Insurance Billing

Commercial Insurance

GeneDx has been selected as a member of the Preferred Laboratory Network for UnitedHealthcare (UHC).

GeneDx is contracted with the nation’s major commercial insurances (please see below).  The patient is responsible for the co-pay, co-insurance and unmet deductible established by his or her insurance carrier. Based on the patient’s insurance, GeneDx will perform a requested benefits investigation (BI) to estimate the patient’s out-of-pocket cost. GeneDx will attempt to contact the patient if the patient’s estimated 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 can offer a financial assistance program based on the patient’s household income and household size. GeneDx also 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.

If the patient decides to cancel the test, we will contact the physician who ordered the test to get their approval before cancellation.

For more information regarding commercial insurance billing at GeneDx, please call us at 855-519-2100

Commercial Insurance Contracts

National Plans
  • Aetna/Coventry
  • Aetna Signature Administrators PPO (ASA)
  • Centene, HealthNet of CA, WellCare, Allwell, Ambetter (excludes state of AZ)
  • Cigna (all plans & products)
  • Cigna HealthSpring (all plans & products)
  • Humana/ChoiceCare (all plans & products)
  • Tricare – via Humana Military or Health Net Federal Services
  • UnitedHealthcare (UHC) – Preferred Laboratory Network
Blues Plans
  • BCBS of Alabama
  • BCBS of Arizona (except Alliance Network & Medicare Advantage)
  • BCBS of Hawaii (Hawaii Medical Services Assoc.)
  • BCBS of Illinois PPO
  • BCBS of Kansas
  • BCBS of Massachusetts
  • BCBS of Michigan (PPO)
  • BCBS of Nebraska
  • BCBS of North Carolina
  • BCBS of North Dakota
  • BCBS of Rhode Island
  • BCBS of South Carolina (excludes Medicaid)
  • BCBS of Texas – HealthSelect ERS
  • BCBS of Texas (PPO Only)
  • BCBS of TN (excludes TennCare)
  • BCBS of VT
  • BCBS of Western NY
  • BCN of Michigan (via JVHL) (Limited)
  • Blue Cross & Blue Shield Blue Card Program
  • Blue Cross & Blue Shield Federal Plans
  • BlueShield of California (excludes Promise Health Plan)
  • BlueShield of Northeastern NY
  • Capital BCBS
  • Capital Health Plan of Florida
  • CareFirst Blue Cross & Blue Shield (PPO Products Only)
  • Florida Blue PPO (if through another PPO network)
  • Highmark of PA & WV
  • Horizon BCBS of New Jersey (Commercial PPO Only)
  • Matthew Thornton Health Plan (Anthem affiliate)
  • Wellmark BCBS (Iowa & SD)
Regional Plans
  • 1199 SEIU Funds (via the Aetna Signature PPO Network)
  • Aetna Better Health (except MI & NY)
  • Affinity Health Plan of NY
  • Affinity Medical Group
  • Alabama Premier Network
  • Alameda Alliance for Health
  • Allied Benefit Systems (via the Aetna Signature PPO Network)
  • Allways Health Partners ( Formerly NHP of MA)
  • AmeriBen (via the Aetna Signature PPO Network)
  • American CareSource Holdings (dba Ancillary Care Solutions)
  • Amerigroup (all states)
  • AmeriHealth Caritas of NH
  • AmeriHealth Caritas of PA & Northeast
  • Amerivantage of Texas
  • Anthem BC and BS Healthcare Solutions (NV)
  • Anthem BCBS Connecticut
  • Anthem BCBS Georgia (PPO Only)
  • Anthem BCBS Indiana
  • Anthem BCBS Kentucky
  • Anthem BCBS Maine
  • Anthem BCBS Missouri
  • Anthem BCBS New Hampshire
  • Anthem BCBS Ohio
  • Anthem BCBS Virginia (PPO Only)
  • Anthem BCBS Wisconsin
  • Anthem Blue Cross of California (except Medi-Cal)
  • APC PASSE dba Summit Community Care
  • Arizona Care Network ACO
  • Avera Health Plans
  • Boon-Chapman (via the Aetna Signature PPO Network)
  • CalOptima
  • CareSource Kentucky
  • CareSource West Virginia
  • Chesterfield Resources (admin for Salvation Army) (via Aetna Signature PPO Network)
  • Christian Brothers Services (via Aetna Signature PPO Network)
  • ClaimsBridge HPN
  • Cofinity PPO (an Aetna affiliate)
  • Colonial Medical Insurance Company (via Aetna Signature PPO Network)
  • Common Ground Healthcare Cooperative
  • Commonwealth Care Alliance, Inc.
  • Community Care Alliance of Illinois
  • Community Care Plan – formerly SFCCN
  • Community First Health Plan
  • Community Health Choice
  • Continental Benefits (via Aetna Signature PPO Network)
  • Cook Children’s Health Plan
  • COPC Senior Advantage (Ohio)
  • Crystal Run Health Plan
  • Cypress Benefit Administrators (via Aetna Signature PPO Network)
