FAQs

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.

Blueprint Genetics works with all commercial insurances and every patient with active benefits can access our diagnostic testing service. We are in the process of contracting with a number of plans but at this time we would most likely file a claim with your plan as an out-of-network service provider.

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.

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.

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 billing.us@blueprintgenetics.com.

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 billing.us@blueprintgenetics.com.

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/

It is the patient’s responsibility to forward Blueprint Genetics the entire payment within 10 days of receipt.

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.

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.

Many patients and families experience economic challenges associated with their clinical situation. 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/

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.

Bank transfers, credit cards, PayPal, or checks are all accepted forms of payment.

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.

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.

Blueprint Genetics’ billing specialists will process insurance prior authorizations (PA) on behalf of the patient whenever allowed, and will assist clinicians with submitting letters of medical necessity (LOMN) and supporting clinical documents.