Our commitment to access
We believe that everyone should have the opportunity to access their genetic information.
Now an in-network provider for the majority of insured patients1
PreventionGenetics is part of Exact Sciences, which is an in-network provider2 with many health plans, including Aetna, Anthem, Cigna, Humana, and UnitedHealthcare. We are enrolled in all 50 state Medicaid plans.
New pre-service prompt-pay rates for all tests
Discounted pre-service pricing is available for all tests. If a patient elects to utilize the prompt-pay price, a claim will not be submitted to their insurance.
Proven expertise in institutional billing
More than 20 years of experience supporting hospitals and health systems through streamlined billing workflows.
Sponsored testing programs for eligible patients
We offer a variety of programs enabling eligible patients to access genetic testing at no charge.
Our experienced team assists with coverage evaluation, benefit investigations, prior authorization requirements, and patient billing questions, helping streamline the process for both health care providers and patients.
Genetic testing insurance and billing process
Clarity up front and support throughout*
1. Provider orders test
Once an order is placed and all necessary information is received, our Billing team begins a benefit investigation to understand the patient’s insurance coverage, estimated out-of-pocket costs, and any prior authorization requirements. We hold tests during this time, unless the test is STAT/rapid or it is specifically requested that we do not hold the test.
2. Patient receives a personalized Quote of Benefits
We send a Quote of Benefits by email and follow up by phone to walk through:
- Estimated out-of-pocket costs
- Deductible and co-insurance details
- Prior authorization needs
- Available payment options
The patient can ask questions, cancel the test, or choose an alternative payment option like pre-service, prompt-pay pricing at this stage. If we do not hear back from the patient after several attempts, we will proceed with testing to avoid delays in care.
3. We can help with required approvals
We submit prior authorizations (PAs) when required and permitted.
4. We offer support and options for out-of-pocket costs
Once all actions with insurance are complete, if there is a remaining balance, the patient receives a statement from PreventionGenetics. We help the patient understand coverage and payment options, including whether they qualify for assistance.
Patient Assistance Program
We partner with patients to explain coverage and payment options, including support for those who are uninsured or underinsured. Our cost estimator tool makes it easy to see if they qualify for financial assistance.3