PROMETHEUS Links FINANCIAL ASSISTANCE APPLICATION FORM INSTRUCTIONS: COMPLETE ALL SECTIONS. USE N/A if section not applicable ACCOUNT NUMBER: PATIENT INFORMATION Patient Full Name: Social Security.
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How to fill out the Prometheus Links Program online
The Prometheus Links Program offers vital financial assistance to individuals requiring diagnostic tests. This guide will walk you through the online application process, ensuring that you can complete the form accurately and efficiently.
Follow the steps to successfully complete the Prometheus Links Program application
- Press the ‘Get Form’ button to access the application form and open it in the appropriate online editor.
- Begin by filling in your account number at the top of the form.
- Complete the patient information section by providing the full name, Social Security number, address, phone number, date of birth, and the number of members in your household as indicated on your most recent tax return.
- Indicate your residency status as a U.S. resident, including Puerto Rico and U.S. territories, by selecting 'Yes' or 'No'.
- Enter the annual gross household income before taxes and deductions in the designated field.
- Provide the state and zip code of your residence.
- Attach a copy of your most recent federal tax return (Form 1040) along with any other supporting documents you need to describe.
- Review the application declarations and ensure you understand the terms, then sign and date the application as the patient.
- If applicable, have the guarantor sign and date the form as well.
- Once all fields are completed, save your changes, and download, print, or share the form as needed.
Complete your application online today to access financial assistance.
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How much does a Prometheus test cost?
For PROMETHEUS® Anser tests, denied insurance claim is assessed after PROMETHEUS Links appeal process is completed. The majority of people never pay more than $250. Some pay as little as $75. Your out-of-pocket cost is capped at $250.
Do you have to fast for a Prometheus blood test?
Can I eat or drink before getting my blood drawn? PROMETHEUS Anser IFX, PROMETHEUS Anser ADA, PROMETHEUS Anser VDZ or PROMETHEUS Anser UST. There are no restrictions.
Is the Prometheus test a blood test?
The PROMETHEUS® Crohn's Prognostic combines proprietary serologic (anti-CBir1, anti-OMPC, DNAse sensitive pANCA) and genetic (NOD2 variants SNPs 8,12,13) markers in an innovative blood test that quantifies a patients individual probability of developing disease complications over time.
What is a Prometheus blood test?
The test, called the Prometheus Monitr Crohn's Disease (Prometheus Labs), provides a single score called the Mucosal Healing Index (MHI) based on 13 biomarkers representing multiple mucosal injury and repair pathways, including CEACAM1, VCAM1, C-reactive protein, Ang1, Ang2, interleukin-7, TGF-alpha, SAA1, MMP1, MMP2, ...
How much does the Prometheus blood test cost?
The majority of people never pay more than $250. Some pay as little as $75. Your out-of-pocket cost is capped at $250. If you are eligible* for the PROMETHEUS Links Program, $250 may be further reduced to $175 or $75.
What is Prometheus IBD sgi Diagnostic?
The PROMETHEUS®IBD sgi Diagnostic® is the 4th-generation IBD diagnostic test and the first and only test to combine serologic, genetic, and inflammation markers in the proprietary Smart Diagnostic Algorithm for added diagnostic clarity.
Does Quest Diagnostics Do Prometheus?
Prometheus® Crohn's Prognostic | Test Detail | Quest Diagnostics.
What is the Prometheus blood test?
The PROMETHEUS® Crohn's Prognostic combines proprietary serologic (anti-CBir1, anti-OMPC, DNAse sensitive pANCA) and genetic (NOD2 variants SNPs 8,12,13) markers in an innovative blood test that quantifies a patients individual probability of developing disease complications over time.
What is a Prometheus IBD panel?
The PROMETHEUS IBD sgi Diagnostic test is the first and only test that combines serologic. genetic, and inflammation markers in a proprietary. Smart Diagnostic Algorithm to provide added IBD diagnostic clarity. This test helps physicians differentiate IBD vs. non-IBD and CD vs.
How accurate is Prometheus test?
With an overall accuracy of 92%, this unprecedented diagnostic test is the most comprehensive IBD test available with proprietary markers to help physicians diagnose inflammatory bowel disease ("IBD") and to differentiate the subtypes of Crohn's disease and ulcerative colitis.
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