PreventionGenetics Billing Policy
PreventionGenetics’ mission is to deliver clinical genetic testing of the highest quality at fair prices with exemplary service to people around the world. We offer three (3) convenient payment options for testing services: institutional billing, self-pay and insurance billing. Please see below for more details on each billing type.
PreventionGenetics offers comprehensive and flexible options for genetic testing. Our test menu includes over 5,000 clinically relevant genes available for targeted testing, single genes, over 200 expertly curated panels or custom tests through our Custom Panel Tool. Many of our tests have the option to reflex PGxome® whole exome sequencing at a reduced cost.
PreventionGenetics will invoice the institution or provider for the total test fee.
An invoice detailing date of service, patient name and date of birth (DOB), CPT Code, test name, and testing fee is generated once testing is complete and a report is issued to the ordering healthcare provider. Date of service (DOS) on the invoice will be the date the sample is received by PreventionGenetics. If the DOS must reflect the date that testing is started (rather than date received), please contact our billing team to make arrangements.
Payment is due 30 days from the date of the invoice. PreventionGenetics accepts Visa, MasterCard, and Discover. We also accept bank wire transfer, ACH, or check.
Monthly statements are available for institutional billing services upon request.
An institutional account is not required by PreventionGenetics. We are happy to setup an account or contract when required by an institution.
The patient or another person accepts financial responsibility for the test fees. This individual must be at least 18 years old and sign the acknowledgement statement on the TRF.
We will invoice the responsible individual once testing is complete. We do not require a credit card to be on file; however, having a credit card authorization on file allows for easy payment processing. Payment is due 30 days from the date of the invoice. Statements showing outstanding invoices and the balance due are mailed at the end of each month. We also email and text statements through our vendor partner AdvancedMD. PreventionGenetics accepts Visa, MasterCard, and Discover. We also accept bank wire transfer, ACH, or check.
Payment plans are available with no fees or interest. Please contact us to arrange a payment plan.
PreventionGenetics will file an insurance claim on behalf of a patient with any commercial insurance company. PreventionGenetics is in-network with a number of insurance providers, please see our list of in-network health plans. To submit a claim to insurance, the required insurance information and documents must be submitted along with a signature from the individual accepting financial responsibility (patient or another individual). Please see the insurance billing section in our myPrevent ordering portal or the paper test requisition form for required information.
Many insurance companies require prior authorization in order to determine whether genetic testing is medically necessary and will be a covered service under the patient's plan. PreventionGenetics will help you and your patients understand their insurance coverage by performing a benefit investigation and/or pre-authorization with any commercial insurance company and Wisconsin Medicaid. For assistance please complete the Benefit Investigation Request Form or contact our insurance specialists.
Prior authorizations can take some time to obtain depending on the insurance plan's policy and documentation requirements. If a sample is received while a prior authorization is still in process, the DNA will be extracted and testing put on hold until the prior authorization has been processed. Turnaround time for test results begins after the prior authorization has been processed and approved.
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.
A monthly statement indicating an insurance claim is in process will be mailed to the patient. No payment will be required from the patient until the insurance claim has been processed and closed. The patient is responsible for notifying PreventionGenetics of the status of the explanation of benefits (EOB) and remitting any funds received directly from the insurance company to PreventionGenetics.
Payment is due 30 days from the date the insurance claim closes. PreventionGenetics accepts Visa, MasterCard, and Discover. We also accept bank wire transfer, ACH, or check.
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.
MEDICARE AND MEDICAID
We are a contracted provider for Medicare and Wisconsin Medicaid. At this time we do not accept any other state's Medicaid.
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 cancer tests. Medicare does not allow pre-authorizations.
Insurance Billing - Cancer Tests
This policy only applies to the following tests:Hereditary Breast and Ovarian Cancer (HBOC)
- Breast Cancer - High Risk
- Breast Cancer - High / Moderate Risk Panel
- Breast Cancer - Comprehensive Risk Panel
- HBOC - BRCA1 & BRCA2
- HBOC- High Risk and Lynch Syndrome
- HBOC - Expanded and Lynch Syndrome
- Hereditary Ovarian Cancer Panel
For other cancer tests as well as institutional and patient-pay billing methods, please refer to our general billing policies.
PreventionGenetics will file an insurance claim on behalf of the patient with any commercial insurance company. To submit a claim to insurance, the required insurance information and documents must be submitted along with a signature from the individual accepting financial responsibility (patient or another individual).
Other than any unmet deductible, co-insurance, or co-payment amount(s) which is (are) the patient's responsibility, PreventionGenetics will accept the amount the insurance company pays as payment in full. We will not balance bill the patient.
Upon request, PreventionGenetics will file a pre-authorization on the patient's behalf with their insurance carrier. On all pre-authorization requests, we will call the patient to inform them of any unmet deductible, co-insurance, or co-payment that they will be responsible to pay. For assistance please complete the insurance Benefit Investigation Form found on our website or contact our insurance specialists.
A monthly statement will be mailed to the patient indicating an insurance claim is in process. No payment will be required from the patient until the insurance claim has been processed and closed. Payment is due 30 days from the date the insurance claim closes. PreventionGenetics accepts Visa, MasterCard, and Discover. We also accept bank wire transfer, ACH, or check.
If you need to cancel a test, please contact us.