We are Here for You
The Sagenex team is here to help. We facilitate every aspect of the diagnostic testing process – from reordering your requisition forms and supplies, to billing and payment processing for your patients and their insurance providers, to providing thorough training and support for your office staff. This saves you time and money, and allows you to pay attention to what’s really important – your patients!
Our hands-on approach doesn’t stop with your staff, though. We have PhD-level toxicologists and analytical chemists who are at your disposal and available for consultation if you ever have questions or need clarification of reported results.
Also, one of the most overlooked challenges in dealing with a patient and their lab services is knowing exactly what to say about the lab. They inevitably have questions about why a certain lab was selected, or why they need to pay separately for lab services. The following two sections provide you with the answers to many of their questions and also offer some great discussion starters to help you set expectations for new patients.
FAQs for MD’s
Answers for Medical Professionals
Why should I drug test my patients?
There are two primary reasons to test patients. The first is to monitor proper adherence to a prescribed regimen of medication – to make sure the patient is taking what he or she is supposed to be taking. The second is to monitor abstinence – to make sure the patient is not taking anything that he or she is not supposed to be taking.
By regularly testing for both the prescribed medication and its metabolite, the doctor can verify proper and consistent usage of the medicine over time. That is to say that not only did the patient take their medicine prior to the test, but also the patient has been taking the medicine regularly over time.
It is also vitally important that the physician identify usage of illicit substances as quickly as possible as rapid intervention is substantially more effective at keeping a patient in a treatment program. It is also imperative that the physician works to deter usage of any drugs of abuse during treatment. According to its “Principles of Drug Addiction Treatment“, the National Institute on Drug Addiction states:
Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.
Why not just use “instant” point-of-care drug screen cups?
According to the package insert , the cup method “provides only a preliminary analytical test result. The test is not intended to be used in monitoring the drug levels. A more specific alternate method must be used in order to confirm the test result.” (Emphasis added)
Further, the US Food and Drug Administration (FDA) states, “[if you use a cup,] it is very important to send the urine sample to the laboratory to confirm a positive [instant cup] result because certain foods, food supplements, beverages, or medicines can affect the results of at-home tests. Laboratory tests are the most reliable way to confirm drugs of abuse.” They go on to say, “many things can affect the accuracy of these tests, including (but not limited to): the way you did the test, the way you stored the test or urine, what the person ate or drank before taking the test, and any other prescription or over-the-counter drugs the person may have taken before the test.”
In a 2013 study by forensic toxicologist David K. Lirette Ph.D., M.S., MT (ASCP), the point-of-care testing cups presented false results approximately 34% of the time (16.1% false positive, 17.9*% false negative). CLICK HERE for Dr. Lirette’s report.
This finding is backed up by a 2013 report published by the American Society of Addiction Medicine. They found that “an examination of LC/MS/MS results following point-of-care (POC) testing in addiction treatment settings found high rates of clinically false negatives, that is, samples tested by POC were reported negative but LC/MS/MS results were positive.” CLICK HERE for the full report.
Another problem presented by the self-test cups is that they do not take adulteration or contamination into account. By using lab-based testing, a specimen can be checked for pH, specific gravity and other factors to make sure that the sample has not been altered.
What “adulterants” do you check for, and why?
All toxicology tests that are performed at Sagenex Labs are adjusted for creatinine. Creatinine is a naturally occurring compound in the body that remains at a fairly constant level. Variations in creatinine levels may indicate changes in hydration of the test subject. These variations are adjusted for in the final Sagenex Lab test results report. In an instance where there are drastic changes in creatinine, it is likely that a specimen has been intentionally diluted or manipulated and may be assumed to be invalid.
Additionally, Sagenex Labs tests for nitrites, pH and specific gravity. All three of these factors can be affected by “tampering” or adulteration of a specimen. For example, the addition of bleach or other cleansers that were inadvertently left in a testing site bathroom will clearly change the pH and nitrite levels of a sample.
By testing for adulterants, Sagenex Labs is able to provide the physician with improved accuracy and greater reliability so that the physician can make better treatment decisions.
