Adaptive assist™patient support program
How we help:
Broad billing support tailored to each patient’s needs
Our commitment to supporting patient access
We understand that each patient’s situation is unique, which is why Adaptive Assist provides support at each point in the insurance and billing process, making each step straightforward and transparent.
Why do we offer the Adaptive Assist Patient Support Program? To help facilitate access to clonoSEQ® testing services for lymphoid cancer patients who could benefit from the clinical insights provided by minimal residual disease (MRD) testing.
ADAPTIVE ASSIST PROGRAM BROCHURE WITH FAQs
We support patients with:
- Upfront, out-of-pocket, and Good Faith Estimates
- Prior authorization management
- Appeal for maximum benefits and lowest out-of-pocket costs
- Assistance with out-of-pocket costs after coverage for qualifying patients
Here’s what you can expect when we work with you, your healthcare team, and/or your health insurance plan.
Step 1: Two Ways to Submit an Application
- Call our Patient Support Team at 1 (855) 236-9230 for 5-minute over-the-phone qualification and enrollment
- Print and mail your application to:
Dept LA 24084
Pasadena, CA 91185-4084
Step 2: Learn Potential
Adaptive will provide an estimate of your upfront out-of-pocket costs and let you know whether you qualify for financial support.
Step 3: Give Permission
If you receive a “Consent to Appeal” form from Adaptive, please fill it out and return it promptly to help us appeal for coverage for your test.
Step 4: Get Updates
Adaptive will notify you of any new information throughout the billing and appeals process.
Print the form to begin the application process—or email it to yourself to complete later.
Need more help?
Speak to one of our expert Patient Support Team members to get answers to your questions.
Call our help hotline at:
1 (855) 236-9230
Monday through Thursday, 9 am to 7 pm; and Friday, 9 am to 5 pm ET
Frequently Asked Questions
clonoSEQ is a test that measures MRD to help you and your doctor plan for your next step in blood cancer care. clonoSEQ is the first and only FDA-cleared test that detects, counts, and tracks MRD in patients with multiple myeloma, CLL, or B-ALL. It is also CLIA-validated to measure MRD in blood samples from patients with DLBCL and other lymphoid malignancies. Adaptive Biotechnologies is the company that offers clonoSEQ.
Depending on the type of insurance you have, coverage for clonoSEQ testing may differ. Adaptive will bill your insurance company directly and work with your plan to obtain the proper level of coverage for clonoSEQ. If your insurance plan limits or fully denies coverage for clonoSEQ, Adaptive will appeal the claim when possible and work on your behalf to seek payment for testing. You may receive a “Consent to Appeal” form from Adaptive. Please fill it out and return it promptly to help us in appealing for coverage for your test.
In some cases, you may have some out-of-pocket costs, such as coinsurance, for clonoSEQ. Please call our Patient Support Team at 1 (855) 236-9230 to understand your potential out-of-pocket costs, verify your coverage, or discuss payment options. Be sure to talk to your doctor about how clonoSEQ may fit into your treatment plan before initiating testing.
Medicare covers clonoSEQ testing performed on blood or bone marrow samples from patients with multiple myeloma, B-cell acute lymphoblastic leukemia, chronic lymphocytic leukemia, or diffuse large B-cell lymphoma at multiple time points throughout a patient’s treatment.
When there is reason to believe that Medicare will not cover the test, you will be asked to review and sign an Advance Beneficiary Notice (ABN) informing you that Medicare considers the test to be not covered, the reason why testing is not covered, and your financial responsibility, prior to any services being performed. For billing questions or to discuss the Adaptive Assist™ Patient Support Program, please contact our Patient Support Team at 1 (855) 236-9230.
If you don’t have insurance, you can call our Patient Support Team at 1 (855) 236-9230 to get a personalized Good Faith Estimate (GFE).
If you’re eligible, we will attempt to qualify you for financial assistance through our Adaptive Assist Patient Support Program so we can accurately assess your GFE. This will help generate an estimate of the potential cost you’ll be responsible to when receiving a clonoSEQ test.
