Medicare, Medicaid and other government plans
Government health programs have their own rules, and we follow them.
Have Medicare, Medicaid or other government coverage? Please contact us before you order.
Contact usInsurance & billing
Paying for your test.
Every test has one published self-pay price, paid when you order. Here is what that means for you, which tests may one day be billed to insurance, and how that will work.
The short answer
It depends on the test, a clinician’s order, medical necessity and your plan. A health plan usually pays for a genetic test only when a clinician who is treating you orders it for a medical reason, and a clinician’s order does not guarantee your plan will pay. Of our tests, only GenePGx will use insurance billing, and that is coming soon. Every test has one self-pay price today.
In the US, the Genetic Information Nondiscrimination Act (GINA), law since 2008, bars discrimination based on genetic information when deciding who can get health insurance and at what rates, or whether someone is suited to a job. It does not apply to life, disability or long-term care insurance, and it does not cover members of the military. Some states add protections of their own.
Which tests
Insurance billing: coming soon
GenePGx
$399 self-pay price today. Once insurance billing opens, you will be able to choose insurance or the self-pay price, with your estimate in front of you first.
Self-pay only
GeneCore, GeneCancer, GeneBaby, GeneDiet, GeneSport, GeneHealth, GeneResilience, Oral Health DNA
We don’t bill insurance for these tests. Each has one self-pay price, paid when you order. GeneCancer: Selected variants only, by genotyping. Not a full-gene test.
Right now
One published price
Every test has one self-pay price on its page, and it is the price you pay at checkout.No claim to your plan
When you pay yourself, we don’t send a claim to your health insurance.Your deductible
A self-pay payment usually doesn’t count toward your plan’s deductible.Private from your plan, if you ask
Paying yourself? You can ask us not to share this test with your health plan.
How insurance decides
Health plans pay for genetic testing on their own terms. These are the ones you will hear most, in plain words.
- A clinician’s order
Someone treating you asks for the test
For a health plan to pay for a genetic test, a clinician who is treating you usually has to order it for a medical reason. A clinician’s order does not guarantee your plan will pay. - Medical necessity
The test has to change a decision
Plans pay when a test is needed to make a decision about your care and the plan’s own rules are met. Your plan decides this, not the lab. - Only what is needed
The genes behind one decision
Insurance usually pays only for the genes linked to the medicine being decided, not for a whole panel.
Coming soon
Two doors: the self-pay price, or your insurance. You see your estimate before anything is tested, and you choose.
- 1Your detailsYou and your clinician give us your insurance details and the reason for testing.
- 2A check before testingBefore any testing, we check your plan’s rules and your benefits. Some plans need approval first.
- 3Your estimateWe tell you your estimated cost. It is an estimate, not a promise: your plan decides what it pays and what you owe.
- 4Your choiceIf your estimate is more than the self-pay price, we contact you before testing. You choose: continue with insurance, switch to the self-pay price, or cancel.
- 5After testingYour plan sends you an Explanation of Benefits, and you pay what your plan says you owe.
Until insurance billing opens, every order is self-pay, and we don’t ask for insurance details.
Questions about cost or billing
Write to us before you order, or about an order you have placed.
Not using insurance? You have the right to a Good Faith Estimate.
Ask about billingQuestions
Can I use my HSA or FSA?
We don’t claim HSA or FSA eligibility for any of our tests. Whether an HSA or FSA can pay for a test is up to your plan, so please check with your plan administrator.
Do I need a doctor’s order?
You can order online; self-pay orders don’t need a doctor’s order. If insurance billing opens, your own clinician will need to order the test. Orders shipped to New York are completed through a physician order or a reference laboratory permitted in New York.
Is there sales tax?
No. There’s no sales tax on our tests, so your total is the price of the tests you choose.
Who will be able to use insurance?
Insurance billing for GenePGx is coming soon. When it opens, it will be for people whose own clinician orders the test for a medical reason, and a clinician’s order does not guarantee your plan will pay. Have Medicare, Medicaid or other government coverage? Please contact us before you order.
One published price. Paid when you order.
Please read
Please read
LabOur genetic tests are laboratory-developed tests performed in our own CLIA-certified laboratory. New York is the exception: orders shipped there are completed through a physician order or a reference laboratory permitted in New York. Our genetic tests have not been cleared or approved by the FDA. Results describe inherited traits and risks and are meant to inform decisions you make with your clinician. They are not a diagnosis.