If a screen shows presumptive positive results, why should we bother confirming the results with LC/MS/MS?
In the American Society of Addiction Medicine’s 2013 white paper on drug testing (CLICK HERE for the report), they found that there were a lot of both “false positives” and “false negatives” when relying upon point-of-care (POC) testing alone. They stated,
“Twenty-nine percent of opioids other than methadone identified by LC/MS/MS were missed by POC tests; 28% methadone, 43% amphetamines, 35% benzodiazepines, 40% cocaine and 20% marijuana. Additionally, investigators found rates of office-based false positive results including 22% of opioids other than methadone identified as positive on POC but negative on LC/MS/MS, 46% methadone, 21% amphetamines, 61% benzodiazepines, 12% cocaine and 21% marijuana.”
Furthermore, conducting LC/MS/MS confirmation testing provides quantitative results that allow physician to know what level of an analyte or metabolite a patient may have in his or her system. This helps the physician to better understand and verify usage timing and volume. Over the course of several testing periods, this helps to “paint a picture” of the patient’s usage practice and history.
How often should I test my patients?
The frequency of drug testing should always be determined by the physician and the purpose and circumstances of the testing. For addiction treatment, for instance, doctors will frequently test a new patient when they admit them into the treatment program to establish a “baseline” for comparison. Then, with most drugs having a window of detection (in urine toxicology) of one to three days, doctors take these sorts of factors into account and guide their decisions accordingly. As the patient demonstrates ongoing compliance, a doctor may then make appropriate changes to the monitoring plan.
The American Society of Addiction Medicine recommends that the treatment of a patient “sometimes requires more frequent testing, more extensive test panels, and more sensitive and specific testing techniques.” They also note that, “The increasing use of designer drugs, such as synthetic hallucinogens and synthetic cannabinoids, often used instead of marijuana to avoid detection by IA test devices, can only be detected with more advanced and extensive drug testing technologies.”
If you would like a reference to medical tools and sources that can help you determine the right testing frequency for your particular circumstances, we are glad to make recommendations to get you going in the right direction.
Ultimately, however, it is always up to the physician to determine frequency of testing for their patients based upon acuity and the individual treatment plan.
Why would I ever want to compare lab results with “old” results?
By starting treatment with a “baseline” test, quantitative results have context. If, for instance, a patient tests positive for THC with a value of 1075 ng/ml, a physician may make better assumptions from an ensuing test with results of 550. If there was no initial test, a physician may falsely presume drug usage, whereas with a base for comparison, the doctor may conclude that the patient’s THC level is falling and consistent with abstinence. If there had been no base, then future testing may lead to faulty conclusions.
Over time, a physician can monitor compliance with a plan of medication by comparing previous results with current test results. Consistent analyte and metabolite levels of a prescribed medication will indicate compliance with a course of treatment. Also, by regular observation of levels of a drug of abuse and/or its metabolites, a doctor can determine if the patient continues with abstinence (falling levels) or has relapsed (rising levels). Without regular monitoring, even quantified results can lead to incorrect conclusions.
Sagenex offers physician-interpreted results. I AM a physician, so why would I want another doctor’s opinion?
Sagenex Labs has two Medical Review Officers that have been certified by the American Association of Medical Review Officers (AAMRO). AAMRO is a medical society dedicated to establishing national standards and certification of medical practitioners and other professionals in the field of drug and alcohol testing. A Medical Review Officer (MRO) is a licensed physician that is responsible for receiving and reviewing, evaluating and interpreting laboratory results and offering medical explanations for the results. They act as an independent and impartial authority and authenticator of the accuracy and integrity of the drug testing process. The MRO helps determine legitimate, plausible and probably medical explanations for laboratory confirmed positive, adulterated, substituted and invalid drug test results.
Additionally, Sagenex Labs MRO’s are available to our client’s physicians at any time for consultation, verification or corroboration of their interpretation of the lab results. Sometimes, it is good to have a second opinion.
Will it increase my staff’s workload if we transition to or to work with Sagenex?