Out-of-pocket cost estimates are available prior to submission of a clonoSEQ order by contacting our Patient Support Team at 1 (855) 236-9230. The amount quoted during this process is an estimate based on plan benefits and unmet deductible or coinsurance and/or copay amounts and is subject to change based on other claims that are being processed for you.
During the call, we will attempt to qualify eligible patients for financial assistance through our Adaptive Assist Patient Support Program so that we can more accurately estimate the potential out-of-pocket costs.
Yes, Adaptive Assist provides support for out-of-pocket costs if you qualify for financial assistance based on your income or medical expenses. The qualification criteria is in the next FAQ. To see if you might qualify for reduced out-of-pocket costs, please call the Patient Support Team at 1 (855) 236-9230 or print the application form and mail it to:
Dept LA 24084
Pasadena, CA 91185-4084
To be eligible for financial assistance, a patient must meet all of the following criteria:
- Be a US citizen or legal resident age 18 years or older
- Patients under the age of 18 are eligible but require the application form to be signed by a parent or legal guardian
- Be uninsured or have insurance that does not cover the full cost of clonoSEQ testing
- Meet financial need requirements based on the patient’s income and the number of persons in their household, or meet financial need based on household size, or sum of medical expenses as a percentage of household income
- Please call the Patient Support Team at 1 (855) 236-9230 or complete the application form above to see if you might qualify for reduced out-of-pocket costs
- NOTE: Patients should be prepared to provide documentation supporting financial need if selected for the program’s eligibility verification process
If you have already received clonoSEQ testing, your insurance company will likely send you an EOB. The EOB is not a bill. It will show what was paid, what deductions were applied, and what part of the total cost is not covered by your insurance. If you have questions about billing or payment, please call our Patient Support Team at 1 (855) 236-9230.
If you received a payment directly from your insurance company for clonoSEQ testing, you are required to forward the payment and related Explanation of Benefits (EOB) to Adaptive Biotechnologies as the provider of these testing services. Please call our Patient Support Team at 1 (855) 236-9230 as soon as possible to learn how to forward the payment and necessary corresponding documents to Adaptive Biotechnologies.
Adaptive Biotechnologies currently offers 3 payment options—phone, online, or mail:
- To pay over the phone by credit card, call our Patient Support Team at 1 (855) 236-9230
- To submit a credit card payment online, visit www.MyLabBill.com/SQ
- To submit a payment via the mail, send a copy of your patient statement for clonoSEQ along with a personal check or money order made out to Adaptive Biotechnologies to the address below
Dept LA 24084
Pasadena, CA 91185-4084
If you have a financial responsibility for clonoSEQ testing, contact us to see if you qualify for financial support.
Adaptive Biotechnologies will perform an upfront eligibility verification of patients applying for financial assistance. You may be required to provide supporting documentation of the financial information provided if your application is selected for review.
You must provide this documentation, such as a W2, paycheck stub, or other such documentation, within 45 days of notification that you have been selected for the process.
Once we review your application along with the documentation you provide, we will send you a letter regarding your program qualification outcome and your level of financial assistance, if applicable. Your approval for financial assistance will be valid for a period of 1 year.
If you have any questions regarding the Adaptive Assist Patient Support Program, please call our Patient Support Team at 1 (855) 236-9230. Representatives are available Monday through Thursday, 9 am to 7 pm; and Friday, 9 am to 5 pm ET.
This page is intended for a US-based audience.
clonoSEQ® is an FDA-cleared test used to detect minimal residual disease (MRD) in bone marrow from patients with multiple myeloma or B-cell acute lymphoblastic leukemia (B-ALL) and blood or bone marrow from patients with chronic lymphocytic leukemia (CLL). clonoSEQ is also available for use in other lymphoid cancers and specimen types as a CLIA-validated laboratory developed test (LDT).
clonoSEQ is only available by prescription from a licensed healthcare professional. Results may vary. Talk to your healthcare provider to see if clonoSEQ testing is right for you. For important information about the FDA-cleared uses of clonoSEQ including test limitations, please visit clonoSEQ.com/technical-summary.