Patient Self-Pay Policy Disclosure

To make RPRD’s testing services (hereinafter the “Services”) accessible to as many patients as possible, RPRD offers discounted pricing for “Self-Pay” patients, which are those who prefer to pay for the Services out of pocket, or those patients who are forced to pay out of pocket due to lack of insurance coverage, or denial of coverage.

A patient may Self-Pay if the patient resides in the United States of America and any of a) through c) apply:

a) The patient has no private health insurance coverage of any kind, and the Services are not otherwise covered by any federal and state healthcare programs such as Medicare or Medicaid.

b) The patient has health insurance, but the insurer(s) will not cover the Services ordered by the patient’s healthcare provider.

c) The patient has health insurance but chooses not to utilize coverage for the Services and instead chooses to be personally liable for all payment obligations related to the Services.

Billing and Refunds

a) All Self-Pay patients will be required to complete and sign the Patient Self-Pay Election Form (the “Self-Pay Form”) and must pay for the testing fee (as shown in Table 1 below) before the testing will be processed. RPRD accepts electronically signed Self-Pay Forms, including but not limited to a PDF copy with the Adobe Digital ID, scanned, or faxed copy. If the Self-Pay Form is signed by the patient’s responsible party, a witness’s signature is also required.

b) RPRD will send an invoice to the patient upon RPRD’s receipt of a completed Self-Pay Form. RPRD accepts payments for the Services from all major credit cards, Flexible Saving Accounts (FSA) and Health Saving Accounts (HSAs). RPRD reserves the right to refuse to process the testing or deliver the test results if the patient fails to fulfill all payment obligations. Partial payments will not be accepted.

c) Pricing for the Services includes non-refundable fee of $50.00 which includes sample collection kit, shipping, and handling.

d) If the sample collection kit has been shipped to the patient and the order is canceled before the test is processed, a refund of $330 for the Precision HealthPGx Panel, $410 for Psych HealthPGx Panel $730 for the WPS testing will be issued to the patient within 30 days of cancellation. If an order is canceled before the sample collection kit is delivered to the patient, the full refund will be issued to the patient within 30 days of cancellation.

RPRD’s Patient Self-Pay Policy is subject to periodic review and adjustment. This Policy is effective as of May 1, 2021.

Table 1: Patient self-pay pricing