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
  • Cigna
Blues Plans
  • Empire BCBS
  • 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 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 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
  • 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
    • Celticare
    • 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 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
  • 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.
  • Virginia Health Network

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
  • 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/orgenetic counseling to view this information, click the link above.