Frequently Asked Questions
PremierTox Laboratory
Patient FAQClinician FAQBilling PolicyBilling FAQPrivacy PolicyTOP
Patient FAQClinician FAQBilling PolicyBilling FAQPrivacy PolicyTOP

Patient Frequently Asked Questions

Why do I need a drug test?

Drug testing can assist your clinician by providing important information for your ongoing treatment.  The results PremierTox provides ensures your physician can: 

    Meet federal and/or state regulations for treatment

    Personalize treatment to a patient’s specific needs

    Monitor patient compliance to treatment plan

    Advocate on behalf of the patient for continued or additional treatment

    Identify individuals that may be at risk for abuse/addiction

    Detect possible drug-to-drug interactions for patient safety

What is medication monitoring?

Medication monitoring is an important set of services that help your health care provider understand the medications you are currently taking.   The results can help inform your clinician to safely prescribe new medication(s) or continue your current medication therapy as part of your treatment plan.  PremierTox can test either urine or oral fluid for many different medications.

Can I order my own tests directly from PremierTox?

At this time, all PremierTox testing must be ordered by a licensed health care professional or their authorized designee.

 

Are my results private?

PremierTox is committed to patient confidentiality, and maintains your privacy in accordance with all regulations and guidelines set by the Health Insurance Portability and Accountability Act (HIPAA).  PremierTox shares test results with only the requesting healthcare provider and any person you formally designate.

 

Who will report my test results to me?

PremierTox will provide your test results to the health care provider who ordered the test.  After they review your results, they may share the results with you.  Per new regulations, patients may receive lab test results directly from the laboratory after those results have been released to the ordering physician.  Please contact PremierTox Patient Services for more information.

 

Who pays for my testing?

PremierTox will bill your insurance company directly for the laboratory services your provider requested.  As they process the claim, your insurance will send an Explanation of Benefits (EOB).  Depending on your insurance company and/or insurance plan, you may receive a statement from PremierTox for any remaining balance on your account, including co-insurance, co-pay or deductible.  These amounts are set by your insurance company, per the terms of your plan.  If you do not have health insurance, or are unable to pay your statement in full at this time, you can apply for financial assistance by contacting PremierTox Patient Services.

Clinician FAQ

Drug Testing General

What can a drug test tell me?

Drug testing can help providers confirm medication adherence compliance by detecting the prescribed compound and/or expected metabolites of that drug.  It may also help identify prescription diversion or abuse of drugs that are not prescribed. Through careful interpretation of test results, clinicians are able to monitor compliance to treatment plans to ensure patient safety and improved outcomes.

What can a drug test NOT tell me?

While providing the clinician with vital information, like concurrent medication use, possible diversion or misuse of prescribed drugs, or even chronic use of medications, a drug test cannot specifically indicate:

  Dosage of a drug in question

   Frequency or exact timeframe of drug ingestion

   Impairment or pharmacological implications from the drug

   Thus, drug testing is just one of many valuable tools to help ensure patient compliance with medication and treatment algorithms.

What is the difference between a preliminary/immunoassay screen and a confirmation/quantitative test?

Each drug has a unique chemical makeup, which lends to its classification and identification through analytical method.  Drugs or compounds of similar structure and/or effect on the body are grouped into classes and can be identified through several unique means of testing.

Preliminary or immunoassay screens are rapid, low-complexity tests that use antibodies to detect the presence of drugs and many other substances in urine. These tests return an answer of only “Positive” or “Negative” for a drug or compound in the specimen.  This positive or negative answer is typically drug class-specific only, and dependent upon the level of the compound above a predetermined cut-off level. 

Because drugs are chemicals with unique structures, it is possible to identify an individual drug through highly specific laboratory analysis.  PremierTox employs state of the art UPLC/MS/MS technology and highly sensitive and specific methodology to determine not just the presence, or absence, of a particular drug but also quantify the amount of drug present.

What is UPLC/MS/MS?

UPLC/MS/MS is the abbreviation for Ultra-Performance Liquid Chromatography/mass spectrometry/mass spectrometry, the testing methodology PremierTox uses to confirm/quantify drug levels in a specimen.

UPLC/MS/MS provides identification of the target molecule(s) based on known characteristics and patterns at specific retention times. The Waters Acquity© UPLC/MS/MS PremierTox utilizes is highly sophisticated tandem technology, utilizing a liquid chromatograph coupled to a mass spectrometer for thorough analysis.