Absolutely not. At Sagenex Labs, we work diligently to simplify our client’s experience.
Our account management and “onboarding” team will provide easy and seamless conversion from any current lab services provider. We furnish all requisition forms, collection cups and bags and other vital supplies. Depending upon your need, location, volume and other factors, we can frequently offer courier services, collection services and other conveniences. We also provide initial training and ongoing support for your staff to make sure that they are familiar with and comfortable with the lab testing process.
At Sagenex Labs, we truly PARTNER with our clients. If there is ever a question, issue or uncertainty – whether administrative or technical – we are available to you. Furthermore, when you call our office, a human will answer your call, not an automated phone system. We offer hands-on customer care.
Won’t lab-based testing be too expensive for some of my patients?
No. We work with every patient to make treatment monitoring affordable.
We keep our pricing competitive for all of our testing, even as we continuously expand and improve our list of services and maintain a rigorous quality assurance program. We do everything that we can to simplify a patient’s experience including working diligently to keep treatment monitoring as affordable as possible. We work with most major insurance carriers as well as Medicaid and Medicare. For uninsured patients (or even insured patients unable to afford their copays, deductible or coinsurance), we provide a financial aid program for those who qualify. Depending on the patient’s income level, they may qualify for a waiver of payment or scale payment structure. In addition, we have extended payment plans. We will work directly with your patient to resolve any payment issues.
What does Sagenex mean to you?
We’re the physician’s partner
Sagenex Labs designs and develops optimum laboratory solutions as it works alongside a wide range of professionals – pain management specialists, corporate medical directors, addiction treatment physicians, third-party administrators and more.
Our comprehensive, customized lab support helps medical professionals make better-informed decisions for their patients and employees because we build our OM lab services around the professional’s needs:
- Employee drug screening
- Prescriptions for pain killers
- Treating individuals struggling with drug addiction
- Phlebotomists and specimen collections
- Courier or shipping services
- Provision of bags, cups, forms and other materials
- Individualized testing (from albumen to z-drugs)
- Industry-leading results reporting
- Easy and secure online access to reports
- Historical usage tracking
- Physician-interpreted data
Sagenex makes things easy
From your initial transition through the length of our relationship.
- We provide complete administrative training for requesting tests, filling out supply requisitions and other day-to-day activities.
- We continue to interact with our clients, often on a daily basis
- We provide maximum accessibility to our operations and administrative staff
- We make our technical staff available
- We provide consultation – making PhD-level analytical chemists, toxicologists, pathologists and even medical doctors available to assist you with interpretation of lab results.
Many labs claim 48-hour turnaround – we deliver
- A full line of laboratory services for a broad spectrum of clients
- Concierge style customer service
- Accessible administrative and technical teams
- Easy reporting all tailored to your practice’s needs
in industry-leading turnaround times – under 24 hours and same-day turnarounds are most common.
A lab that cares – Sagenex Labs
Physician’s Discussion Guide
To Help You Introduce Sagenex Labs…
As a partner, Sagenex is not only dedicated to your needs, but also the needs of your patients. To help you prepare them for working with us, we’ve provided this brief explanation of who Sagenex is and what we do for them:
Sagenex works with your physician to provide a comprehensive monitoring program as part of their overall treatment plan. We do not provide “simple drug testing”; rather, we provide multiple services that are bundled together to provide your physician (and other treatment specialists) thorough diagnostic report to facilitate your care.
Sagenex Labs will also provide separate billing for your laboratory services. If needed, they can provide flexible payment options or financial aid in many circumstatnces. For an explanation on how these services are billed to your insurance carrier or if you are uninsured or have questions about what you can expect, visit sagenex.com/billing. It will also explain what to do if you receive an Explanation of Benefits (EOB) or bill.
For your convenience, we’ve also included some helpful information on what to expect during their office visit for specimen collections and how they should prepare:
You will be expected to provide your name, date of birth, address, and all insurance information, if applicable, including any secondary or supplemental insurance to the front office staff at your physicians’ office.
If your patients are interested in more information about Sagenex and how their billing and payments work, CLICK HERE.