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

Commercial Insurance Contracts

National Plans
  • United Healthcare (UHC)
  • Aetna
  • Cigna
Blues Plans
  • Anthem BCBS California
  • Anthem BCBS Connecticut
  • Anthem BCBS Georgia
  • Anthem BCBS Indiana
  • Anthem BCBS Kentucky
  • Anthem BCBS Maine
  • Anthem BCBS Missouri
  • Anthem BCBS New Hampshire
  • Anthem BCBS New York (Empire BCBS-PPO)
  • Anthem BCBS Ohio
  • Anthem BCBS Virginia
  • Anthem BCBS Wisconsin
  • BCBS Alabama
  • BCBS Arizona
  • BCBS Hawaii (Hawaii Medical Services Assoc.)
  • BCBS Illinois
  • BCBS Kansas
  • BCBS Massachusetts
  • BCBS Michigan
  • BCBS Nebraska
  • BCBS North Carolina
  • BCBS North Dakota
  • BCBS Rhode Island
  • BCBS South Carolina
  • BCBS Texas
  • BCBS Vermont
  • BCBS Western NY (Healthnow)
  • BlueShield of California
  • Blueshield of Northeastern NY (Healthnow)
  • Capital Health Plan
  • CareFirst Blue Cross & Blue Shield
  • Empire BCBS PPO (an Anthem plan)
  • Empire BCBS HealthPlus
Other Plans
  • Absolute Total Care Healthy Connections-SC (Centene)
  • Aetna Better Health NJ
  • Aetna Better Health WV
  • Affinity Health Plan, Inc
  • Alameda Alliance for Health
  • Allwell (Centene)
  • Ambetter (Centene)
  • American CareSource Holdings (dba Ancillary Care Solutions)
  • Amerigroup District of Columbia
  • Amerigroup Georgia
  • Amerigroup Iowa
  • Amerigroup Kansas
  • Amerigroup Louisiana
  • Amerigroup Maryland
  • Amerigroup Nevada
  • Amerigroup New Jersey
  • Amerigroup New Mexico
  • Amerigroup Tennessee
  • Amerigroup Texas
  • Amerigroup Washington
  • AmeriHealth Caritas Delaware
  • Avera Health Plans
  • Beech Street (through MultiPlan)
  • Bridgeway Health Solutions-AZ (Centene)
  • Buckeye Health Plan-OH (Centene)
  • California Health & Wellness (Centene)
  • CalOptima
  • Capital Health Plan
  • CareSource Kentucky
  • CareSource West Virginia
  • Cenpatico Integrated Care (Centene)
  • Centene Corporation
  • Centurion (Centene)
  • Cigna HealthSpring Medicare Advantage
  • Common Ground Healthcare Cooperative
  • Commonwealth Care Alliance, Inc.
  • Community Care Plan (CCP)
  • Community Care Network
  • Community First Health Plan
  • Community Health Choice
  • Cook Childrens Health Plan
  • Coordinated Care-WA (Centene)
  • CORE Care Select
  • Coventry Health Care (an Aetna affiliate)
  • Crystal Run Health Plan
  • Dean Health Plan
  • Employer Health Alliance
  • Evicore Healthcare (EVC)
  • Evolutions Healthcare Systems (PPO Network)
  • First Carolina Care
  • First Choice Health Plan of Mississippi (PPO Network)
  • First Health (an Aetna affiliate)
  • Geisinger Health Plan
  • Group Health Cooperative
  • Gulf Coast Provider Network-Sarasota Memorial PHO
  • Granite State Health Plan-NH Healthy Families (Centene)
  • Health West Provider Network
  • Harvard Pilgrim PPO
  • Health Alliance Medical Plans
  • HealthCare Partners
  • HealthFirst
  • Health Net of California, Inc.
  • Health Net, Inc. (Centene)
  • Health New England
  • HealthNet, Inc. Health Choice of Alabama (PPO Network)
  • Health Net Federal Services – Tricare West
  • HealthNow NY, Inc
  • HealthPartners, Inc.
  • HealthSelect ERS (through BCBS TX)
  • Home State Health – MO (Centene)
  • Humana Military – Tricare East
  • Illinicare Health-IL (Centene)
  • Independent Medical Systems
  • Indiana University Health Plan (IUHP)
  • Integrated Health Network MHNS
  • MDWise – IUHP
  • Island Group Administration, Inc
  • Jade Medical Group
  • Joint Venture Hospital Laboratories (JVHL)
  • Kova HealthCare
  • Lehigh Valley Health Network
  • Louisiana Healthcare Connections (Centene)
  • Loyola University Medical Center
  • Magnolia Health-MS (Centene)
  • Managed Health Services (MHS)-IN (Centene)
  • Maryland Physicians Care
  • Memorial Health Partners Hospital Network
  • Meritage Medical Network
  • MHS Health Wisconsin (Centene)
  • Michigan Complete health (Centene)
  • Mississippi Physician’s Care Network
  • Molina Healthcare of South Carolina
  • Molina Healthcare of Utah
  • Molina Healthcare of Washington
  • Multiplan
  • North Alabama Managed Care Inc. (NAMCI PPO)
  • Nebraska Total Care (Centene)
  • Neighborhood Health Plan of Rhode Island
  • NH Health Families – Granite State Health Plan (Centene)
  • NovaNet, Inc.
  • Partners Health Plan
  • Peach State Health plan – GA (Centene)
  • Ped-I-Care
  • Physicians Plus
  • Pomco
  • Preferred One
  • Prime Health Services PPO Network
  • Private Healthcare Systems-PHCS (through MultiPlan)
  • 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
  • Stratose
  • Suburban Health Organization
  • Sunflower Health Plan-KS (Centene)
  • Sunshine Health-FL (Centene)
  • Superior Healthplan-TX (Centene)
  • Sutter East Bay Hospitals
  • Sutter East Bay Medical Foundation
  • Sutter Physicians Alliance
  • Tricare
  • Trillium Community Health Plan-OR (Centene)
  • Tufts Associated HMO, Inc.
  • University of Maryland (UMMS)
  • US Family Health Plan at Saint Vincent’s
  • Virginia Health Network
  • Viva Health
  • 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 North Carolina
  • WellCare Health South Carolina
  • WellCare Health Tennessee
  • WellCare Health Texas
  • Western Sky Community Care, Inc.-NM (Centene)

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.