Insurance Billing

GeneDx accepts all commercial insurance and we are in-network with the majority of commercial health plans. The patient is responsible for the member financial responsibility listed on the Explanation of Benefits (EOB) which includes co-pay, co-insurance and unmet deductible established by their health insurance provider.

Commercial Insurance Contracts

National Plans

  • United Healthcare (UHC)
  • Aetna
  • Cigna

Blues Plans

  • Empire BCBS
  • Empire BCBS HealthPlus
  • Anthem BCBS GA
  • Anthem BCBS VA
  • Anthem BCBS IN
  • Anthem BCBS KY
  • Anthem BCBS OH
  • Anthem BCBS MO
  • Anthem BCBS WI
  • Anthem BCBS CT
  • Anthem BCBS ME
  • Anthem BCBS NH
  • Anthem BlueCross CA
  • BCBS South Carolina (administered by Avalon)
  • BCBS Alabama
  • BCBS Arizona
  • BCBS of Illinois
  • BCBS of Kansas
  • BCBS Massachusetts
  • BCBS Michigan (Commercial Only)
  • BCBS Nebraska
  • BCBS North Dakota
  • BCBS North Carolina (Medicare Advantage)
  • BCBS of Rhode Island
  • BCBS of Texas
  • BCBS of Vermont
  • BCBS of Western NY (Healthnow)
  • Blueshield of Northeastern NY (Healthnow)
  • BlueShield of California
  • Capital Health Plan
  • CareFirst Blue Cross & Blue Shield
  • Wellmark BCBS (Iowa & South Dakota)

Other Plans

  • Aetna Better Health NJ
  • Aetna Better Health VA
  • Aetna Better Health WV
  • Affinity Health Plan, Inc
  • Alameda Alliance for Health
  • American CareSource Holdings (dba Ancillary Care Solutions)
  • Amerigroup DC
  • Amerigroup FL
  • Amerigroup Georgia
  • Amerigroup Iowa
  • Amerigroup Kansas fka KanCare
  • Amerigroup Louisiana fka Healthy Blue
  • Amerigroup Maryland
  • Amerigroup Nevada
  • Amerigroup New Jersey
  • Amerigroup New Mexico
  • Amerigroup Texas
  • Avera Health Plans
  • Amerigroup Tennessee
  • Amerigroup Washington
  • AmeriHealth Caritas Delaware Multiplan
  • CalOptima
  • CareSource West Virginia
  • CareSource Kentucky
  • Centene Corp
  • Bridgeway Health Solutions
  • Cenpatico Integrated Care
  • Ambetter
  • California Health & Wellness
  • Sunshine Health
  • Peach state Health plan
  • Illinicare health
  • Managed Health Services (MHS)
  • Sunflower Health Plan
  • Louisiana Healthcare Solutions
  • Michigan Complete health
  • Magnolia Health
  • Home State Health
  • NH Health Families
  • Buckeye Health Plan
  • Trillium
  • Absolute Total Care
  • Superior Healthplan
  • Coordinated Care
  • MHS Health Wisconsin
  • Commonwealth Care Alliance, inc
  • Community Care Plan CCP – fkna SFL Community Care Network
  • Community First Health Plan
  • Common Ground Healthcare Cooperative
  • Community Care Alliance of Illinois (CCAI)
  • Community Health Choice
  • Cook Childrens Health Plan
  • Coventry WV
  • Crystal Run HP
  • Dean Health Plan
  • Employer Health Alliance
  • Evicore Healthcare (EVC)
  • Evolutions Healthcare Systems, Inc NAT PPO NETWORK
  • First Carolina Care
  • First Choice HP of Mississippi PPO Network
  • Geisinger Health Plan
  • Group Health Cooperative
  • Gulf Coast Provider Network – Sarasota Memorial PHO
  • Hawaii Medical Services Assoc. (BCBS Hawaii)
  • Health Alliance Medical Plans
  • Health Net Fed Services – TRICARE NORTH & WEST
  • Health Net of California, Inc
  • Health New England
  • HealthCare Partners
  • HealthFirst
  • HealthNet, Inc. Health Choice of Alabama PPO Network
  • HealthNow NY, Inc
  • HealthPartners, Inc.
  • HealthSmart
  • Humana Military – TRICARE SOUTH
  • Independent Medical Systems
  • Indiana University Health Plan (IUHP) & MDWise
  • Inland Empire Health Plan
  • Island Group Administration, Inc
  • Jade Medical Group
  • JVHL (Joint Venture Hospital Laboratories)
  • Lehigh Valley Health Network
  • Loyola University Medical Center
  • Maryland Physicians Care
  • Medical Cost Containment
  • Memorial Health Partners Hospital Network
  • Meritage Medical Network
  • Mississippi Physician’s Care Network
  • Molina of South Carolina
  • Molina HC of Utah
  • Molina HC of Washington, Inc
  • MultiPlan, Inc
  • NAMCI
  • Neighborhood HP of Rhode Island
  • NovaNet, Inc.
  • Partners Health Plan
  • Ped-I-Care (CMS CSHCN)
  • Physicians Plus
  • Pomco
  • Preferred One
  • Prime Health Services PPO Network
  • Provider Select
  • River City Medical Group
  • Rocky Mountain Health Plan
  • Samaritan Health Services
  • Sanford Health Plan
  • Scott & White Health Plan
  • Sharp Rees-Stealy Medical Group, Inc
  • South Broward Hospital District – Memorial Integrated Health Network MHNS
  • Stratose
  • Suburban Health Organization
  • Sutter East Bay Hospitals
  • Sutter East Bay Medical Foundation
  • Sutter Physicians Alliance
  • Three Rivers Provider Network
  • Tufts Associated HMO, Inc.
  • University of Maryland Health Plans
  • University of Maryland Health Partners
  • University of Maryland Health Advantage
  • US Family Care
  • Virginia Health Network
  • Viva Health Medicare Advantage
  • Viva Health Commercial HMO
  • WellCare Health Arizona
  • WellCare Health Arkansas
  • WellCare Health Connecticut
  • WellCare Health Georgia
  • WellCare Health Illinois
  • WellCare Health Kentucky
  • WellCare Health Louisiana
  • WellCare Health Maine
  • WellCare Health Mississippi
  • WellCare Health Missouri
  • WellCare Health New Jersey
  • WellCare Health New York
  • WellCare Health South Carolina
  • WellCare Health Tennessee
  • WellCare Health Texas
  • Wellmark BCBS Iowa
  • Wellmark BCBS South Dakota
  • Zelis HealthCare