 

Why are screening and confirmation cut-off levels different?

Screen and confirmation testing are performed using different instruments, which employ different types of testing methodologies. The immunoassay tests used to perform initial drug screening are designed to quickly react to detect a wide range of chemically similar compounds to provide a rapid qualitative result. In contrast, the UPLC/MS/MS testing PremierTox performs, is an intensive process that identifies specific drugs and metabolites and quantifies their level in the specimen.

What does ng/mL mean?

PremierTox employs highly sensitive testing methodology that can detect drugs down to billionths of a gram in one milliliter of solution, expressed as ng/mL (nanograms per milliliter).

What is specimen validity testing?

PremierTox performs specimen validity testing at the provider’s request to detect substitution, adulteration, or dilution of urine specimens:

Substitution - Providing a specimen that is not characteristic of human urine. Typically, this may be water or water with substances added to mimic urine.

Adulteration – Providing a specimen with added substance(s) to a specimen to mask the presence of, or chemically destroy, the drug or drug metabolite that the specimen may contain.

Dilution - Result of either ingesting large amounts of water typically just before urine donation, adding water to the specimen after collection, or as a result of physiological conditions.

How long are drugs stable in a urine sample?

This length of time a drug is stable in a specimen is dependent upon the drug. Typically drugs are stable in urine for a week at room temperature and for at least a month at refrigerated temperatures. If frozen the sample remains stable for longer periods.

General Toxicology

Why were other drugs or compounds detected in the drug test, which were not prescribed to the patient?

There are possibly several potential reasons for this occurrence:

Metabolism – essentially all drugs are consumed or transformed in the body by multiple pathways to enhance their utilization and/or elimination. Slight structural modifications to a drug by enzymes can lead to the production of one or more compounds. Some of these are actively therapeutic and some are not. Some drugs, like some benzodiazepines can be metabolized to another therapeutic compound, which may cause confusion in the interpretation of results.

Abuse/diversion –the patient may be taking drugs they were not prescribed.

If unexpected results do arise from a drug test it is important to carefully discuss them with your patient before taking next steps. A possible retest may be necessary to confirm.

 

Why were prescribed drugs not detected in the drug test?

There could be several reasons that a urine drug screen provided an unexpected negative result for a drug prescribed to a patient:

Patient non-compliance with medication therapy

Drug ingestion not taking place within detection timeframe. Drugs remain in the body for a limited amount of time based on their chemical properties.

Metabolism may also affect drug test results. Medications are often metabolized into other compounds and the actual prescription drug, or “parent drug” may no longer be present in the body.

The level of drug or compound in the urine specimen may have been below the cutoff levels of the device or instrument analysis.

If unexpected results do arise from a drug test it is important to carefully discuss them with your patient before taking next steps. A possible retest may be necessary to confirm.

 

How can the screen be negative and the confirmation test result be positive?

Immunoassay screen tests are by design, a low sensitivity, low specificity test and may not be able to detect drugs below a cutoff level that’s much higher than confirmation testing.  In addition, the preliminary screens may not be able to detect all drugs within the drug class, as not all members of that class will react equally to the methodology.  For example, many synthetic opioids like Tramadol, may not be detected by a standard Opioid screen.  

PremierTox offers confirmation testing with UPLC/MS/MS to uniquely identify individual drugs and metabolites through precise measurement of both mass and chemical structure of molecules in a specimen.  Quantitative methodology has a much higher level of both specificity and sensitivity to a targeted set of drugs or compounds and may detect analytes at a much lower concentration than the screen. 

How can the POC screen I performed in my office be positive, but the confirmation test result be negative?

The in-office preliminary screening devices are often subject to a phenomenon known as cross-reactivity.  Some unrelated compounds, but with some structural similarities may cause a positive result even though the target drug or compound is not actually found in the specimen.

PremierTox performs quantitative analysis via UPLC/MS/MS, which is highly drug-specific and not subject to cross-reactivity, ensuring an accurate result. 

How long are drugs detectable in the urine after ingestion?

The available window of time for drug detection depends on several factors, including the genetic makeup and behavioral patterns of the patient, the drug in question, and the length of time that the patient has been taking the drug.  

Why should I test for Ethyl glucuronide (EtG) instead of ethanol?

Ethanol is detectable in urine for only a few hours after ingestion. Ethyl glucuronide (EtG) and Ethyl Sulfate (EtS) are detectable for several days after exposure. Thus, these metabolites provide for a better indication of ethanol exposure.

