Insurance Billing

Commercial Insurance

GeneDx accepts all commercial insurance policies. The patient is responsible for only the co-pay, co-insurance and unmet deductible dictated by his or her insurance carrier. GeneDx will perform a benefit investigation and contact the patient if the patient’s out-of-pocket cost is expected to be greater than $100. We will work with the patient if the patient has a financial difficulty and offer a financial assistance program based on their income.

If the patient decides to cancel the test, we will contact the physician that ordered the test to get their approval before cancellation. GeneDx provides a compassionate care price as well as a payment plan for patients who are financially challenged. If the patient receives a payment from the insurance company, it is patient’s 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. For more information regarding commercial insurance billing at GeneDx, please call us at 888-729-1206.

Commercial Insurance Contracts

National Plans
  • United Healthcare (UHC)
  • Aetna
  • Blue Cross Blue Shield Association
  • Cigna
  • Centene Corporation
  • Commonwealth Care Alliance (CCA)
  • Multiplan
  • NovaNet PPO
  • Stratose Coalition America including Plan Care America,
  • OPPN, NPPN, 4Most PPO
Blues Plans
  • Anthem/Wellpoint of California
  • Anthem/Wellpoint of Connecticut
  • Anthem/Wellpoint of Indiana
  • Anthem/Wellpoint of Kentucky
  • Anthem/Wellpoint of Maine
  • Anthem/Wellpoint of Missouri
  • Anthem/Wellpoint of New Hampshire
  • Anthem/Wellpoint of Ohio
  • Anthem/Wellpoint of Virginia
  • Anthem/Wellpoint of Wisconsin
  • BCBS of Alabama
  • BCBS of Arizona
  • BCBS of Georgia
  • BCBS of Hawaii
  • BCBS of Illinois
  • BCBS of Kansas
  • BCBS of Rhode Island
  • BCBS of South Carolina
  • BCBS of Texas
  • BCBS of Vermont
  • BCBS of Northeastern New York
  • BCBS of Western NY
  • BlueShield of CA
  • BlueShield of Northeastern NY
  • CareFirst BCBS
  • Empire BCBS
Other Plans
  • Avalon Healthcare Solutions (SC)
  • CalOptima
  • Crystal Run Health Plan (NY)
  • Dean Health Plan
  • Evolutions Healthcare Systems (FL)
  • First Choice Health Plan (MS)
  • Group Health Cooperative (WA)
  • Gulf Coast Provider Network (FL)
  • HealthChoice Network (AL), including NAMCI, HealthNet, Alabama Premier Health
  • Health Partners
  • Healthfirst (NY)
  • Healthnow (NY)
  • Humana Military Tricare
  • Inland Empire Health Plan (CA)
  • Island Group Administration
  • Loyola University Medical Center (IL)
  • MS Physicians Care Network/MS State Network
  • Neighborhood Health Plan of RI
  • Physician’s Plus
  • POMCO Group (NY)
  • Provider Select (TX)
  • River City Medical Group
  • Sanford Health Plan (MN, IA, SD, ND)
  • Sutter Medical Foundation

Medicaid

GeneDx is a registered provider with several Medicaid plans. Although we are a registered provider with these plans, prior authorization is required for Medicaid samples and must be obtained by the ordering physician’s office. In an instance where we receive a Medicaid sample without a prior authorization, the test will go on hold and not proceed in the lab. In most cases, Medicaid will not cover genetic testing for these conditions, as Medicaid coverage varies by state.

States that GeneDx is a Medicaid Registered Provider
  • Alaska Medicaid
  • Colorado Medicaid
  • Connecticut Medicaid
  • Florida Medicaid
  • Georgia Medicaid
  • Illinois Medicaid
  • Indiana Medicaid
  • Iowa Medicaid
  • Kentucky Medicaid
  • Maryland Medicaid
  • Massachusetts Medicaid
  • Medi-Cal (California)
  • Michigan Medicaid
  • Minnesota Medicaid
  • Mississippi Medicaid
  • Missouri Medicaid
  • Nebraska Medicaid
  • New Mexico Medicaid
  • New York Medicaid
  • North Carolina Medicaid
  • Ohio Medicaid
  • Oklahoma Medicaid
  • Oregon Medicaid
  • Pennsylvania Medicaid
  • Tennessee Medicaid
  • Texas Medicaid
  • Vermont Medicaid
  • Virginia Medicaid
  • West Virginia Medicaid
  • Wisconsin Medicaid

Medicare

GeneDx is a Medicare provider and therefore is able to accept Medicare patient samples, if covered by Medicare coverage policy. A completed Advance Beneficiary Notice (ABN) is required when Medicare medical necessity criteria are not met.

Insurance Forms

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