Breath Test Order Form
IMPORTANT INSURANCE & PAYMENT INFORMATION
CDI will submit a claim on the patient’s behalf to commercial insurance, Medicare or Tricare. Insurance may cover some or all of the test depending on the patient’s insurance plan and benefits. In the event the patient’s insurance provider denies the insurance claim, or if the patient has not met the deductible or has a coinsurance or co-pay, or if for any reason the insurance does not cover the full amount of the test, the patient is responsible to pay CDI for products and services received.
CDI does not accept any Medicaid plans: therefore any Medicaid patient taking a test will be responsible for the full cost of the test. CDI offers convenient payment plans and financial hardship programs for qualifying patients. Patients may pay upfront via check sent with the kit or credit card. The maximum out-of-pocket cost per test is $175 for patients that pay promptly in accordance with CDI patient billing policies and programs. Click here for an updated list of in-network providers.