  • Dean Health Plan
  • Direct Care Administrators (via Health West PPO)
  • Emblem Health – SOMOS IPA Limited
  • Empire BC/BS (PPO Products Only)
  • Empire HealthPlus of NY
  • Employee Benefit Management Services (EBMS) (via Aetna Signature PPO Network)
  • Employer Health Alliance (aka, The Alliance)
  • Evolutions Healthcare Systems PPO
  • FedMed PPO
  • First Choice Health Plan of Mississippi PPO
  • First Health PPO (an Aetna affiliate)
  • FirstCarolinaCare Insurance Company
  • Gateway Health Plan
  • Geisinger Health Plan
  • Government Employees Health Association (GEHA)
  • Gulf Coast Provider Network PPO- Sarasota Memorial/Web-TPA
  • Hamaspik Choice
  • Harvard Pilgrim Health Care
  • Harvard Pilgrim Health Care
  • Health Alliance Medical Plans
  • Health Choice
  • Health Choice/NAMCI
  • Health Net of California
  • Health New England
  • Health West PPO
  • HealthCare Partners
  • HealthChoice PPO
  • HealthEZ (via Health West PPO)
  • HealthFirst of NY
  • HealthPartners of MN
  • HealthSCOPE Benefits (via Aetna Signature PPO Network)
  • HealthSmart & Ancillary Care Services PPO
  • HealthSmart Benefits Solutions
  • Healthy Blue – Louisiana
  • Healthy Blue – NC
  • In Total (part of UHC)
  • INDECS (via Aetna Signature PPO Network)
  • Independent Medical Systems
  • Indiana University Health Plan (IUHP)
  • Inland Empire Health Plan
  • Innovative Healthware Services dba Claimsbridge PPO
  • Integrated Health Network MHNS
  • InterCommunity Health Network Coordinated Care Organization
  • InTotal Health Plan – UHC Community
  • Island Group Administration, Inc
  • Jade Health Plan Medical Group
  • JHHC – Employee Health Plan
  • JHHC – Priorty Partners
  • JHHC – US Family Health Plan
  • Kova HealthCare IPA
  • Lehigh Valley Health Network
  • Loyola University Medical Center
  • Lutheran /Three River Medical Associates
  • Lutheran Preferred Network
  • Magellan Complete Care of Virginia
  • Magnacare (now Brighton Healthcare Network) Preferred Lab
  • Maryland Physicians Care
  • MBA Benefit Administrators (via Health West PPO)
  • MDWise Excel Network
  • Medicaid Traditional FFS (except Nevada)
  • Medical Cost Containment PPO
  • Medicare Traditional Fee for Service
  • Memorial Health Partners (MHP)
  • Mercy Network
  • Meridian of IL & MI
  • Meritage Medical Network
  • Mississippi Physician’s Care Network
  • Molina Healthcare of New York
  • Molina Healthcare of South Carolina
  • Molina Healthcare of Texas
  • Molina Healthcare of Utah
  • Molina Healthcare of Washington
  • Multiplan/PHCS/Beech Street
  • MVP Health Care, Inc
  • NAMCI PPO
  • National General Benefits Solutions (via Aetna Signature PPO Network)
  • Neighborhood Health Partnership of Florida
  • Neighborhood Health Plan of Rhode Island
  • Network Health Plan
  • Nippon Life Benefits (NLIA) (via Aetna Signature PPO Network)
  • NovaNet PPO
  • Optima Health Plan by Sentara
  • Partners Health Plan of NY
  • Physicians Medical Group of San Jose
  • Piedmont Community Health Plan
  • PreferredOne Administrative Services Inc (via Aetna Signature PPO Network)
  • Prime Health Services PPO
  • Provider Select PPO
  • Quartz Health Solutions
  • River City Medical Group
  • Samaritan Health Plans
  • Samaritan Health Services
  • Sanford Health Plan
  • Sanford Health Plan – ND & MN
  • Scott & White Health Plan
  • Sharp Rees-Stealy Medical Group
  • SIHO
  • South Broward Hospital District – Memorial Heath System MHS CCP
  • Suburban Health Organization
  • SummaCare
  • Summit Administrators (via Health West PPO)
  • Sunrise Medical Advantage HMO – VA, IL, NY, PA
  • Sutter East Bay Hospitals
  • Sutter East Bay Medical Foundation
  • Sutter Physicians Alliance
  • Tall Tree Administrators (via Health West PPO)
  • The Uniformed Services Family Health Plan (USFHP) @ Saint Vincent’s
  • Three Rivers Provider Network PPO
  • TLC Advantage PPO
  • Trustmark Companies (Trustmark, CoreSource, FMH,CoreSource, NGS CoreSource, Starmark) (via Aetna Signature PPO Network)
  • Tufts Health Plan (excludes Public Plan)
  • UCHealth Plan Administrators
  • Unicare of WV
  • Unicare PPO
  • University of Maryland Health Plans
  • Virginia Health Network PPO (MedCost)
  • Viva Health
  • WebTPA (via Aetna Signature PPO Network)
  • WellMed (via UHC Network)
  • WellSpan Populations Health Services (via Aetna Signature PPO Network)
  • Zelis PPO Networks (e.g. Stratose, 4MOST, HFN, PPOPlus)