Are all opiates the same? Will all opiates yield a positive result on the preliminary screen?

Opiates/opioids are a class of analgesic drugs often prescribed to provide relief from pain. Though they are related in their mechanism of action they all vary in their structure.  This affects the qualitative screen’s ability to detect or differentiate between many individual opiate drugs.  A standard Opiate screen may not detect many synthetic opioids, but confirmation can identify the specific drug.

 

Are there any other causes of a positive opiate result, other than an opiate drug? 

Ingestion of significant quantities of poppy seeds products may trigger a positive opiate result.

 

How can I tell if a benzodiazepine result is consistent with the prescription regimen?

Benzodiazepines are a class of drugs that provide relief from anxiety and induce sedation. While related in their actions, their reactivity with the screening immunoassay will vary from drug to drug. Therefore, the preliminary screen may be negative but PremierTox quantitative analysis via UPLC/MS/MS will detect the specific drug.

 

Careful determination of benzodiazepine regimen compliance often requires careful review of results to determine both medication adherence and chronic use.  Benzodiazepines also have a complicated metabolic process that often involves conversion to other branded therapeutic drugs.  In many cases the answer will be obvious but if not, you may consult with one of our skilled toxicologists during normal business hours.

Why is my patient testing positive for alpha-hydroxyalprazolam?

Alpha-hydroxyalprazolam is a natural by-product of chronic ingestion of alprazolam, or Xanax®. Through oral administration, alprazolam is readily absorbed and distributed throughout the body. Alprazolam is extensively metabolized in humans through oxidation, primarily by cytochrome P450 3A4, and conjugation.  Approximately 80% of a dose of alprazolam is subjected to renal excretion within 72 hours with about 20% of the dose eliminated as unchanged alprazolam and 17% as alpha-hydroxyalprazolam, the remainder as other metabolites.  For an average healthy patient that is chronically administrated alprazolam, he/she should excrete both alprazolam and alpha-hydroxyalprazolam.

Will Ritalin® (methylphenidate) test positive for methamphetamine?

No. Methylphenidate is a drug used to treat ADHD and will not cross react with the amphetamines or methamphetamine preliminary screen. PremierTox tests for methylphenidate and its metabolite, ritalinic acid, through UPLC/MS/MS for individual identification and quantification.

Does the detection of methamphetamine automatically mean that my patient was illicitly abusing the drug?

No. The unique structure of methamphetamine actually exists in two mirror images of each other, called stereoisomers.  One form, d-methamphetamine, is a strong central nervous system stimulant and is frequently associated with abuse.  The other form, l-methamphetamine, has less central nervous system stimulation or addictive properties of the d- isomer, but has greater peripheral vasoconstrictive properties, used in nasal inhalers.

 

There are several pharmaceutical products that will result in a positive methamphetamine finding:

Vicks® Nasal Inhaler – this product contains the I-methamphetamine isomer.

Deprenyl (Selegine®) - prescribed to treat Parkinson’s disease, this is also the l-methamphetamine isomer

Benzphetamine (Didrex®) - an anorectic drug that is metabolized by the body to form d-methamphetamine

For more information on methamphetamine and how PremierTox analysis may help you interpret patient use, please click here.

PremierTox Testing Services

Can you test for every drug?

No laboratory can test for every drug available, and not every drug may be deemed medically necessary by the patient’s insurance company.  PremierTox Laboratory has an extensive catalog of drugs and their metabolites for effective compliance monitoring that include those most commonly encountered in medication therapy, pain management, and abuse situations.  Please click here for more information.

Can I write in a specific test if its not already printed on the requisition?

You may request a test for a drug group or class of drugs to also be tested at any time. Simply write the test code and test name on one of the blank lines provided in the test requested section.

What are the different options available to receive test results?

Results may be forwarded to the provider by secure fax, mail, phone, email, or can be retrieved through our exclusive online specimen entry and results management software premiertoxdirect.com

How do I order more testing supplies?

Please call customer service at 1-877-412-8330 during normal business and one of our supplies sales associates will gladly assist you.

What kind of expertise do you have on staff that I can ask for help or interpretation of results?

At PremierTox, we are committed to ensuring you have all the support needed to properly interpret results to inform your decision-making.  Our skilled toxicologists have decades of experience and are available to answer any questions you have during normal business hours. Simply call 1-877-412-8330 to speak with any of our expert staff now!

What information MUST be on a specimen label so it will not be rejected?

