Billing Information

Your payment requirements are determined by the billing options selected during activation. When you choose:

Cash Pay - payment is required online or with the specimen submission. Installment plans may be available. Medicaid patients should choose this option.

Insurance Billing - an initial payment must be submitted online or with your specimens. Including payment qualifies you for prompt pay discounts* on any additional amounts you may owe after your insurance provider processes your claim.

Medicare or Tricare - patients are not required to provide an initial payment unless they are ordering certain services which are not covered by Medicare or Tricare.

*Applicable discounts are not available to patients who see physicians in Florida or New York.

Your payment amount and estimates of out-of-pocket costs are provided when you activate your test online after receiving a collection pack. You can also estimate payments by entering your requisition or activation number here.

An insurance-ready receipt is provided when your test is complete. You can download a PDF of your receipt (also called an electronic requisition or eReq) by entering your activation number at gdx.net/activate or by using the link emailed to you when you activated your test.

Yes! Choose the Cash Pay billing option and when your testing is complete we will provide an insurance-ready receipt that may be used to file a claim for reimbursement from your commercial insurance plan. Contact your insurance provider for additional requirements and be sure that you and your physician provide the following items during activation:

• Payment for the full cash price of the test OR the appropriate initial payment.
• At least one ICD-10 diagnosis code. Only your physician can provide this information and it will be required by your commercial insurance plan before processing a claim.
• Address at which you reliably receive mail.
• A completed online activation or your signature on the back of the requisition form included in the collection pack.

We provide a variety of testing services, and some of them may or may not be covered by your insurance plan.

Once your physician has ordered a Genova Diagnostics test for you, you can submit the CPT codes for your test to your commercial insurance plan to determine coverage. Contact your physician for more information.

Typically, commercial insurance plans do not guarantee coverage until a claim is submitted. Therefore, even if an insurance company indicates that a service is covered, it does not guarantee that they will make a payment. All covered services or patient cost-sharing obligations (deductible and/or coinsurance) depend on your policy.

If a test service is denied by your insurance, we will apply credits so your costs will be close to our patient pay option.

Sometimes insurance companies will need supporting documentation even after we've filed a claim. If this happens, we will provide any appropriate information we have on file for your order, except for medical records which are only available from your physician. We take your privacy seriously, and only information which is necessary and allowed under HIPAA guidelines will be shared with insurance.

In the rare circumstance that your insurance company still elects not to process or finalize your claim, then we'll provide credits so your costs will be close to our patient pay option.

We are an in-network provider with the following insurance plans and will submit claims on your behalf when coverage is indicated. If your commercial insurance or Medicare Advantage plan is not on this list, we will still file a claim for you.

• CareFirst Blue Cross Blue Shield:
  • Blue Cross and Blue Shield members, including Federal Employee Program, receiving services ordered by HCPs that reside in MD, DC and Northern VA.
  • CareFirst BCBS HMO products identified with prefixes XIC, XIK, XWR, XIR are not contracted.
• Blue Shield of California - BCBS patients, including out-of-state BCBS members, receiving services from health care practitioners in California.

If we are in network with your insurance, you must still provide payment with your specimen submission but we will not charge your credit card until your insurance claim has been processed. Depending on how your insurance company processes the claim, we will send you a bill if you owe more than what you authorized with your test submission.

It depends. If your commercial or Medicare Advantage insurance does not cover the full cost of your testing you could owe an additional balance after your claim is processed. We are unable to confirm any additional amounts owed until your insurance claim is processed.

If you do owe more, we will send you a statement reflecting the additional amount due along with any credits and discounts* we are able to apply. It is important that you respond to all statements in a timely manner as discounts or credits may expire.

*Applicable discounts are not available to patients who see physicians in Florida or New York.

If you provided the full initial payment with your original specimen submission, you do not need to submit an additional payment when re-collecting specimens. We will bill the re-collection using the same billing method as the original specimen submission, but we may place your re-collected specimens on a separate order to prevent reporting delays.

If we are billing your insurance, you may owe additional amounts after your claim is processed. However, the amount due for your original and resubmitted specimens combined will not exceed the out of pocket cost provided to you when activating the original test on our website, so long as you paid your full initial payment and respond promptly to any bills you may receive in the future.

You must provide your re-collected specimens to the lab within 30 days of the collection pack order date.

There are many different types of Medicare coverage options, and the billing for your order will be based upon which type of plan you have. Here are some different categories of Medicare coverage for patients who also have commercial insurance (Blue Cross and Blue Shield, Aetna, etc.). If you're unsure of which type of plan you have, we strongly encourage you to contact your insurance company.

• Did you choose to have your Medicare benefits through a commercial insurance plan instead of the traditional way?
  If so, you likely have a Medicare Advantage Plan, also called a Medicare Replacement Plan because it replaces your traditional Medicare coverage. If this applies to you, then please see our Insurance Billing guidelines.
• Did you obtain additional insurance coverage to pick up the costs that Medicare didn't cover?
  You likely have a Medicare Supplement Plan. These plans are designed to supplement your regular Medicare coverage, and cover the gap between what Medicare does and doesn't cover. If this applies to you, then you still have regular Medicare coverage. Please see our Medicare guidelines, as these apply to you.
• Is your Medicare coverage designed to pay for additional patient responsibility your regular commercial insurance doesn't cover?
  If so, you probably have Medicare Secondary Coverage. In these cases, we will bill your regular insurance first and then send the claim to Medicare to review any additional charges. If this applies to you, then you still have regular Medicare coverage, even if it's not your primary insurance. Please see our Medicare guidelines, as these apply to you.

Medicare only covers laboratory services defined as medically necessary for the diagnosis and treatment of patients. Medicare will not cover a service if:

• The lab test was not properly documented by the ordering practitioner. To ensure we meet Medicare documentation requirements, we require all Medicare orders to be completed online and must be e-signed by the ordering practitioner. If an online order is not received for a Medicare patient, the specimen will be discarded as soon as it is received by our laboratory.
• The lab test was ordered by a practitioner who doesn't have a Medicare authorized degree type. In these cases, you will be responsible for our Cash Pay (no insurance) price for the service.
• The lab test was ordered for screening purposes. In these cases, you will be responsible for our Cash Pay (no insurance) price for the service.
• The patient was on chelation therapy while the specimen was drawn. In these cases, you will be responsible for our Cash Pay (no insurance) price for the service.
• The lab test is considered statutorily non-covered. Our statutorily non-covered tests are:
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