Medicaid

GeneDx is a registered provider with several Medicaid plans. Most Medicaid plans require that prior authorizations must be obtained for all genetic testing. GeneDx will initiate prior authorizations whenever possible. There are some Managed Medicaid plans that stipulate prior authorizations must be obtained by the ordering provider’s office. Please ensure that the patient has active Medicaid coverage before shipping their sample. Medicaid coverage varies by state and, in many cases, Medicaid will not cover genetic testing. Please visit your state’s Medicaid website for specific information on covered services.

States that GeneDx is a Medicaid Registered Provider
  • Alabama Medicaid
  • Alaska Medicaid
  • Arizona Medicaid
  • Arkansa Medicaid
  • California Medicaid
  • Colorado Medicaid
  • Connecticut Medicaid
  • Florida Medicaid
  • Georgia Medicaid
  • Illinois Medicaid
  • Indiana Medicaid
  • Idaho Medicaid
  • Iowa Medicaid
  • Kansas Medicaid
  • Kentucky Medicaid
  • Louisiana Medicaid
  • Maine Medicaid
  • Maryland Medicaid
  • Massachusetts Medicaid
  • Michigan Medicaid
  • Minnesota Medicaid
  • Mississippi Medicaid
  • Missouri Medicaid
  • Montana Medicaid
  • Nebraska Medicaid
  • New Jersey Medicaid
  • New Mexico Medicaid
  • New York Medicaid
  • North Carolina Medicaid
  • North Dakota Medicaid
  • Ohio Medicaid
  • Oklahoma Medicaid
  • Oregon Medicaid
  • Pennsylvania Medicaid
  • South Carolina Medicaid
  • Tennessee Medicaid
  • Texas Medicaid
  • Utah Medicaid
  • Vermont Medicaid
  • Virginia Medicaid
  • Washington (State) Medicaid
  • Washington DC 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

Plans may require additional documentation to complete the prior authorization process and/or genetic counseling to view this information, click the link above.
 
*PLEASE NOTE: If ordering hereditary cancer testing for a patient covered by United Healthcare insurance, please click here to view an important order process notification.*