Insurance Billing

PreventionGenetics is committed to providing the highest quality genetic testing to all patients. Our philosophy is that genetic testing should enhance the quality of clinical care for the patient and be affordable to everyone.

Processing medical insurance claims may be challenging and time consuming. Many insurance companies require prior authorizations in order to determine whether genetic testing is medically necessary and will be a covered service under the patient's plan. PreventionGenetics' billing department is available to assist clients with benefit investigations.

It is important for patients to understand that insurance claims may not cover all costs of genetic testing and they may be financially responsible for some or all of the cost of testing. The patient is responsible for any portion of the test fee not covered by the insurance company for any reason including, but not limited to, co-payments, co-insurance, unmet deductibles, or non-covered services. This may be true even if prior authorization was obtained as prior authorization does not guarantee payment by the insurance company for the service provided.

Prior authorizations can take some time to obtain depending on each individual insurance plan's policy and documentation requirements. If a sample is received while a benefit investigation is still in process, the DNA will be extracted and testing put on hold until the benefit investigation has been processed. Turnaround time for test results begins after the benefit investigation has been processed and approved.

We will file a benefit investigation on behalf of the patient with any commercial insurance company and Wisconsin Medicaid. Benefits quoted will be based on our status as an out-of-network provider.

We are in-network (contracted provider) with the following health plans:

  • Security Health Plan
  • HealthChoice (State of Oklahoma)
  • Wisconsin Medicaid
  • Medicare
  • HealthPartners
  • Exceedent Health
  • eVicore Lab Network
  • HarvardPilgrim Health Care
  • Dean Health
  • Prevea360
  • SSM Wisconsin
  • Health Traditions
  • WEA Trust

For Medicare, the patient must meet Medicare criteria for genetic testing in order for the services provided to be considered covered and reimbursable. We do require Medicare patients to sign a completed Advance Beneficiary Notice (ABN) in advance of testing to acknowledge financial responsibility should the testing not meet Medicare criteria for covered service. For cancer tests that have specific testing criteria published by Medicare, we do not require an ABN as long as we have sufficient clinical information to support that the patient meets the criteria. Our genetic counseling team can assist with testing coverage details.

For any patient with Tricare insurance, we require the patient to sign a completed Tricare Waiver (specific to his or her Tricare region) in advance of testing.

If the patient's sample is collected in the state of New York, a New York State Non-Permitted Laboratory Test Request approval letter must be included at time of specimen submission.

To request assistance please provide the following information to or fax 715-207-6602. Please feel free to call us with insurance questions at 715-387-0484 ext 212.

Benefit Investigation Request Form