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How much do PrEP lab tests cost through Nurx?

Before you begin PrEP you’re required to get lab tests to confirm that you are HIV negative and have healthy kidneys. You’ll re-do these tests every three months after beginning PrEP. Our preferred testing option is at-home tests through our home testing partner, Molecular Testing Labs (MTL). We’ll send you everything you need to collect samples at home, then you’ll return them by mail to the lab in a prepaid envelope (though please note that home testing is not yet available in New York state). We have worked hard to provide ease and cost transparency with our home testing option. If you would like to order PrEP, start your order here.

 

For those paying without insurance:

$164 for comprehensive testing, which includes all of the necessary tests to get on PrEP + extra testing for sexually transmitted infections (STIs) + pregnancy testing (if applicable).

$94 for basic testing which includes all of the testing necessary to get on PrEP + pregnancy testing (if applicable).

 

For those paying with insurance:

We accept insurance for lab testing as well – but if you choose to pay with insurance your out-of-pocket expense will depend on whether Molecular Testing Labs is in-network with your insurance and on your specific plan’s coverage. We will charge you $15 for a medical consultation. Once your tests have been processed by our partner lab, they will bill your insurance and you will receive a bill for any out-of-pocket costs (in addition to the above fees) including copays and deductibles associated with your plan. Please CLICK HERE to see if your insurance is in-network.  It is important to note that if your insurance is in-network with Molecular Testing Labs and you have not yet met your deductible, you may be billed for the full price of lab testing at the rate negotiated between MTL and your insurance carrier, which is usually around $250-$300. If your deductible has been met then only standard copays will apply. Molecular Testing Labs has a generous financial aid package for qualifying patients.

*BLUECROSS PATIENTS PLEASE NOTE: BlueCross has changed their policies with our partner lab and is no longer processing patient claims in a way compatible with our telehealth platform for patients to exercise in-network benefits with the at-home testing kits. We’re sorry this changed happened. We are actively working towards a solution. In the meantime, claims will likely be processed as out of network and result in a $99 bill.

If you’d prefer not to do home testing you are welcome to have your labs done at a local lab like LabCorp or Quest. Once you have submitted your request for PrEP, simply message us and tell us that you would like lab testing at LabCorp or Quest. Pricing at local labs depends on your insurance coverage. We recommend calling your insurance company in advance to confirm whether LabCorp or Quest is the in-network laboratory.

 

For billing questions:

If you have questions regarding a bill you received from our lab partner, Molecular Testing Labs (MTL), please contact MTL Client Relations directly at (360) 693-8850, or visit their website at https://moleculartestinglabs.com/pages/contact-us. Our lab partner has a financial assistance program that may be able to help. They can also help answer more specific questions about your insurance plan and the billing process.

In addition, we recommend reaching out to your insurance company to confirm what your deductible is, how you can meet it, and how much you have met already. You may also want to ask when that amount resets.

For future testing, we recommend the following tips to help you keep this process as affordable as possible. You’ll want to contact your insurance company and ask if you can use any lab for testing purposes, or if you are required to use an in-network lab. If you are allowed to use any lab, it might be more affordable to use your insurance company’s “preferred” lab. It might be more cost-effective to pay out of pocket for our home testing kits, depending on the testing kit, if your insurance company does not cover the labs or does not provide great coverage for lab testing. Here are a few helpful questions to ask your insurance company:

  1. Is Molecular Testing Labs in-network?
  2. Do I have a deductible for lab testing?
  3. Do I have a copay or co-insurance associated with my insurance plan?
  4. If they ask which lab tests will be ordered please refer to the information below to see what is included in the test kit in addition the CPT and Diagnosis Codes used.

 

PrEP Comprehensive Kit:
Chlamydia (Site: Genital)
Chlamydia (Site: Throat)
Chlamydia (Site: Rectal)
Gonorrhea (Site: Genital)
Gonorrhea (Site: Throat)
Gonorrhea (Site: Rectal)
HIV
Syphilis
Hep B
Creatine
Pregnancy (if applicable)

 

PrEP Basic Kit:
HIV
Hep B
Pregnancy (if applicable)

 

CPT Codes:
82565
86780
87340
87389
87491
87591

 

Dx Codes:
Z20.6
Z11.3
Z11.4
Z51.81

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