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.

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 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/

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.

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/

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.

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.