Please remember that verifying insurance coverage requirements or obtaining preauthorization is often necessary PRIOR TO SPECIMEN COLLECTION. Some insurance carriers allow a request for preauthorization to be submitted on the day of specimen collection for certain testing, but our laboratory recommends submitting the preauthorization request PRIOR TO specimen collection to avoid delays in specimen processing and resulting. View detailed preauthorization information.
Insurance coverage for genetic testing
Genetic testing is best covered by insurance when medical necessity is established. Although necessity can vary by insurance carrier, genetic testing is typically considered medically necessary when all of the following guidelines are met:
- The results of the test will assist in diagnosis; and
- The result of the test will directly impact the treatment being delivered to the member; and
- After history, physical examination, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies, a definitive diagnosis remains uncertain.
Our laboratory is often in-network and credentialed with insurance carriers within the following states: NE, IA, MO, KS, CO, WY, SD.
Medicaid / Medicare coverage
Our laboratory accepts patients with Medicaid and Medicare coverage; however, specific criteria must be met for genetic testing to be approved.
To determine if criteria have been met for your patient, access the National Coverage Determination (NCD) for Cytogenetics or the Local Coverage Determination (LCD) for Molecular Studies (provided by the U.S. Department of Health and Human Services).
MEDICARE NOTE: By law, we are required to bill hospitals for all Medicare hospital inpatient testing and for patients living in skilled nursing facilities (SNF).
If it is determined by pre-authorization/pre-determination that genetic testing is not considered medically necessary by the patient's insurance carrier's definition (including Medicare), and the patient wishes to proceed with testing, we offer the following options:
Receiving a bill for genetic testing
You may receive a bill from the Human Genetics Laboratory months after you last saw your health care provider. Some genetic tests are more complex than others and take weeks to process. Additionally, insurance carriers can take over two months to process claims, and longer if we need to resubmit information. All of this can delay the sending of your bill. Also, you may not have been to the Human Genetics Laboratory, however, your health care provider sent us a sample for testing.
- Genetic testing performed by the Human Genetics Laboratory is billed through Nebraska Medicine. If you have questions about your bill, please call the number on your statement.