and properly submitted item, Metametrix will file a claim with BCBS.
  • You will be billed for any remaining balance once BCBS has processed the claim and made a determination of coverage.

For HMO members:

  • You must sign and complete the Test Requisition Form (TRF) found within the contents of the test kit.
  • Metametrix can file insurance claims as a courtesy through our PrePay Advantage program. To file the courtesy claim, you need to submit full payment at the Patient Prepay price with a copy of your insurance card at the time of specimen submission. Click here to learn more about our PrePay Advantage program.
  • The following items must be submitted according to the kit instructions:

    MISSING ITEMS WILL DELAY THE RELEASE OF TEST RESULTS

    • Completed and signed TRF
    • Your collected specimen(s)
    • Your Payment - full Patient Prepay price
    • Copy of your valid insurance card (front and back)- for PrePay Advantage program participants ONLY

For POS, EPO, HSA and All Other Members (including out-of-network PPO):

  • Prior to testing, you are advised to click here to check our growing list of participating BCBS - PPO networks. Claims that are classified as out-of-network are your financial responsibility.
  • You must sign and complete the Test Requisition Form (TRF) found within the contents of your test kit.
  • For GI Effects tests, a partial payment is due at the time of specimen submission. See GI Effects partial payment structure and options. For all other tests, payment (20% of the test’s list price) is due at the time of specimen submission.
  • The following items must be submitted according to the kit instructions:

    MISSING ITEMS WILL DELAY THE RELEASE OF TEST RESULTS

  • Once we receive each completed and properly submitted item, Metametrix will file a claim with BCBS.
  • You will be billed for any remaining balance once BCBS has processed the claim and made a determination of coverage. Payments made that exceed the list price of any particular test will be properly applied, and the excess will be reimbursed accordingly.

If you are concerned about the potential denial of claims and would like to limit liability, we recommend our Patient Prepay option. For more information on Metametrix payment options, please contact our Billing department.

Things to Consider

  • A BCBS claim will automatically be filed for in-network PPO patients, unless we receive instructions to do otherwise. However, we cannot file a claim without your complete insurance information.
  • Metametrix can refile BCBS claims that are denied based on invalid and/or missing information. However, we will not refile Out-Of-Network claims that BCBS has denied and classified as your responsibility.
  • If BCBS denies your claim, you will be responsible for the remaining balance. If you are concerned that your claim will be denied and want to limit your liability, we recommend our Patient Prepay option. For more details about this option, please contact our Billing department.

Frequently Asked Questions

  1. What if I am a Blue Cross Blue Shield HMO subscriber?
    2. Answer: We are not a contracted HMO provider but can file claims as a courtesy through our PrePay Advantage program.To file the courtesy claim, you need to submit full payment at the Patient Prepay price with a copy of your insurance card at the time of specimen submission. Click here to learn more about our PrePay Advantage program. For additional questions, please contact our Billing Department.

  2. How will I know if my test is covered?
    3. Answer: Only BCBS can determine whether a test will be covered. For more information, please contact BCBS Customer Service at the number listed on the back of your ID card.

  3. How do I know if I’m selecting the right payment option?
    4. Answer: Now that you know Metametrix has expanded our payment options in a way that may benefit you, instructions on how to proceed are located in our “What to Do Now” section. Please contact our Customer Service department if you are still unsure about the right option for you.

  4. How will I know the cost of my test?
    5. Answer: If you are a PPO member, then we will file a claim on your behalf and no payment will be due at the time of filing. In the event that there is a remaining balance not covered by BCBS, then you will be billed at that time.

    If you are a POS, EPO, HSA and All Other BCBS Members (including out-of-network PPO): Prior to testing, you are advised to click here to check our growing list of participating BCBS - PPO networks. Claims that are classified as out-of-network are your financial responsibility. For GI Effects tests, a partial payment is due at the time of specimen submission.See GI Effects partial payment structure and options. For all other tests, payment (20% of the test’s list price) is due at the time of specimen submission. Once BCBS has processed the claim and made a determination of coverage, then you will be billed for any remaining balance not covered by BCBS.

    If you are an HMO member, Metametrix is not a BCBS-HMO provider, and therefore, full payment at the Patient Prepay price is due at the time of specimen submission. We can file insurance claims as a courtesy per our "PrePay Advantage" program once full payment at the Patient Prepay price has been submitted. Click here to learn more about our PrePay Advantage program. For additional questions, please contact our Billing department.

  5. If my claim is denied, how will I know AND what should I do next?
    6. Answer: If your claim is denied, BCBS will notify you with an explanation of your benefits, and you will be billed for the balance remaining on your account. In the event that this happens, please contact our Billing department to pay your remaining balance(s).

  6. Can you tell me if my claim will be approved/denied?
    7. Answer: No, only BCBS can make the determination of whether your claim is approved or denied.

  7. Which forms of payment does Metametrix accept?
    8. Answer: Acceptable payment methods are Visa, MasterCard, American Express, Discover, money order, or check payable to Metametrix. Canadian and International residents may pay by credit card or wire transfer only.