 

Insurance Billing Process

 

STEP 1: HEALTHCARE PROVIDER SUBMIT TEST REQUISITION FORM

To reduce testing delays, please send the following information with each patient specimen:

  • ICD 10 diagnosis code(s) to the highest level of specificity written on the test requisition form
  • Prior authorization reference number, if prior authorization has already been initiated
  • Clinical summary from genetic counseling appointment
  • Summary of patient’s clinical diagnosis/presentation
  • Pedigree or summary of three-generation maternal and paternal family history

The information should be sent with your patients’ samples or directly to our Missing Info Team (Fax: 201-421-2304, GDXRCMissinginfo@genedx.com) to avoid delay.

 
 

STEP 2: HEALTHCARE PROVIDER PRIOR AUTHORIZATION (PA)

 

NOTE: If a patient’s health insurance plan requires prior authorization (PA) or medical precertification, the test will be put on hold until an approved PA is obtained.

To reduce testing delays, please send the following information with each patient specimen:

  • ICD 10 diagnosis code(s) to the highest level of specificity written on the test requisition form
  • Prior authorization reference number, if prior authorization has already been initiated
  • Clinical summary from genetic counseling appointment
  • Summary of patient’s clinical diagnosis/presentation
  • Pedigree or summary of three-generation maternal and paternal family history

The information should be sent with your patients’ samples or directly to our Missing Info Team (Fax: 201-421-2304, GDXRCMissinginfo@genedx.com) to avoid delay

  • If any information necessary to submit the prior authorization is missing, our Missing Info Team will reach out to you to request the documents.
  • The GeneDx Patient Advocate Team will reach out to the patient/guardian to inform them about the PA process

 
 

STEP 3: GENEDX OBTAINS AN ESTIMATE FROM PATIENT’S INSURANCE

To help determine what the testing will cost, will reach out to the patient’s health insurance provider to request a benefit investigation to help determine your financial responsibility. This is an estimate of the patient’s out-of-pocket expense for the laboratory testing, given to us by their health insurance provider, and it is based on their current medical benefits plan and usage. We will attempt to contact the patient if the estimate is over $100. We will make up to 3 attempts to reach the patient.

Tip: Please make sure to provide the best contact information (phone, email, mailing address) so we can reach the patient successfully.

 
 

STEP 4: GENEDX MAILS BILL TO PATIENT

Once the exact amount of patient’s member responsibility is determined, we will send the bill.

 


 

Tip: The patient may receive an Explanation of Benefits (EOB) from their insurance company. They are NOT responsible for any balances until they receive a bill directly from GeneDx.

If the patient decides to cancel the test, we will contact the physician who ordered the test to notify them of the cancellation.

 
 

Insurance Billing Process

Plans may require additional documentation to complete the prior authorization process and/or genetic counseling. Click here to view these additional forms.

 
 

Payment Options

GeneDx accepts the following payment methods:

  • Credit Card—AMEX, Discover MasterCard or Visa
  •  

  • Checks or Money Orders—please make payable to GeneDx
    • Mail to: GeneDx Inc.
    • P.O. Box 21997
    • New York, NY 10087-1997

     

  • Wire Transfer—please contact us at 1-844-241-1233 to arrange for wire transfer payment from your bank

If you have received your bill and would like to pay online now, please use our convenient, patient-friendly Payment Portal.

 

If you receive a payment from your health insurance company, it is your responsibility to pay GeneDx within 10 days of receipt of that payment. This payment is not eligible for reduction under any financial assistance or compassionate care program.

 
 

Installment Payment Plans

To assist with the cost of testing, GeneDx offers no-interest, no-fee payment plans. The total amount owed may be divided up over 12 months, if under $1,000 or over 24 months, if over $1,000.