Billing

  GeneCare Files Insurance!

Insurance coverage for genetic testing is complicated.  You may be surprised to learn GeneCare will work with you and your insurer to help collect on the tests your physician has ordered.  GeneCare makes it a priority to provide the best customer service to our referring physicians and their patients.  However, insurance coverage varies by patient, by your employer's policy, by you insurer and even your physician.

GeneCare offers the following services to make the process more convenient for you and your physician:

  • We bill your carrier directly.
  • We work with you to help you resolve coverage issues.
  • We regularly file appeals on our patients' behalf if coverage is denied.

We file claims electronically with most of the nation's leading health insurance providers. This list is continually expanding as we add new contracts.  If you are interested in a particular insurer, please call us. Most HMO's have capitated labs and require authorization for GeneCare services unless we are contracted with them.

For more information on genetic testing coverage, contact the Member Services department of your insurer directly.

You Are Your Own Best Advocate
In our experience, persistent attention to your insurance claim can be helpful during the appeals process. Here are some helpful hints from our Client Services department:

  • Gather as much information as possible about your plan and your insurer's procedures for handling a claim, including:
    • Your policy ID number
    • Your policy contract and summary plan, to fully understand your benefits
    • Contact information for your Customer Service Representative at the insurer
  • Save all your Explanation of Benefits (EOB) statements for laboratory testing even if the tests have been paid. You may be able to use these to back up claims for additional tests.
  • Act immediately if you receive a denial from your insurer. Call the claims administrator at your insurance company and ask for an explanation. An error may have been made by the claims department.
  • When you first call your insurer, be sure to write down the name(s) and phone number(s) of the people with whom you speak. Then, follow-up in writing. It's important to have written documentation in the event of a dispute.
  • If after pursuing the appeals process, you still feel your insurance company incorrectly denied benefits for laboratory testing, contact your State insurance commissioner's office.

If you have questions about an EOB sent by your insurance company, contact our Client Services department at (866)485-3336.

Your Physician Can Help
To increase the likelihood of your insurer covering the tests ordered for you by your physician, a few minutes of your physician's time can make a big difference. Pass these suggestions along:

  • Certain diagnosis codes (ICD-9) are more likely to trigger a denial than others. Make sure your physician selects the most appropriate ICD-9 code (s).
  • Make sure to include a copy of your current insurance card along with the test requisition

You CAN Go Out of Network!

  • Many physicians are under the incorrect impression they cannot order a test from an out-of-network laboratory.
  • In fact, physicians regularly go outside their network to order the appropriate tests necessary for the care of their patients.
  • If your insurer's Exclusive or Preferred Laboratory does not offer the "equivalent test" to ours, or does not offer the test at all, your physician can order the test from GeneCare.
  • As an out-of-network laboratory, GeneCare agrees to accept the usual and customary to any non-contracted health plan.

Diagnostic Tests

  • Hundreds of insurance companies throughout the United States regularly cover genetic testing
  • Despite insurers' greater willingness to cover tests, patients with limited coverage on their policies may initially be denied reimbursement for these tests. GeneCare will work diligently with you to advocate on your behalf. 

For more information, contact our Client Services department at (866)485-3336 or email us at info@genecare.com.

Billing And Insurance Policy
Listed below are our policies for various types of payment arrangements.  Please feel free to call our billing department at (866) 485-3336 before your appointment if you have questions or need to arrange an alternate payment plan.

GROUP/INDIVIDUAL COVERAGE: - We request you pay your co-payment (usually 10-20%, depending on the insurance carrier) plus unmet deductible at the time of the appointment. We will file insurance and notify you when we receive payment. We will refund any overpayment to you or request additional payment if necessary. You are responsible for handling any problems arising with your claim. We are always glad to assist if possible. Your account is due in full within 90 days from the date of service.  If your insurance carrier has not remitted payment in that time, the balance becomes due from you.

HMO INSURANCE COVERAGE: - If you bring your referral or authorization form with you to your appointment, your services will be covered 100%. Exception: some payers require co-payments for office visits at time of service in the range of $10.00 - $30.00. Please refer to your insurance card. If we DO NOT have the proper authorization at time of service, we cannot guarantee your insurance will cover the charges.

MILITARY INSURANCE COVERAGE: - Your services will typically be covered 100% by your insurance.  If your coverage is with TriCare, you must bring a non-availability form to your appointment.

MEDICAID: - We do file for Medicaid.  We accept assignment.  Please bring a copy of your Medicaid card.

NO INSURANCE: - An initial payment of 20% is required on the date of appointment for patients without insurance. Monthly payments may be made until the account is paid. We request any patient without insurance call our billing department before coming for an appointment so we may arrange a suitable payment plan.

NOTE TO ALL INSURANCE HOLDERS: - Not all insurance companies will pay for all types of testing.  If you are unsure of your coverage, call your insurance office for more information.

We accept cash, check, Mastercard, Visa, AMEX and Discover. Our billing department is always willing to help with problems or questions concerning billing or insurance.