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. Based on the patient’s insurance, GeneDx will perform a 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 x 7770

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
  • First Health, an Aetna Affiliate
  • 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

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. GeneDx will initiate these prior authorizations. There are some Managed Medicaid plans that stipulate prior authorizations must be obtained by the ordering physician’s office. Tests will be placed on hold and not proceed in the lab for all Medicaid samples until an approved PA is obtained. 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
  • 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.