Fees for Functional Tumor Cell Profiling fees are influenced by the number of drugs tested, however the greatest expense and effort accrues in obtaining and processing the specimen. Processing usually takes several hours of technician and technologist time, along with reagents, disposable labware, etc..  Dr. Weisenthal's slide and data interpretation generally requires 4 to 6 hours of his time.  Therefore, a base testing fee applies, to which an incremental per-drug fee is added.  The fee per drug is relatively much smaller than the base fee and so there never is any question that drugs are added to panels inappropriately, although each additional drug tested does add expense and effort to the testing process and these expenses must be recovered.  Dr. Weisenthal individually designates a drug panel for each patient based upon what is appropriate to the patient's clinical situation and also what is possible with respect to the size and condition of the biopsy specimen that is sent to us.  Physician requests for specific drugs, including new drugs, are always honored if the drug is obtainable. 

 

Fees for functional tumor cell profiling services can range from $3,500 to more than $5,000 in some cases.  We will send your patient a written estimate of fees for his or her tests as soon as we have received a specimen so that your patient will have the opportunity, in advance, to accept or decline our functional tumor cell profiling testing services.    

 

Medical Insurance Coverage

Insurance coverage for Functional Tumor Cell Profiling varies depending upon the reimbursement policies of the patient's insurance carrier and the provisions of his or her specific insurance policy.  Many insurance carriers cover most or all of the testing fees, excluding normal co-payments and deductible amounts.  However, other insurance carriers pay for only a portion of the costs and some carriers may deny claims completely.  Patients will be billed for any co-payments, deductible amounts, or other balances that are not paid by the patient's carrier.  As a courtesy to your patient, we gladly will submit insurance claims to the carrier before requesting payment from the patient.  We will also assist in appealing an unfavorable coverage decision in the event that an insurance claim is denied.  Our collections policy is liberal and humane.  We always allow ample time for insurance claims work their way through the system, including carrier information requests and appeals when necessary

 

Effective July 1, 2008, Weisenthal Cancer Group elected voluntarily to opt-out as a Medicare provider owing to excessive delays in receiving payments and also due to Medicare's erratic coverage patterns, despite the fact that an exhaustive technology review by Medicare resulted in what was supposed to have been routine coverage for Medicare beneficiaries for functional tumor cell profiling beginning in February of 2007.  We regret that Medicare's slow and inconsistent payment policies along with its lack of responsiveness to our inquiries necessitated this action on our part.  This does NOT mean that we do not perform testing for Medicare beneficiaries.  We offer our testing services equally to all patients.  However, it means that Medicare beneficiaries assume financial responsibility for their testing services in the same manner as non-Medicare beneficiaries.  

Once we receive a specimen for testing, we notify each patient by priority mail of the probable cost of his or testing and offer the patient the opportunity to decline our testing services and thereby avoid testing costs.  If a patient elects to receive our services he or she receives a bill from us after we have completed testing and have reported test results to the ordering physician.

    

Pro Bono Services

Dr. Weisenthal recognizes that, as a medical professional, he has a responsibility to provide services to indigent patients if it is possible to do so.  Owing to the fact that drug, labor, and other direct costs which Dr. Weisenthal must pay in order to provide Functional Profiling are considerable and also that he is highly limited in the number of paid and unpaid assays he physically can perform - generally only about 40 per month in total - he is not able to offer free assays to every indigent patient who may need one.  He sincerely wishes that he could.  However, if a physician phones Dr. Weisenthal to request pro bono testing for an indigent patient and if that physician and all other physicians providing care to that patient are  waiving fees for their services entirely, Weisenthal will also waive his fee.  Further, he will provide the service at his own expense - paying for technologist's labor, drugs, and other materials out of his own pocket to the extent that his caseload permits it. We beleive that is a fair and humane policy.