The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
Are you in-network with my insurance plan?
Blueprint Genetics works with all commercial insurances and every patient with active benefits can access our diagnostic testing service. We accept all commercial insurance plans; however, we do not have contracts with all commercial insurance plans. We will file claims and appeals with a patient’s insurance plan. Patients with a commercial insurance plan for which Blueprint Genetics is a contracted provider are subject to the deductible, coinsurance, or co-pay obligations of their plan.
We are in-network with the following insurance plans:
- Anthem® Blue Cross® California
- Anthem® Blue Cross® Blue Shield® Connecticut
- Anthem® Blue Cross® Blue Shield® Maine
- Anthem® Blue Cross® and Blue Shield® New Hampshire
- Blue Cross® and Blue Shield® of Massachusetts
- Blue Cross® and Blue Shield® of New Mexico
- Federal Blue Cross Blue Shield
- Harvard Pilgrim Health Care
- Horizon® Blue Cross® and Blue Shield® of New Jersey
Can you tell me exactly how much I am responsible for?
Under our commercial insurance billing policy patients are responsible for any unmet deductible, co-pay, or co-insurance up to the full amount of the test. In some cases, the insurance company may only approve a portion of the billed amount (allowable), and in those situations the patient is responsible for any unmet deductible, co-pay, or co-insurance up to the allowable amount.
Do you balance bill patients?
Patient financial responsibility (also known as out-of-pocket or OOP) is limited to unmet deductible, co-pays, and co-insurance. Blueprint Genetics will make every effort to obtain the maximum amount of reimbursement from insurance benefits providers which may include patient participation in the appeal process. Under our commercial insurance billing policy, the financial responsibility (OOP) for each patient will be communicated up-front so patients can make informed decisions about testing.
Does Blueprint Genetics accept Medicare or State Medicaid?
Patients with Medicare or Medicaid are eligible for our Financial Assistance Program. After an order is placed, one of our billing specialists will contact the patient and inform them of their out-of-pocket cost and explain their payment options under our Financial Assistance Program. For more information contact Blueprint Genetics billing support at email@example.com.
For registered hospital inpatients and/or outpatients that have Medicare coverage, Blueprint Genetics will bill the hospital directly. A signed and completed Advance Beneficiary Notice (ABN) is required for molecular tests, as Medicare may not cover molecular testing.
Blueprint will file claims with the patient’s health plan. The patient will be held liable for any balance due as indicated on the Explanation of Benefits (EOB). The patient may qualify for financial assistance.
Blueprint Genetics is not a participating provider in any Medicaid program.
Does Blueprint Genetics accept Tricare, CHAMPUS, or other Military Insurance plans?
Patients with Tricare, CHAMPUS, or other military insurnance plans are eligible for our Financial Assistance Program. After an order is placed, one of our billing specialists will contact the patient and inform them of their out-of-pocket cost and explain their payment options under our Financial Assistance Program. For more information contact Blueprint Genetics billing support at firstname.lastname@example.org.
What am I financially responsible for if I have commercial insurance?
Patients are responsible for co-pays, co-insurance, and any unmet deductible as determined by their insurance provider. Blueprint Genetics has a generous Financial Assistance Program that can reduce a patient’s financial responsibility based on need and family income level. More information on the Financial Assistance Program can be found here: https://blueprintgenetics.com/financial-assistance-program/
What happens after a benefit investigation?
One of our billing specialists will contact the patient (normally within 72 hours after an order is placed) and inform them of their out-of-pocket cost, taking into account any unmet deductible, co-pay, and co-insurance, as well as explain their payment options under our Financial Assistance Program.
What happens if my insurance company sends me a payment instead of Blueprint Genetics?
For plans that send payment directly to their members (including many BCBS plans), the patient must agree, that if they receive payment from their insurance carrier for Blueprint services, they will endorse the check and send it to:
200 Forest Street, 2nd Floor
Marlborough, MA 01752
For any questions, please contact our billing support team at 1.650.452.9340 Ext. 1 or email@example.com.
What happens if my insurance plan denies the claim?
If a claim for reimbursement is denied, or the amount of reimbursement is insufficient, Blueprint Genetics will file an appeal with the insurance provider whenever allowed. We will also assist patients if the appeal for medical review must be initiated by the patient or policy holder. Patients are responsible for any unmet deductible, co-pays, and co-insurance even if the insurance plan denies the claim and all subsequent appeals.
What if I am not satisfied with my options under the financial assistance program (FAP)?
Blueprint Genetics is committed to increasing accessibility for all patients to our diagnostic testing services. If a situation arises where we cannot provide an acceptable billing solution, there is no obligation to proceed with testing. In the rare case that a patient decides not to move forward with testing, we will obtain approval from the ordering physician and cancel the test.
What if I cannot afford the cost of genetic testing?
Many patients and families experience economic challenges associated with their clinical situation and we understands that at a time when a patient may be facing many other medical expenses, working genetic testing into their budget may be challenging. In certain situations, patients may qualify for a reduction in their out-of-pocket expense. Eligibility for our Financial Assistance Program is based on need and requires that patients supply information on family size and income. More information on the Financial Assistance Program can be found here: https://blueprintgenetics.com/financial-assistance-program/
What is an insurance Benefit Investigation (BI)?
Blueprint Genetics will contact the patient’s insurance provider and verify that the insurance is current and active. Coverage for clinical diagnostic genetic testing services can vary significantly across insurance providers and plans. The purpose of the insurance Benefit Investigation (BI) is to determine the in-network and out-of-network coverage including deductibles, co-pays, co-insurances, out-of-pocket maximums, exclusions, and requirements such as prior authorization (PA) or pre-certification.
What payment methods can I use?
Bank transfers, credit cards, PayPal, or checks are all accepted forms of payment.
When am I responsible for paying my portion (OOP)?
For patients who choose to use their commercial insurance, we will forward the appropriate notification of obligation to the patient as specified by the Explanation of Benefits (EOB). In all instances, Blueprint Genetics will adhere to the terms of the patient’s individual policy insofar as payments for services are concerned. Patients should check with their local provider or insurance provider for preauthorization and coverage questions related to our services.
Patients who choose to participate in our self-pay option under the Blueprint Genetics financial assistance program (FAP) are expected to make some kind of payment before testing is started. When Blueprint Genetics bills a patient’s insurance for our services we usually finish the testing and report our results before the claims process is completed. Patients are sent a statement from Blueprint Genetics which includes their final determination of financial responsibility (OOP) once the claims and appeals process has been exhausted. In certain situations, the patient financial responsibility (OOP) can be less than the original amount of unmet deductible, co-pay, and co-insurance communicated to the patient.
Will my insurance pay for the testing?
Coverage for testing can depend on various factors including your medical condition, family history, and what kind of testing has been ordered as well as your insurance plan’s determination of medical necessity. The billing specialists at Blueprint Genetics work closely with insurance benefit providers to collect the maximum allowable reimbursement under each unique plan.
Will you process prior-authorizations?
Blueprint Genetics’ billing specialists will provide prior authorization concierge support for the clinician and patient before the sample is drawn when possible. Additionally, we can assist clinicians with submitting letters of medical necessity (LOMN) and supporting clinical documents. Blueprint Genetics complies with all appropriate statutes and rules governing insurance billing and claims for reimbursement.