Using Commercial Insurance with GeneDx
Information provided in this section is intended only for U.S.-based patients.
GeneDx accepts all commercial insurance and we are in-network with the majority of commercial health plans. The patient is financially responsible for the member responsibility amounts their health insurance plan lists on the Explanation of Benefits (EOB), which may include co-pay, coinsurance, and unmet deductible.
Financial Assistance Program – Helping to Make Genetic Testing Accessible
GeneDx understands that at a time when a patient may be facing many other medical expenses, working genetic testing into their budget may be challenging. That’s why we offer a Financial Assistance Program (FAP) to assist qualifying, eligible patients. Available to patients using commercial insurance, the FAP can, if approved, reduce the amount owed for the patient responsibility as specified on the explanation of benefits (EOB).
Patients can apply for FAP prior to or during the ordering and testing process. If approved, a final bill from GeneDx will reflect the adjusted amount owed. The FAP is not available for:
- Certain commercial health insurance plans
- Any federally or state-funded insurance plans (e.g. Medicare, Medicaid, Tricare)
- Patients utilizing self-pay
Insurance billing forms
Some commercial health insurance plans may require additional documentation to complete the prior authorization and/or billing process. Additional forms can be accessed on the Resources and Forms page.Learn more
Medicare & Medicaid
GeneDx is a Medicare provider and therefore is able to accept Medicare patient specimens, if covered by Medicare coverage policy. A completed Advance Beneficiary Notice (ABN) is required when Medicare medical necessity criteria are not met.
While GeneDx is a registered provider with several Medicaid plans, prior authorization (PA) is required for Medicaid specimens. GeneDx will initiate these PAs.
There are some Managed Medicaid plans which stipulate that prior authorizations must be obtained by the ordering physician’s office.
In some cases, Medicaid will not cover genetic testing for these conditions, as Medicaid coverage varies by state.
- 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
Financial Policy for Institutional Billing
GeneDx can directly bill a referring institution if an institutional account with GeneDx has been established.
This is intended to simplify the test ordering process for the referring healthcare provider.
This works very well for hospitals and institutions with clinical laboratories and those that have a Send-Out or Referral Testing department.
Establishment of an institutional account is very simple and requires only a phone call to GeneDx Accounts at (888) 729-1206, option 4.
GeneDx allows multiple ways for patients to pay their bill and offers no-interest, no-fee payment plans.
Easy paymeNt without insurance
- Please note: If the self-pay option is chosen, patients will not be able to submit the GeneDx invoice to their health insurance company.
- Patients: If you receive a payment from your health insurance company, it is your responsibility to pay GeneDx within 10 days of receipt of that payment.
- Healthcare providers: When ordering the test(s) in the GeneDx Provider Portal or completing the test requisition form, please select the Patient Bill option.
AMEX, Discover, Mastercard or Visa. Please have your bill available when paying online.
CHECKS & MONEY ORDERS
Please make checks and money orders payable to GeneDx. Mail to:
P.O. Box 21997
New York, NY 10087-1997
Payments can be made via wire transfer from your bank.
Please contact us at 1-888-729-1206, option 2, to arrange for wire transfer payment from your bank.