To ensure that results are specific to a patient we require the patient’s full name and date of birth as minimum requirements for specimen labeling.  Date and time of specimen collection are also required to ensure proper specimen integrity and record keeping.  To help minimize rejections at the lab, please ensure that all specimens are properly labeled with all required patient information.

Why can’t the specimen be tested if the cup broke or leaked during transit?

Sample integrity is crucial to valid results and a broken transport cup could allow contamination of the specimen. A sample with compromised integrity may cause incorrect results and would not be valid for making sound medical decisions.

Do you store patient specimens for later testing/retesting if needed?

Yes. Specimens are retained for three months after testing is completed.

Why is Ambien® (zolpidem) listed as a benzodiazepine?

While zolpidem is not structurally related to the benzodiazepine class it does share some pharmacological properties with the class. The major pharmacological properties responsible for sedative, anticonvulsant, anxiolytic and myorelaxant drug properties are due to the interactions between zolpidem and a subunit of the GABA receptor. Zolpidem is a hypnotic (a drug that induces sleep in a patient), and will not cross-react with the benzodiazepine immunoassay screen.

Billing Policy

We work with insurance companies across the country to ensure proper coverage and offer financial assistance for patients who qualify.  Most of our insurance partners, including federal providers, require PremierTox to send a bill for any remaining balance, co-pay, or deductible, as explained in the insurer’s Explanation of Benefits (EOB), or any other statements you may receive. It is important to know that these amounts are determined by the insurance plan, and PremierTox may appeal on your behalf when coverage has been denied.  If you have any questions about your statement or our billing policy please contact PremierTox Patient Services at any time.

If you don’t have health insurance or can’t pay your account balance in full at this time, please contact Patient Services to see if you are eligible for financial assistance in accordance with state and federal guidelines.

Our billing policy is outlined below:

PremierTox bills insurance on behalf of patients.

Following test completion and reporting of results, PremierTox will verify the patient’s insurance eligibility and bill the participating insurance plan(s).  The patient will receive a statement from PremierTox, detailing test charges and submission to insurance.  The patient may also receive an Explanation of Benefits from their insurance company. It is important to inform the patient that neither of these documents are a bill; they should not send payment to the insurance company or PremierTox at this time. PremierTox will appeal to insurance in every case where large patient balances are owed.  PremierTox will send a statement to the patient reflecting the insurance plan’s final determination of benefits and their remaining balance.  They may also receive a final statement from their insurance.

Patient Billing

Following test completion, we will verify uninsured status with the patient and/or the provider.  PremierTox will then send a statement to the patient reflecting their total balance.  Our dedicated billing specialists are available to work one-on-one with each patient and determine their eligibility for discounted services and/or assistance with any remaining balance due.  Patients may contact the PremierTox Patient Services department with any questions regarding their account.

Billing FAQ

When it comes to healthcare billing, we know it can be complicated. Patient Services representatives are available to help you understand any balance remaining on your account. Some of the most frequently asked questions are below:

Why did I receive a statement for PremierTox services?

PremierTox bills your insurance directly for any testing your doctor orders on your behalf.  Your insurance company will send you an Explanation of Benefits (EOB) that shows how they processed the claim for the test. Depending on your health plan, you may receive a statement that shows a co-payment or a deductible. If you do not have insurance, you may be able to apply for financial support. 

 

I received a check from my insurance company for PremierTox Laboratory services. What should I do with it?

If you receive payment from your insurance for PremierTox testing, you are responsible for forwarding this payment to PremierTox. Simply endorse the back of the check “Pay to PremierTox,” sign and mail to PremierTox:

PremierTox Laboratory

c/o Patient Services

2431 Lakeway Drive Suite 17A-1

Russell Springs, KY 42642

 

How will this affect my credit score?

At this time, PremierTox does not take any actions that will negatively impact a patient’s credit history.

 

Why can’t my deductible/co-pay be discounted?

Your health insurance coverage is a contract between you and your insurance company.  The amount remaining –often a co-pay or deductible- is determined by your insurer and PremierTox may not discount this amount.  PremierTox offers interest-free payment arrangements to assist with any remaining balance on your account. Please call Patient Services to set it up today.

Privacy Policy

Your Information. Your Rights. Our Responsibilities.

