East Side Clinical Laboratory will work with the ordering physician to obtain the required prior authorization based upon the requirements established by each payor. When a test is ordered that is deemed as a molecular or genetic test, the laboratory will contact the payor to inquire about what is required. Clinical information and patient history may be requested for submission to the payor to determine medical necessity and coverage criteria. Once a denial or authorization is obtained, the laboratory will contact the provider and/or patient to inform them of the outcome and to educate them regarding their options for testing and financial responsibility.
Important Note: Prior authorization approvals are coverage determinations and do not eliminate the patient’s financial responsibility.