Insurance Billing Program:

The Genova Diagnostics' insurance billing program allows patients to enjoy the benefits customarily associated with traditional insurance-reimbursed medical services. A select menu of our clinical tests is offered under this plan for healthcare practitioners licensed with degrees typically accepted for diagnostics by insurers.

Genova Diagnostics does not courtesy bill to insurance and requires practitioners to utilize the insurance billing program for all of their insurance billing for the tests included in the program.

When utilizing Genova's Insurance Billing Program, patients pay a deposit and provide insurance information to Genova Diagnostics. Genova Diagnostics files insurance on behalf of the patient. Once the claim is processed the deposit is applied to amounts assigned as patient responsibility per the explanation of benefits. The deposit is the extent of the patient's responsibility for non-covered amounts; however, the patient may be billed for deductibles, copayments, and coinsurance in excess of the deposit. Most insurance companies provide payment and an explanation of benefits directly to Genova Diagnostics; however some insurers such as Blue Cross & Blue Shield often pay patients directly. If the patient is paid directly they are required to forward the insurance payment and a copy of the explanation of benefits to Genova Diagnostics. If Genova Diagnostics is unable to determine the application of benefits by the patient's insurance, the patient is required to provide a copy of the explanation of benefits to Genova Diagnostics.

How To
If followed completely, the three steps below will ensure that patients enjoy lower out-of-pocket expense.

Step 1  -  Payment: Patient insurance billing program deposit payment and proper requisition must be included with the specimen kit to qualify for the program.

Step 2  -  Practitioner Information: Provision of practitioner specific information necessary for filing of a health insurance claim on the patients behalf:
     a) Complete requisition with ICD-9 diagnosis coding noted.
     b) Practitioner must have a valid NPI which must be entered on the requisition.

Step 3  -  Insurance Information: Patient must provide insurance information with a copy of the front and back of the patient's insurance card.
     a) a) The patient must be a current subscriber in a health insurance program accepted in the insurance billing program. Genova Diagnostics' testing is covered by over 500 insurers nationwide. Please call Genova Diagnostic customer service at 800-522-4762, ext 1 to ensure the patient's insurance company is currently accepted into Genova's insurance billing program. Patients covered by insurers excluded from the insurance billing program should utilize our discounted patient prepay program for Genova Diagnostics' services (see Patient Prepay section).
     b) Medicare - Genova Diagnostics is a Medicare provider. Government health care programs including Medicare, Medicaid, CHAMPUS, TriCare, and Medicare Advantage are not covered in the program. Orders submitted under any of the above programs can only be billed directly to those plans, and are not qualified for Genova Diagnostic's insurance billing program.
     c) If payment from insurance goes directly to the patient, the patient must forward that payment amount, along with a copy of the explanation of benefits (EOB), to Genova Diagnostics. This occurs most often with Blue Cross/Blue Shield subscribers.
Blue Cross Blue Shield subscribers will usually receive payment and/or an EOB directly. BCBS subscribers must send a copy of the EOB, and the BCBS payment, if any, to Genova Diagnostics.
     d) In order to substantiate medical necessity for testing and to qualify for insurance reimbursement, practitioners may be required to provide medical records to patient's insurance carrier. Practitioner failure to provide this information to the insurance carrier in a timely manner may result in patient responsibility for the charges at list price.

Please note that each of the items shown in Steps 1-3 is required for the patient to be included in this program. If any of these items above are not provided, the patient may be responsible for the total list price less payments received by Genova Diagnostics.

Secondary Insurance

Genova Diagnostics does not file secondary insurance for patients utilizing the Insurance Billing Program. Patients may use their billing statement, or an itemized statement can be provided to patients on request, to seek reimbursement of out of pocket expenses paid to Genova.

Genova Diagnostics will file secondary insurance when billing contracted Government payers excluded from the Insurance billing program.