This notice describes how PremierTox uses medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

YOU HAVE THE RIGHT TO:

Get a copy of your paper or electronic medical record

Correct your paper or electronic medical record

Request confidential communication

Ask us to limit the information we share

Get a list of those with whom we’ve shared your information

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you believe your privacy rights have been violated

Your Choices

YOU HAVE SOME CHOICES IN THE WAY THAT WE USE AND SHARE INFORMATION AS WE:

Tell family and friends about your condition

Provide disaster relief

Include you in a hospital directory

Provide mental health care

Market our services

 

Our Uses and Disclosures

WE MAY USE AND SHARE YOUR INFORMATION AS WE:

Treat you

Run our organization

Bill for your services

Help with public health and safety issues

Do research

Comply with the law

Work with a medical examiner or funeral director

Address workers’ compensation, law enforcement, and other government requests

Respond to lawsuits and legal actions

 

 

Your Rights

WHEN IT COMES TO YOUR HEALTH INFORMATION, YOU HAVE CERTAIN RIGHTS. 

This section explains your rights and some of our responsibilities to help you.

 

GET AN ELECTRONIC OR PAPER COPY OF YOUR MEDICAL RECORDS:

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.  Please contact the business office at (877) 412-8330 to learn how to get that information.  PremierTox provides a simple Patient Records Request form for your use.

We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

ASK US TO CORRECT YOUR MEDICAL RECORDS:

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this by contacting the business office at (877) 412-8330.

We may say “no” to your request, but we’ll tell you why in writing within 60 days.

REQUEST CONFIDENTIAL INFORMATION:

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

We will say “yes” to all reasonable requests.

ASK US TO LIMIT WHAT WE USE OR SHARE:

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care or if state or federal law require us to provide  that information to third parties.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a state or federal law requires us to share that information.

GET A LIST OF THOSE WHOM WE'VE SHARED INFORMATION:

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

GET A COPY OF THIS PRIVACY NOTICE:

You can ask for a paper copy of this notice at any time.  We will provide you with a paper copy promptly.

CHOOSE SOMEONE TO ACT FOR YOU:

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information once you have signed the appropriate forms.

Before we can rely on that person to act for you, PremierTox will make sure the person has this authority and can act for you.  We will do this by asking to review the forms and confirming your identity and consent.

FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS ARE VIOLATED:

You can complain if you feel we have violated your rights by contacting us through our Privacy Officer at: 

(877) 412-8330 or email privacy@premiertox.com  We will work with you to promptly address the issue.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

  

Your Choices

FOR CERTAIN HEALTH INFORMATION, YOU CAN TELL US YOUR CHOICE ABOUT WHAT WE SHARE. 

If you have a clear preference for how we share your information in the situations described below, please let us know.  Where possible and not prohibited by law, we will follow your instructions.

 

IN THESE CASES YOU HAVE BOTH THE RIGHT AND CHOICE TO TELL US TO:

Share information with your family, close friends, or others involved in your care by providing us with written permission to share that information

Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

IN THESE CASES WE NEVER SHARE YOUR INFORMATION UNLESS YOU GIVE US WRITTEN PERMISSION:

Marketing purposes

Sale of your information

We will never share any substance abuse treatment records without your written permission. This prohibition does not apply to provision of urine drug screen requisitions or results.

 

Our Uses and Disclosures

HOW DO WE TYPICALLY USE OR SHARE YOUR HEALTH INFORMATION?

We typically use or share your health information in the following ways.

Treat you

   We can use your health information and share it with other professionals who are treating you.

   Example: A doctor treating you for an injury asks another doctor about your overall health condition. 

 

Run our organization 

   We can use and share your health information to run our laboratory processes, improve your care, and contact you    when necessary.

    Example: We use health information about you to manage your treatment and services. 

 

Bill for your services

  We can use and share your health information to bill and get payment from health plans or other entities.

  Example: We give information about you to the  billing company, your physician or medical care provider, or your health   insurance plan so it will pay for your services.

 

HOW ELSE CAN WE USE OR SHARE YOUR HEALTH INFORMATION?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

 

Help with public health and safety issues

We can share health information about you for certain situations such as: 

Preventing disease

Helping with product recalls

Reporting adverse reactions to medications

Reporting suspected abuse, neglect, or domestic violence

Preventing or reducing a serious threat to anyone’s health or safety

 

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

 

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

For workers’ compensation claims

For law enforcement purposes or with a law enforcement official

With health oversight agencies for activities authorized by law

For special government functions such as military, national security, and presidential protective services

 

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

 

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and provide a copy of it to you at your request.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

 

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.